Leadership is required on both national and local levels. Local leadership is incredibly important to both define and execute a clear vision of what the emergency department does and what emergency care is. Emergency medicine leaders at a local facility must clearly articulate and define what the role and function of the emergency department is, how it fulfills that function, and its relationship to the public, patients, the hospital and other health care assets, and the community. When that does not occur, the emergency department is defined by others and is often mischaracterized as being “all things to all people.”
Each clinician and staff member on every shift must know the roles, responsibilities, values, and leadership philosophy of the emergency department. Without vision, people perish. That vision should not change each shift according to the whims of the physician on duty or the medical staff. That is a recipe for dysfunction, confusion, and poor performance.
Health care is rapidly transforming from individual autonomous practice patterns into team-based care. The emergency department is one of the best-suited environments to hardwire effective teamwork. Organizations go through phases, from performing as multiple individuals to working as a group to becoming an operational team. Simply working together does not make a team. In an effective team, all members give up some independence and autonomy to become something bigger than themselves. More important, they truly care about one another and about their mission and work hand in hand to ensure its fulfillment. A team is committed to a shared vision and goals, has clear roles and responsibilities, communicates constantly and collegially, places a high value on competence and performance, and holds individuals and the team accountable. Outcomes are everything. Most important, a team attracts and retains the best people much more easily than a group of individuals. A high-performing team is where our future lies.
The emergency department can be a best-practices example of teamwork and provides an opportunity to expand this important concept across units, facilities, and health systems.
3. Systems Thinking
Peter Senge published his seminal book, The Fifth Discipline, in the 1990s, and almost every industry readily adopted it. That is, of course, except health care. Emergency physicians, by their role in health care and from their experiences, have a jump on others with regard to systems thinking. We spend so much of our day trying to unclog the organization and create flow for our patients that we have improved our understanding and identification of upstream and downstream opportunities. As consolidation occurs in health systems and additional spokes (both brick-and-mortar and virtual) are added to the delivery model, systems thinking will become more highly valued and a requisite for success. How do you move patients through at the highest quality and lowest cost? Efficiently and effectively.