4 Common Emergency Department Culture Issues and How to Fix Them

Emergency Department culture impacts everything from provider retention and patient experience to efficiency metrics and care quality. In my years of experience turning around emergency departments. No matter the performance issue an emergency department faces, the solution to that issue is invariably culture change. When an emergency department leader focuses on culture first and aligns the team around a culture of service, performance improves.  

So, what exactly is “culture of service” and how can you influence it?  

A culture of service prioritizes the needs of team members and customers over individual needs. It depends upon a servant leader leadership style, which is also defined by making sure that other people’s highest-priority needs are being met.

The Robert K. Greenleaf Center for Servant Leadership defines a servant leader as a leader who “focuses primarily on the growth and well-being of people and the communities to which they belong. While traditional leadership generally involves the accumulation and exercise of power by one at the “top of the pyramid,” servant leadership is different. The servant-leader shares power, puts the needs of others first and helps people develop and perform as highly as possible.”

The culture of your emergency department is shaped by your medical director’s leadership and communication style, daily interactions between team members, team attitudes, and your leader’s and team members’ level of engagement in their practice. A healthy culture is evidenced by reduced provider burnout, improved communication, improved patient satisfaction and care quality, and boosted efficiency metrics.

Here is an overview of the five most common emergency department culture issues I have run across and their antidotes:

1.    Hierarchal Leadership

When leaders let their ego get in the way of putting their team member’s needs first, the team has a tendency to feel unempowered and disengaged. Top-down leadership fuels a lack of engagement and trust amongst the team. When leaders consider it their responsibility to serve their team rather than the team serving them, engagement and trust builds. Engendering a culture of servant leadership at your facility requires that you develop an engaged medical director who encourages staff involvement, leads by example, puts team-member needs first, and truly listens to team needs.

 A few tactical ways to replace hierarchal leadership with servant leadership include:

·      Encouraging leaders and team members to ask themselves, “How can I serve this person?” at every interaction.

·      Asking all staff, “What is one thing I can do to make your life easier?” and then truly listening to their feedback and taking action to put processes in place that consider their feedback.

·      Performing anonymous surveys to seek feedback on what you can do to improve the way you serve the team.

2.    Siloed Thinking/Misaligned Goals

If team members are not clear on departmental goals or how their actions impact those they interface with, tension and inefficiency is inevitable. A team that is not aligned around shared values and goals lacks accountability and motivation. An aligned team has defined core values and metric goals, is locally invested, and prioritizes communication with all they interface with.

A few ways to replace siloed thinking with aligned thinking include:

·      Instating regular interdisciplinary meetings

·      Clearly documenting and communicating shared goals

·      Establishing shared incentives  

3.    Incivility

Studies have shown that when people experience incivility at work their performance declines, they are less committed to the organization they work for, and in some cases, they take their frustrations out on customers. In the healthcare sector, incivility is common in the form of bureaucratic culture, extremely siloed processes, and uncivil communication. This results in a decrease in quality of care, higher provider turnover, loss of productivity, lack of provider engagement, and poor patient experience.

We have found that when we encourage respect at every interaction, positive communication, and simple gestures like a smile or a hello when you pass team members in the hall, productivity, patient experience, and engagement all improve.  

A few simple ways to promote civility include:

·      Setting a new standard by defining civility as important as metric success

·      Modeling the standard through your own behavior

·      Asking team members to hold you and each other accountable

4.    Burnout and Turnover

It is no secret that burnout and turnover is a concern in healthcare, especially in emergency medicine. It has a toxic ripple effect, resulting in unstable teams (mostly staffed with temporary providers who are not invested in community), high recruiting costs, lost revenue during recruitment, inefficiencies due to lack of engagement, and poor patient experience. We have found that engagement is the antidote to burnout and turnover.

A few key ways to improve provider engagement include:

·      Providing leadership development programs and other education and peer review opportunities

·      Recruiting a local provider team who is invested in the community they serve

·      Increasing doctor-nurse engagement and interdisciplinary process improvement efforts

·      Offering providers the opportunity to share in ownership of their practice  

In summary, replacing hierarchal leadership with servant leadership, misalignment with alignment, incivility with civility, and disengagement with is bound to not only remedy your department’s culture issues, but also make a substantial positive impact on your provider team’s quality of life, your ED’s quality and efficiency metrics, and your bottom line.