Transforming Emergency Care: Bridge’s Proven Framework for Sustainable Change
Dr. Alicia Gonzalez repeatedly observed the same pattern in her emergency department. Although buprenorphine was considered the gold standard of care for opioid use disorder, the lifesaving medication was not available to be prescribed to patients at her California hospital, which is a phenomenon seen nationally.
Over six years, the Bridge Center has developed, tested, and refined a structured framework for healthcare change in response to a persistent problem in emergency medicine: despite strong evidence, it can take up to 17 years for new practices to become standard care. Bridge has used the approach to support hospitals in 40 states – including 291 out of California’s 330 hospitals – in building medication for addiction treatment (MAT) programs, changing national standards for prehospital addiction treatment, and expanding access to sexually transmitted infection screening and reproductive healthcare.
As a clinical champion for CA Bridge, Dr. Gonzalez worked to bring buprenorphine treatment to patients at hospitals across California. Described in writing for the very first time by Gonzalez, Elizabeth Keating, and Aimee Moulin in the Western Journal of Emergency Medicine, the framework for change is now available for hospitals to adopt nationwide.
Bridge’s experience showed that innovative ideas often stall due to limited executive support, insufficient training, or institutional resistance, particularly when addressing stigmatized conditions.
Evidence alone is often not enough; sustainable change requires deliberate strategies to align stakeholders, shift culture, and build momentum – it requires changing hearts and minds.
Stakeholder Alignment and the Traffic Light Model
Change begins with understanding who influences decisions inside a hospital and accepting that resistance is part of the process, especially when care is stigmatized. Using a “traffic light” approach, the Bridge framework recognizes that some colleagues are quick to lean in and help build new workflows when change is proposed – green lights – while many more are open but need change to be simple and clearly worthwhile – yellow lights. A small minority – red lights – may push back loudly at first.
The Bridge approach focuses on supporting early champions, removing barriers for the majority, and listening to skeptics without letting them halt progress. As results become visible, hesitation often gives way to buy-in, and resistance frequently turns into advocacy.
“I want to offer patients evidence-based medicine to help them live the healthiest lives possible, but bureaucracy, business, and stigma are often barriers to change,” said Dr. Jennifer Zhan, an emergency physician in Los Angeles and clinical implementation leader with The Bridge Center. “The advice in this article can help expand access to care for substance use disorders, screening and treatment of sexually transmitted infections, reproductive care, and much more. I’m thrilled to share the Bridge framework with people who will be a catalyst for change.”
Seven Principles for Sustainable Change
Once momentum for change is established, the Bridge framework emphasizes seven principles to translate ideas into practice:
- Build an interdisciplinary team of green and yellow lights, with representation from bedside clinicians, nursing, pharmacy, IT, patient navigation, and leadership.
- Adapt proven models from institutions already implementing similar programs.
- Map a realistic timeline that addresses training, communication, and workflow details beyond major milestones.
- Prioritize facilitation and coordination across disciplines.
- Ensure inclusivity by tailoring messaging to stakeholder motivations – green lights respond to mission and passion, yellow lights to workflow efficiency and patient outcomes, and red lights to maintaining standards of care.
- Secure executive sponsorship early to reinforce legitimacy and address resistance.
- Measure success and publicly celebrate progress, using data and patient stories to reinforce impact and sustain engagement.
“We didn’t make these steps up overnight. They were developed from hundreds of hours of learning, coaching, and training on a variety of topics, in multiple states, and across completely different care settings,” said Dr. Gonzalez, Bridge’s Director of Training. “Physicians and nurses often have the best ideas to improve patient care because they’re the ones at the bedside, and yet they’re normally not the ones making decisions about care delivery and not formally trained in how to do it, either. Turns out, with an effective and practical framework, clinical staff can consistently make meaningful, patient-centered change. And it’s awesome.”
Why This Framework Matters
Nearly one in five emergency department patients lacks another source of care. Improving outcomes for marginalized populations therefore depends on effective, scalable change within emergency settings.
The Bridge framework proposes implementation as a human challenge rather than a purely technical one. By addressing culture, incentives, and communication alongside protocols, it demonstrates that frontline clinicians can lead meaningful transformation — ensuring evidence-based care reaches patients when it matters most.
Read the full article, including Dr. Gonzalez’s hospital case study, in Western Journal of Emergency Medicine. Be sure to also review Bridge’s toolkits for emergency department implementation change on our Resources page.