Ten leadership mistakes ED managers should avoid

Today’s ED leaders are facing tougher challenges than ever. "Just being a high quality practitioner is not enough anymore," says Robert W. Strauss, MD, FACEP, a team-building consultant and chairman of Emergency Treatment Associates in Poughkeepsie, NY. "Quality care is certainly a foundation, but it’s not the sole ingredient for success. We need to continually improve our leadership skills, embrace change, and adapt." Here are some leadership mistakes to avoid:

• Waiting until tomorrow. "Leaders have to move proactively," says Thom Mayer, MD, FACEP, FAAP, chairman of the Emergency Department at Fairfax Hospital in Falls Church, VA. "Putting things off is almost always a mistake. Allowing things to get to a crisis stage is a common way of doing things, saying, ‘Well, hopefully it will go away on its own.’ The trouble is, it almost never does."

• Playing dictator. To confuse leadership with authoritarianism is a mistake. "In our ED, people don’t do what I say because I’m the boss or the doctor. They do it because it makes sense, and it fits with their understanding about what’s best for the patient overall," says Mayer. "An attitude of, ‘Do it because I said so,’ doesn’t work."

Acting like a dictator will not only cause resentment, it’s also ineffective. "It’s hard for a team to really work closely together if they have a domineering leader who never gives them a chance to be full-blown teammates," advises Hans Finzel, executive director of CB International, a leadership training ministry in Wheaton, IL, and author of The Top Ten Mistakes Leaders Make. "People don’t just want to be machines or puppets with the head person pulling the strings."

If a leader acts like a dictator, he or she will miss out on valuable input. "The biggest problem with that is the boss doesn’t know everything. Because he or she doesn’t know the whole picture, they must realize the value of everyone on the team," says Finzel.

The coach model of leadership is more effective, he says. "The coach realizes he or she has to call the plays but realizes the great talent is on the field with the players," he explains. "Leaders should help their staff develop skills, help them get ongoing training, invest in their lives, and take good care of them."

• Lack of communication. As a rule, the more staff knows, the better. "Sometimes leaders hide critical information because they’re on a power trip," says Finzel. There is a big difference between providing information and communicating, he notes. "You can’t just give out data, you need to get through to people and make sure staff understand the big picture, which includes the inner workings of the hospital."

Leaving staff in the dark is a mistake. "That’s very discouraging, especially when big decisions are being discussed that will affect your life," says Finzel. "A leader can never communicate too much—it’s their prime responsibility."

• Absence of affirmation. Leaders should make every effort to commend staff when they’ve done a good job. "A good leader acknowledges a job well done, and a bad leader only lets people know when they’ve stepped out of line or blow it," Finzel says. "Research shows people are more motivated by affirmation than pay raises, and people will leave a job if it’s a negative place to work." Many ED managers make a point of sending employees letters of commendation to go into their personnel files.

• Never allowing staff to make critical decisions. ED managers need to mentor the next generation of leaders. "A key way to do that is to allow others to make critical decisions at critical moments," says Finzel, who subscribes to what he calls the "80/20" rule. "Eighty percent of the time, people will make good decisions, and 20% of time they won’t. But it’s OK, because that’s the way they learn."

• Dirty delegation. When leaders delegate responsibility, they should do it with no strings attached. "There’s nothing that people hate more than a boss always looking over their shoulder," says Finzel. "A mature leader knows there is more than one way to do a job, and everybody wants to feel they have some ownership, a piece of the process that belongs to them."

• Putting paperwork before peoplework. With pressures from administrators and managed care, leaders can become buried in bureaucracy. "The health care industry has become a victim of paperwork, but leaders have to focus on people and not just sit behind their desk filling out forms." says Finzel.

It’s important to make time to connect with ED staff outside the ED. "Ninety percent of effectiveness in leadership is getting along with people, so you need to make time to stay in personal touch with people working for you," says Finzel. "It’s important to be with the people you work in a less intense environment."

Staff retreats and getaways are a good way to do this. "It is necessary to avoid typical interruptions of beepers, pagers, and the possibility of being called into clinical service," says Strauss. "A retreat more than than pays back its dividends."

To be most effective, these get-togethers should be held regularly. "A common mistake is the assumption that if we go away for two days, we’re done," says Strauss. "A retreat is a good beginning, but it should be done on an ongoing basis." An outside facilitator should be used, so the ED leaders participate not as leaders but as members of the group, he suggests.

• Having a provincial focus. It’s key to be part of the hospital’s global vision. "We have a responsibility to sit in on as many staff planning meetings as we can and join in the institution’s efforts to be successful," Strauss recommends. "We need to look in our own department for programs which can be adapted toward those ends."

To be most effective, ED leaders should have common goals with hospital administration. "Look for areas where our incentives are aligned," says Strauss. "Those areas include getting more business, providing more cost appropriate care, and developing patient and other customer-friendly care."

The key is to participate in the strategic planning of the institution, he says. That may include developing a chest pain center or fast track, starting a customer relations program, creating an occupational health program, learning to use clinical pathways effectively, or implementing a mechanism to deal with complaints.

• Trying to do it all alone. No matter how dynamic the leader, no one should put the burden of success solely on his or her shoulders. A team approach is necessary for an ED to reach its goals. "It’s impossible for an individual to assume responsibility for all of the different programs and processes which are necessary to be successful," Strauss says. "If everybody in the group expects the directors are going to be solely responsible, it won’t work."

Individuals must meet as a group to determine goals and how to accomplish them. "The director may be in a position to bring more to the table, but to be successful it’s necessary for all members of the group to participate in the growth of the department," says Strauss.

"It’s particularly dangerous for the director to believe he or she is totally responsible for creating change," he says. "Broad participation is necessary—you can’t do everything. When the entire group participates there is greater success."

• Failing to focus on the customer. With the pressures of survival in today’s competitive health care market, it’s easy to lose sight of the community’s needs. "Don’t assume we know what they want, or that we understand their perceptions of us," says Strauss. "There’s only one way to find out, and that’s to ask them." Implementing surveys or holding focus groups are common ways of achieving this.

• Failure to network. ED leaders need to learn from other’s successes and failures. Attending conferences are an effective way to keep current about today’s challenges. "We are all going through the same process and learning what works and doesn’t work. Conferences provide you with information about what works and also some of the unforeseen problems," says Strauss. "Many of the instructors are going through the same challenges that all of us are, and make themselves readily available."