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“The first responsibility of the leader is to define reality. The last is to say thank you. In between, the leader is a servant.”

Max DePree, Leadership is an Art1

“Management is doing things right; leadership is doing the right things.”

Warren Bennis, On Becoming a Leader2

“People want to be settled; but only insofar as they are unsettled is there any hope for them.”

Ralph Waldo Emerson3

“Do those served grow as persons? Do they, while being served, become healthier, wiser, freer, more autonomous, more likely themselves to become servants?”

Robert Greenleaf, Servant Leadership4

Regardless of the size or sophistication of the hospital, the emergency department (ED) is an area of complex interactions with multiple providers involved in numerous, interrelated processes with disparate resources. The impact of an ED on the healthcare community is staggering in its reach, confusing in its complexity, and intimidating in its scope. Because of its complexity, a patient encounter requires that multiple tasks are provided in a smooth, coordinated fashion for the patient to receive the best possible care. However, if 1000 sequential functions must be performed correctly, for the ED to be reliable, doing 999 of those things right is a formula for failure, not success.5 From the standpoint of the patient, the family, and the healthcare provider, all 1000 functions must be coordinated in a timely fashion, or the patient and the system that serves the patient will both suffer.

The ED constitutes a substantial business entity in any hospital, accounting for no less than 40%, and often up to 70% of the total hospital admissions.6 Of these, a disproportionate number are intensive care unit admissions because nearly two-thirds of all intensive care stays in the United States are generated through ED admissions.7 Even small EDs are businesses approaching or exceeding $1 million in annual revenue, and large EDs can account for literally tens of millions of dollars of revenue to the healthcare system.

For all these reasons, success in the ED requires effective leadership and management to coordinate the multiple processes involved in even the simplest aspects of clinical care. These skills are necessary for the clinicians and all the members of the ED to learn to have the training, resources, facilities, staff attributes, and sense of mission that are required for appropriate clinical care.

Despite the complexity, sophistication, and financial importance of the ED, the degree to which formal management and leadership training are applied varies widely. One of the central goals of this textbook is to ensure that the principles of ED leadership and management are available to those entrusted with the care of emergency patients. Since its beginnings as a defined specialty in the late 1960s, emergency medicine has depended on a ...

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