Strategies to boost ED manager’s influence

Learning new skills can win over management

Many ED managers complain that their department is the Rodney Dangerfield of the hospital because they can’t get any respect from upper management. But respect is earned, not given, says Gregory Henry, MD, FACEP, risk management consultant at Emergency Physicians Medical Group in Ann Arbor MI.

"You can’t change other people, so change yourself," he advises. "If you just walk into administration and say, I need more money for this,’ you will mostly be viewed as a pain. If you say, I can save you money in the following 10 areas,’ they’ll say, Would you like a chair?’"

"When many administrators go to CEO school,’ one of the things they learn is that ERs are financial losers," notes Richard Bukata, MD, medical director of the emergency department at San Gabriel (CA) Valley Medical Center and clinical professor of the department of emergency medicine at Los Angeles County/University of Southern California Medical Center.

EDs must be viewed as the financial winners that they are, Bukata emphasizes. "The fact is, they are one of the major drivers of the hospital; they are typically responsible for 40% of admissions," he says. "If you take the position that your department loses money for the hospital, you will come to administration hat in hand — from a position of weakness."

Thus, say the experts, winning over management takes a combination of new skills and a new attitude.

Business skills critical

Many of the skills needed to successfully run any business also are critical to ED managers, Henry adds, but many ED managers lack these skills.

"I would say that 95% of ED managers got their job as director because they were good clinical doctors," he notes. "It had nothing to do with being good at solving management issues like interpersonal problems. We have used the wrong criteria set."

Here are some of the key skills Henry says should comprise that criteria set:

  • Conflict resolution.

"You need this skill not only to keep feathers from being ruffled, but to protect the hospital from, for example, EMTALA [Emergency Medical Treatment and Labor Act] violations," he says. "If I have to send a patient out because an annoyed doc refused to come in, it can put the whole system in jeopardy."

  • Complaint management techniques.

"You can turn unhappy customers into loyal customers and prevent them from going to an attorney," Henry notes.

  • Budgeting.

"EDs have twice or three times the drugs they actually need," he asserts. The reason is that managers have not made systematic analysis of what is needed, he says. "We have to adapt the industrial just-in-time supply approach," Henry explains.

  • Standardization.

"Different docs may want different sutures, but why do you need three or four different types?" he asks. "Research the literature, and just get one."

Your ED is a multimillion dollar business, Bukata notes, and you should think of it as one. "Basically, you have to ask the core question: Does this section of the hospital make money, or lose it?" At our own hospital, we have done analyses that show the hospital makes money not only from the patients we’ve admitted, but from those we’ve discharged," he explains.

Accounting was asked to analyze how much money was collected per patient discharged, he explains, and "it was substantially in excess of our expenses."

Of course, Bukata says he got off on the right foot by convincing the CEO to chair a project to make the ED better, and he spoke his language. For example, he points out, hospitals use two employee hours per patient as a benchmark. Thus, if an ED sees 60 patients per day, hospital administration is pleased to pay for 120 man-hours.

If you bring on another clerk to handle more patients more efficiently, you convert that into patient dollars, Bukata says. "Say a clerk for 12 hours costs $180; how many patients more do you need to see to pay for that clerk?" he asks. "The answer is, less than one: That’s the way this should be viewed," Bukata explains.

Henry concurs. "The worst thing about saying, I’m underappreciated’ is you are either not as good as you think you are, or you do not know how to toot your own horn," he says.

A smart ED manager will know how to get the recognition he or she deserves, Henry adds. "Bring things to the table that are of interest to the administrator. "Take his five top priorities and apply them against your emergency department."

Good care is a given, he says. Today, administration wants to know if you get along with other departments or handle complaints well, Henry notes. "In other words, if you want to be appreciated, do something that will make you appreciated," he adds.


For more on improving managerial skills, contact:

  • Gregory Henry, MD, FACEP, Risk Management Consultant, Emergency Physicians Medical Group, 1850 Washtenaw Ave., Ann Arbor, MI 48104. Phone: (734) 995-3764. Fax: (734) 995-2913. E-mail:
  • Richard Bukata, MD, FACEP, Medical Director of the ED, San Gabriel Valley Medical Center, 227 W. Orange Grove Ave., Sierra Madre, CA 91024. Phone: (626) 836-3700. Fax: (626) 836-3702. E-mail: