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Emergency departments (EDs) must consistently deliver exemplary results within a highly regulated and unpredictable environment. Leaders must simultaneously provide a proscriptive, predictable, and reliable service while demonstrating agility and responsiveness to conditions, which fall outside of the standard workflow and their control. Effective leadership requires consistent delivery of optimal results, high performance, and increasing productivity.

To accomplish these goals, leaders must facilitate and develop

  • Strong strategic plans
  • Positive departmental culture and identity
  • Robust clinical and administrative processes
  • Quality performance measures and improvement in architecture
  • Effective learning and innovation systems

Effective ED leaders perform their duties within the institution's and the service line's organizational infrastructure, integrating meetings, processes, relationships, and tools.

This chapter explores the concepts of organizational infrastructure and describes examples of meetings needed to create an effective and well-managed department. Every ED has an infrastructure. Successful ED leaders proactively define and organize their department processes or, if not, the department may organically and entropically evolve and change from day to day. A number of factors influence the ED infrastructure, which may include organizational culture, size, mission, past performance, leadership style, affiliations, physician engagement, or incentives.

Regardless of form, it is within and through the department's infrastructure that the department leadership and clinical professionals

  • Define the identity and direction of the department
  • Create work systems
  • Measure and address performance
  • Prepare for future challenges

A well-defined service-line infrastructure does not inherently drive better performance; rather it is an organizational tool, which must be used by passionate professionals. In other words, systems are only successful if people committed to reaching defined outcomes consistently utilize them. A well-managed department requires leaders, who are knowledgeable, set goals, create vision, define plans, engage staff, evaluate results, hold people accountable, and have the initiative to take action. A thoughtfully implemented infrastructure provides the construct and organizational discipline, in which to channel departmental resources toward achieving the desired results.

It is rare to find an organization with aspirations of mediocrity, yet many function as if that is the aim. The absence of identity, strategic direction, standards of practice, and accountability makes it impossible to efficiently move a complex system toward any exceptional purpose. These strategies and standards must be developed and managed by the department's leaders. A clear organizational chart, with defined reporting relationships, is vitally important to the effective management of the ED.

Knowing/defining who is responsible for what domains is the first step in creating accountability. Too often, supervision and goals are divided into “silos,” with the

  • Nursing leadership managing nurses, techs, and unit clerks
  • Medical director directing the physicians and other providers
  • Diagnostic services reporting to another department entirely
  • Registration personnel, who are often among the first contacts for ED patients, commonly reporting to the business office

Cohesive Leadership

However, patients do not experience ...

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