Pearls of Wisdom from ED Leaders

Emergency medicine has its own unique challenges involving leadership, people skills, time management, and setting boundaries in a job that has none. Each month, ED Management will ask an ED leader to share some words of wisdom with our readers. This issue features Sheldon Jacobson, MD, professor of emergency medicine and chairman of the department of emergency medicine at the Mount Sinai Medical Center in New York City. In this issue, Dr. Jacobson shares strategies for managing the ED.

1. Managers should remain as close to their product as possible by working as many clinical shifts as is practical. This ideally would include off-hours tours of duty as well as daytime shifts. This policy applies to both physicians and nurses in administrative positions. The goal is to use this unique perspective to learn about your operation as a provider on the line, rather than as an off-line observer. The result is a gain in credibility and the opportunity to bond with your health care team and to provide reality-based leadership and vision.

2. To direct your day-to-day operations as well as short- and long-range planning, and for maximizing reimbursement, each ED should have a world class information and tracking system. This system includes not only the requisite hardware and software, but dedicated personnel to maintain and upgrade the equipment, who will also educate the staff about the use of the database. This system should interface with your inpatient and registration systems and have a modular upgradable platform.

3. The old adage, "It is better to light a candle than curse the darkness," is one of my credos. When you are faced with the realities of institutional decision making, and you are unable to obtain support for your highest priority projects, retreat and let things cool off for awhile. For your mental health and the benefit of your program, choose another project that can definitely be accomplished without additional agreements or resources. This will raise your spirits and your visibility and limit the possibility of developing an adversarial relationship with your administrative leadership. This fallback position will also help your staff maintain a positive outlook and will mitigate the fallout of your temporary failure to move your program ahead.

4. Demonstrate your statesmanship by summarizing failed negotiations, reiterating your position and the consequences that might ensue because of a lack of progress. When you are unable to move a program forward that you feel is of vital importance to the ED and/or your institution after multiple attempts at compromise and modification; do not threaten or point fingers at individuals, simply state the facts from your perspective. Send copies of this summary to the individuals with whom you have been dealing and, in selected circumstances, to their bosses. If the document is well thought-out and the issues are straightforward, there is a good chance that a ruling in your favor may come down from on high. It may be delayed a few weeks to allow the negotiators to take responsibility for their changed positions, but you will have achieved your goals.

5. In short, knowledge is strength, and informed managers earn the respect of their colleagues, which gives them an edge when seeking support. When you believe in something, fight hard for it when you must, but allow others to retain their dignity, or your efforts will be self-defeating in the long run.