6 Philosophies Forward-Thinking Emergency Departments Share

Emergency departments that embrace the below philosophies benefit from outstanding culture and in turn  high physician retention rates and leading performance metrics.

We are owners, not renters

Successful emergency departments engender a sense of ownership among the team by engaging them in formal and informal meetings, seeking and implementing their feedback, and rewarding their accomplishments.

We are here to serve

Strong emergency departments view all – from medical directors and physicians to nurses and techs – as important members of the team and they prioritize serving their team members so that they may better serve their patients. This means doing the extra thing to make life easier for every person you interact with, every day.

We are accountable

Thriving emergency departments consider every challenge and opportunity and consistently address issues rather than shifting blame or accepting the status quo. That means turning phrases such as, “I can’t do that. It’s not our policy...” and “that’s not my job…” on their heads and replacing them with constructive phrases like, “Let me see what I can do,” and “Let me find someone who can help.”

We are positive

Positivity breeds more positivity. Consistent positive communication across all roles within the emergency department makes it difficult to have a negative interaction with a colleague or a patient, which improves both patient satisfaction and provider burnout and turnover rates.

We communicate with respect

Improved efficiency, quality, and practice culture starts with better face-to-face communication at every interaction, from patient check-in, to patient hand-off, to admission, discharge, or transfer. Every interaction, no matter how high-stress should be positive, constructive, and respectful.

We are innovative   

The definition of insanity applies here: you cannot keep doing the same thing over and over and expect different results. Your ED must evolve to succeed. Part of innovating for the future is considering the department’s impact on the entire continuum of care. Overall, successful emergency departments ask “how can we do it better?” rather than holding on to, “that’s the way we’ve always done it.”

Adopting these philosophies can pay dividends in reduced provider turnover costs due to increased provider satisfaction, increased efficiency due to improved interdisciplinary relations, and more satisfied patients due to kind, respectful interactions and smoother patient transitions. These tenets contribute to a strong program culture, and by building a solid cultural foundation, you set the tone for lasting, tangible increases in patient and clinician satisfaction, positive community reputation, and quality and efficiency performance improvements across the board.

Culture Check Up: How to Assess Your Emergency Department Culture

Whether you are aware of it or not, your emergency department has a unique subculture within your organization. Hopefully the subculture is positive and harmonious. If there are elements of dysfunction begin by assessing your emergency department’s current strengths, weaknesses, and opportunity areas. Outlined below are steps to follow to assure your emergency department team is united and headed in a direction that mutually benefits the providers, staff, hospital or health system, and the patients and community you serve.

1. Identify key stakeholders

When working to assess the culture of the emergency department, it is crucial to include everyone who works within or interfaces with the emergency department in your assessment. This includes:

• Hospital administration

• Hospital leaders and community providers who interface with the emergency department

• Physicians and Advanced Practice Providers

• Nurses and technicians

1. Have face-to-face conversations with key stakeholders

Once you have identified stakeholders, talk with them to clearly understand their vision, needs, and goals. The act of asking for input is itself a great opportunity to promote a culture where everyone feels valued. Start by asking:

• What do you love most about your job?

• What would you change that would make coming to work each day a more positive experience?

• How does/can the emergency department contribute to achieving your goals/meeting your needs?

1. Summarize key challenges and opportunities

A collective review of answers to the questions in the previous section can illuminate core strengths and weaknesses of department culture. After you have this information, natural themes will emerge around which workflows, processes, and training need to be improved to promote a more satisfied staff and in turn safer, more cost-effective, efficient patient care. Your summary should include a full assessment of the following:

• How does the community perceive the emergency department?

• What are the abilities of the current clinical staff?

• What is important to each stakeholder and are priorities aligned?

• Physician turnover, how often are providers leaving and why?

• How are physician relations with APPs, nursing staff, and techs?

• What defines success?

• What is the general attitude among staff?

• Does the clinical staff feel supported?

• Does the clinical staff feel invested?

• What are the primary communication issues within the department?

• Where does efficiency/throughput break down? Why?

10 Traits of Great Clinical Leaders

Your medical director’s leadership sets the tone for the entire emergency department. A medical director who understands both the daily realities of clinical work and the operational and financial realities your hospital faces is critical to the effective development of your emergency department. While leadership is not the focus of medical school, that does not  mean you cannot  find a medical director with leadership experience or develop your current medical director to lead your emergency department.

Essential traits of effective medical directors include:

1. Leads by example (not word alone)

2. Willing to defer credit to team members rather than taking credit

3. Ability to have positive conversations about conflict

4. Ability to communicate department vision, goals, and progress toward achieving those goals

5. Servant leadership mindset (believes he/she works for the team rather than the team working for him/her)

6. Is comfortable leaving their title and ego at the door and working alongside their team in the trenches

7. Willingness to be open and vulnerable with team members

8. Open to receiving and sharing both positive and negative feedback

9. Invested in seeking and acting on the input of every member of the team

10. Positive mindset, views challenges as opportunities to improve

All effective leaders establish trust. The above list includes foundational traits leaders who have the unwavering trust of their team and peers embody. If your emergency department leadership is not trusted, you must resolve that issue with coaching, mentoring, or a leadership change before your department will be able to realize its potential.