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Emergency medicine has undergone several transitions within the medical field. In the 1970s and 1980s, the emergency department (ED) was perceived as mission required—perhaps a necessary evil. The ideal ED was one that did not cause problems for the administration—no complaints. In the 1990s, with the prominence of managed care and capitation, the ED began to shrink in importance and became “mission unnecessary,” as fewer patients were likely to use its services. This was a time when many EDs were afforded very limited resources.

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More recently, the ED has become “mission critical,” the “front door of the hospital.” Hospital boards and administrations, as well as national regulatory agencies, scrutinize the ED, its services, and the satisfaction of all who use the ED. To succeed in this complex environment, ED leaders must do more than simply cover the schedule with highly qualified practitioners. ED leaders must address the demands of multiple stakeholders, who insist that both the patient's needs and their own are fully addressed.

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The key relationship between ED staff and non-ED medical staff (referred to in this chapter as medical staff) must be thoughtfully and intentionally nurtured. While developing and maintaining effective working relationships with the medical staff can be challenging, there are multiple daily opportunities to successfully collaborate with the medical staff to provide quality care to patients. Ideally, communications will build on a foundation of mutual respect and appreciation for each other's roles.

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From the ED's limited vantage point, it is difficult to recognize that medical staffs comprise large numbers of individuals, each potentially overwhelmed with the intricacies of the changing healthcare environment, increasing patient demands, decreasing reimbursement, contradictory regulatory interventions, government oversight, and so on.

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ED leaders have a choice: either allow their departments to become another burden on the medical staff and the source of complaints; or to become colleagues, friends, and supporters of the medical staff. The primary advantages of the latter approach are both improved relations with the medical staff and more importantly, improved care of the patients.

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The consequences of inability to integrate with the medical staff are quite serious and all too often lead to a physician's or group's departure from an institution. A pattern of inattention to medical staff issues and reactively (rather than proactively) addressing issues will ultimately create frustration, anger, and a reputation of noncaring. Can a pattern of poor relationships and medical staff dissatisfaction with the group be turned around? It can, but it is like turning the Titanic—it takes enormous effort and may be too late anyway. Titanic-like disasters can be avoided with advance planning, a thorough understanding of the environment, constant attention to changing tides and new obstacles, an alert team, and a well orchestrated and proactive problem prevention program.

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The continued presence of the ED group often depends on maintaining the goodwill of the medical staff. Establishing peer relationships by ...

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