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11 Leadership Lessons From The Emergency Department

While I certainly have learned from every experience I have had, some environments absolutely offer the opportunity to learn more, faster.  The Emergency Department was one of those places for me.  


1. Panic when I panic. 
In stressful situations, leaders lower their voices as everyone else raises theirs.  Leaders remain calm in the face of chaos.  Everyone will watch for each micro-reaction on your face, and look for the slightest hint that things are about to spiral out of control.  No matter what you feel on the inside, no matter how close you feel to coming unraveled, you must keep your demeanor calm and keep the team focused on the task at hand.

2. I’ll get you there on time.  
Leaders make commitments to staff, the people they serve, and to the passage of time itself - and keep them.   Keeping commitments builds trust and will allow people to follow you.

3. I don’t do mad dashes.
This of course doesn’t mean don’t act expediently in an emergency, but rather it says that poor planning does not constitute an emergency.  Leaders teach their staff how to manage their own time and to pay attention to the gaps that can come back and hurt the whole team.   There will be appropriate times to bail your team out of their poor decisions, and there will be other times to let them suffer the consequences, as pain is a good teacher.   The lesson: those who plan their shift well go home on time; those who don’t, get stuck in the department.

4. Sometimes you’ll have that.
This is the escape clause within my rules.  Sometimes no matter how much you plan or anticipate for situations, problems arise.  As the saying goes, “s**t happens”.  Lead with the flexibility to adapt in these situations.

5. When I tell you to go home, go home.
The Emergency Department is an environment that will take every ounce of your energy, and a never-ending stream of patients just keeps coming in.   This doesn’t mean we ignore our patients - or leave them or our team hanging - but there comes a time when a leader must remind team members to recharge their batteries.  We each have to have a full tank of energy if we want to have anything to offer the patients and the team.  Trust me; the same work will be here, and likely more of it, tomorrow.

6. Just because you can doesn’t mean you should.
As healers, we want to fix things; that’s what we do.  But each procedure, each test, each medication carries a risk.   Sometimes in attempting to do something for a patient we can make them worse, or even harm them.   This doesn’t mean to not act, or to not give comfort; just be aware that all actions have consequences.

7. Sometimes doing nothing IS doing something.
There are times when resisting the urge to intervene is the hardest thing to do, but the best thing to do.   Leaders know that things take time, medications need time to work, and patients need time to turn corners.  It is important to balance the need for patience with the need for action.

8. It can get worse.
Leaders hope for the best but plan for the worst.   There is no excuse to not have a plan.  Period.   It may not be a detailed document but in the back of your head at all times, but it better at least be a worst-case scenario and a sense of direction of how to get out.

9. Never lie.
Leaders never lie; to patients, to families, to staff.  Ever.   Be very clear and methodical in your choice of words, as they are likely to be remembered for a very long time in certain situations - and carry a power you don’t realize.   Keep clean lines of communication and learn to manage conversations, or they will manage you.

10. Assume nothing.
Perhaps this is slightly paranoid - but I promise it will keep you out of trouble.  Everybody you work with, including me at some point – will be out to get you.   They of course don’t mean it maliciously, but if you aren’t careful one of us, the patient, or the family, will burn you.  And then both you and the patient will likely suffer a bad outcome.   Patients will leave important parts of the story out, nurses will get busy and mislabel labs, and consulting physicians will be lazy and want you to send a patient home rather than come in and admit them.   These aren’t bad people; they are overworked people, scared patients, or families in denial, but where will they be when you hear, “remember that patient you sent home yesterday?” followed by a sinking feeling in your chest.   Leaders are respectful to all they encounter, but they also assume nothing - and close every loop.

11.  If you start a fire and put it out, you're not a hero; you’re an arsonist.
Creating a problem, either intentionally, or unintentionally, and then subsequently solving the very same problem is expected behavior and not an opportunity for self-adulation. You broke it, so yes - please fix it.   Just be sure to do so quickly, correctly, respectfully, and with as little fanfare as possible.

Though my years as a PA in the Emergency Department is a couple decades in my past, these leadership lessons have applied to every setting, in every industry I have found myself in since.