Running an emergency department is like a battle: It takes an army

The last few days have been rough. The emergency department is overcrowded, and patients have been very sick. Treatments were labor-intensive, and patients holding in the ED took up valuable resources at the cost of others. I could see the frustration on the faces of physicians, nurses and other staff. A physician and a nurse separately pulled me aside to have conversations about what the ED has become and why it was like this.

That led me to ask, where are you today? Inspired by a clear focus on the problem or defeated by a seemingly muddy and frustrating process with no clear solution in sight?

As leaders in health care, responsibilities are plentiful. But no responsibility is more important than direction. What is the single biggest challenge facing your institution today and what role is each employee playing in combating it? That is something everyone should be able to articulate. There are so many battlefronts, but who is the enemy? Where is the front line? Who is the support? Battle terminology is helpful because human nature leads us to unity and solidarity behind a common cause.

So what is the enemy? Nursing shortage? Bed shortage? Medication shortage? The electronic medical record system? All these bring challenges and mean different things to different staff, but we lack the common enemy that unites us. Could it be delivery of better health care? Patient safety? Reducing iatrogenic infections? The list seems endless. But, with each of us focused on one battle, we lose track of the war. With no clear direction, we become easily distracted, apathetic, and complacent. And then, the war is lost.

If you don’t know what your facility’s top challenge is today, stop reading this and go find out. Ask your supervisor and if they don’t know, keep going up the chain. What would it look like if you could walk the hallways and stop any employee and ask them what the biggest challenge facing your hospital is and what their part is in the battle, and then have them answer it!

From physician to housekeeping, from the cafeteria to human resources, from lab to security, if we all knew our common enemy and knew our part, the daily challenges would not seem meaningless. Look back at history, and the critical role women played in World War II. Look at any military history and read the importance of support personnel, front-line personnel and the importance of a common enemy.

Here’s an example: You work at a hospital whose biggest challenge today is the nursing shortage. (Not a far stretch of the imagination). You may be quick to brush this issue under the rug or move the discussion on to something else. But I would argue that behavior does more damage than good. Own the problem. Use the problem to fuel your organization. Articulate the role each of us plays in that war. There are not enough nurses and rooms go unstaffed, and patient care gets delayed.

What’s your role?

Are you a housekeeper? Your role is critical — turnover of rooms has to be so much faster since we have so few to spare! Without you, it falls apart.

Are you security? A safe environment for our staff and patients, especially those in the waiting room, is critical. And the waiting room is full. Without you, we can’t work safely, and it all falls apart!

Are you a pharmacist? The shortage of nurses means more tasks for each nurse to perform. The work you perform is critical! The additional tasks you absorb decrease that burden on nurses. In addition, the extra work you do keeps our patients safe and prevents medical errors — something we are prone to do when it is so busy. Our nursing colleagues and our patients greatly appreciate you, especially during these times and without you, it all falls apart!

Are you working in IT? Today’s systems are increasingly complex, and we rely on them to function with zero downtime! Your role is critical! We can’t deliver healthcare if our systems break down or our equipment malfunctions. Backup systems are slow and disrupting, and patient care suffers. We need you, and we need you working hard, fast. And we thank you for taking in our frustrations at equipment failures and broken systems. We also need you to advocate for our time since it is overtaxed and being stolen from patients! You are mission critical!

Are you a nurse? We thank you for staying, working overtime, accepting the challenge and fighting at the front line. We know you have choices and know you care about your patients. We hear you, and we are trying our best to help. Here are some concrete ways we are working on the problem (be sure you can name at least three … and they can, too).

Are you a physician? Never before has there been a higher demand on administrative duties than today. We know this is problematic. We also know that the nursing shortage means slower turnaround, poor flow and increased demand on you to perform tasks previously relegated to nursing. We all appreciate your work on the front line of this battle. Here are the ways we are working to fix the problem (name the three; make sure they know them).

Everyone must be able to articulate the problem, the one issue above all issues that plague your institution. They must all be aware of their personal role in the battles — support, front line, etc. We all must be able to articulate the problem and our personal role in the solution. Without it, the fight seems pointless. We are not inspired. We become defeated. And if we become defeated, we leave. And if we leave, we leave behind the very people that are the purpose of our existence, our patients. Who suffers? We all do.

Nothing is more infuriating than having someone say, “we are working on it,” and then walk away. You spend your days seeking solutions to these crises, make sure people know it!

Once you have your common enemy, share your top three solutions. Make sure people know that you really are seeking a solution and how. Those same people will go on to articulate the problem and your solutions to other employees, patients, and family members.

Be the spark of inspiration. Find that common enemy and use it to motivate everyone around you. We don’t hear it enough, but it is the truth. What we do matters so much, and it can so easily be buried in the mountain of human frustration, pain, and suffering.

Sam Ashoo is an emergency physician who blogs at Admin EM.

Image credit: Shutterstock.com

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