Leadership in the Hospital Emergency Department during Winter
Effective leadership of vital in the healthcare profession and entails a conduct of effective and innocuous running of any medical practice and directing activities of a group to reach to certain goals (Al-Sawai, 2013). The importance of leadership has been highlighted by the modernization agenda as well as the NHS (Barr & Dowding, 2015). A leader should be competent enough to cope with change and should have a great charismatic influence on the members of that group. Leadership theory is a changing aspect (Al-Sawai, 2013). The perspectives of leadership according to Hartley and Benington, (2010) are, the personal abilities of the leader, organizational positions as well as the social practices and collaborations of leadership.
Leadership should embrace diversity within the whole organization and should go forward to enhance an efficient use of resources during the designation of the management procedures (Barr & Dowding, 2015). Leadership should entail the following approaches in order to optimize management and promote the achievement of common goals; transformation, communication and collaboration, motivation, legal and ethical issues, emotional intelligence, conflict management, shared (team) leadership, distributed leadership, ethical leadership, interdisciplinary and interprofessional working, and purposeful results based clinical leadership (Al-Sawai, 2013; Goodwin, 2013).
This task requires the consideration of the role and behavior of the leader in different work scenarios within the healthcare environment. Relevant contextual, cultural and personal factors to good leadership will be discussed. The four chosen leadership context are; “hospital emergency department during Winter, a disciplinary meeting for a staff member, surgeon error in the operating theatre, and investigating a nurse recruitment leadership program for the unit”.
It has been studied that emergency departments (ED) have had many managers but little true leadership (Kayden, Anderson, Freitas & Platz, 2014). However, ED departments are characterized with serious shortage of staff, pandemics and disasters to include endless and varying challenges in the day to day life. The role of a leader in the ED department entails handling continual change, increased prospects of customers and patients, insufficient resources as to the number of patients, competition from other brilliant clinicians and administrators, huge chunks of data to look at and sort out, and the rising alertness of patients (Kayden, Anderson, Freitas & Platz, 2014).
Seasonal variation is one of the major reasons for overcrowding in hospitals. During Winter, many patients seek medical attention for chronic cardiorespiratory conditions (Penner, 2013). As a result, the ED department becomes overcrowded. This mean that the demand for urgent care goes above the capacity of clinicians and nurses to provide efficient care within a rational time span. There is an urgent need for ED leaders to address the issue to prevent tragic occurrences (Kayden, Anderson, Freitas & Platz, 2014). During Winter there is also prolonged stay of already admitted patients in the department. Hospital resources remain unchanged while the need for care rises. Poor ambulance diversion, long consultation and admission periods and assessment are other factors to the overcrowding of the ED departments. This consequently leads to overcrowding considering that the number of staff members is also constant (Penner, 2013).
The Role of a Leader in a Disciplinary Meeting for a Staff Member
One of the interventions that a leader should apply in this scenario is developing systems that hasten the consultation and the admission processes. A leader should be swift enough to include triage systems in care (Iacobucci, 2017). These systems reduce the waiting times by great margins. He should also be in a position of introducing protocols for diagnosis. There should an immediate emergency nurse and physician staff rise and it is also a good trait to introduce fast-track area for low acuity patients.
The leader should introduce training prior to the Winter season on the physician on matters to do with patient flow (Ho, Selinger, Lauscher, Cordeiro & Scott, 2012; Kayden, Anderson, Freitas & Platz, 2014). They should also influence good communication, cooperation and team work. In extremely urgent cases, such experts may be imported from different departments. This will significantly reduce the waiting time. This goes hand in hand with the introduction of short-stay units, observation beds and the setting up supportive staff like social workers or discharge planners. The short stay units particularly use a simple strategy of treat and release (Bercaw, 2016).
Technology is one changing aspect in the society. This aspect should be exploited by all means prior or even during the Winter season. A good leader’s role is installing information systems and electronic tracking boards (Tan, 2018). The information systems are electronic and real-time that have a significant input against the busy ED and the factors of the Winter season that lead to overcrowding. These systems support ED flow and controlling peak volumes (Tan, 2018).
Leaders ought to develop a strong framework regarding matters of ambulance diversion, use of walks in clinics and even swift home based care (Roundtable on “Crisis in the ER how can we improve emergency medical care?”: hearing, n.d.). These three interventions are purposely meant to allow for reduced population of patients in the department as well coping with the scarce resources such as beds in the ED wards. It is also the duty of leaders to introduce systems such as physician order entry, care testing points and registration on bedsides to ease the poor patient flow during winter (Mcnew, 2018). This is a concept parallel intervention.
Effective healthcare requires that there is an effective team work between members of the staff (Barr & Dowding, 2015). When a member of staff does not meet the required standards of duty, he or she pulls the team behind and is a hindrance to the attainment of the healthcare goals. Discipline at duty is very necessary because of the present co-morbidities and the rising intricacy of specialized care. It is the role of a leader to give disciplinary warning to an unprofessional staff member who does not adhere to the behavioral standards of an organization (Porter-O’Grady & Malloch, 2017).
The role of a leader in the disciplinary meeting should not be judgmental. A leader should listen first. According to (Porter-O’Grady & Malloch, 2017) there are two forms of listening that a leader should adopt; contextual and content listening. Content hearing entails keen listening on what is being said. The contextual listening on the other hand is the ability to listen when basing that on the surrounding circumstances like events in the external environment that affect actions of people and the resources they can access (Porter-O’Grady & Malloch, 2017). A leader therefore should not only listen what the person called to the disciplinary panel is saying, but also connect that with the circumstances within the working environment before administering any punishment. That means one role of a leader is preparing and developing appropriate listening skills with keen attention on assessing the words and actions of the person.
Good leadership in a case like this requires emotional intelligence (Hartley & Benington, 2010). What is meant by emotional intelligence is generally defined as dealing effectively with the emotions of self as well as others to include capacities such as having responsiveness, self-awareness as well as self-management (Johnson, 2014). No matter how aggrieved a leader may be because of an action of a person who is under disciplinary panel, he or she should remained composed. A leader should not burst out in anger and utter strong words against the staff member. Instead, he should listen strategically what the person’s say and address him or her with composure (Hartley & Benington, 2010).
A disciplinary action should be guided by legal and ethical issues. Therefore leaders ought to follow law and ethics when confronting and giving punishment to the offender staff member. The member is entitled to a fair hearing as required by the law. According to Hartley and Benington (2010), responsibility in the healthcare environment is subjective to employment, civil and criminal and professional practice. This therefore calls for leaders to participate upholding legal and ethical issues while administering disciplinary actions. Ethics deals with the study of conduct from a moral perspective. The leader should be a role model in ensuring that ethical issues are adhered to and understood. Ethical and legal issues control how the manager communicates with the staff member under trial. These aspects also control how to manage the conflict should it arise when discussing the errant staff member.
Aspects of conflict management, teamwork, shared (team) leadership, distributed leadership, ethical leadership, interdisciplinary and interprofessional working inform leadership in operations theaters.
Effective leadership for a surgical team is widely accepted for many reasons. According to a study conducted on cardiac surgical teams, it was determined that teamwork is a special quality in the operating room and a great contributor to safe care and operation success (Catchpole, Mishra, Handa & McCulloch, 2008). It directly affects technical performance and patient outcomes in that it build on feasible interactions and dimensions that form a bridge for technical and non-technical performance and the period of the operation (Catchpole, Mishra, Handa & McCulloch, 2008). Leaders in the surgeon teams have great influence against errors during operations.
The first role of a leader is ensuring that there is effective communication between the team members (Stone et al., 2017). This has been identified as a non-technical issue but a vital aspect as afar as operation success is concerned. It has been established that communication failure is among the reason there are many surgical errors and negative operational outcomes especially in heart operations. A leader should be a good example to the other members of the surgical team. Training of surgeons is more of technical knowledge and not leadership oriented. Having a leader with the leadership skills is a boost to the team because they have someone to emulate. The team leader should guide and influence conversations. These conversations should lead to patient centered care. In case the team leader choses to perform one thing during the operation, he or she should effectively communicate that to the rest of the team. He should also be ready to listen to an opinion of another person. This is more of team (shared) or team leadership since the decision to take one intervention is guided by different opinions within the team.
A leader should be the mediator in time of conflicts (Bala et al., 2015). There is a time during an operation when a conflict will arise within a team over undertaking an intervention against another. The role of a leader in this scenario is resolving the conflict by reducing the adverse criticism and allowing a cohesive discussion on how to reach to the goal of treatment. This can be by engaging the members in perioperative errands (Stone et al., 2017).
When conflicts arise and a decision needs to be taken urgently, the team leader should take the role of evaluating the impacts of one intervention over the other or by collective responsibility whereby the majority decision wins. Engaging in lengthy conflicts during operations is a source of errors and may have tragic effects should be the condition be so urgent and risky to the patient’s survival (Bala et al., 2015). These aspects of decision making guided by shared leadership have great influence on the outcomes of performance and when leadership acts competently then the probability of making errors is minimized.
Recruitment is an aspect that supports the theory of leadership as a changing aspect. Leadership should concentrate on recruiting competent staff members because job vacancies are part of institutional nature. It is rare to find nurses remaining in a single position throughout a year or for several years (Thomas, 2012). Allowing new people to join in an organization is very useful in that it allows new skills into the facility (Urgo, 2017). It also helps in ensuring that the existing staff members are not too comfortable in their positions and they give way for new However, if that is not done competently, it can be a disaster if the process is done unethically and unprofessionally.
The role of a leader in a recruitment program is ensuring that the whole process goes on well free from corruption following using these general aspects of good leadership (Valentim, 2016); collaboration, legal and ethical issues, shared (team) leadership, distributed leadership, ethical leadership, interdisciplinary and interprofessional working, and focused results-based leadership (Urgo, 2017).
It is advised to the leaders to first look out for the active role occupied by the exiting staff member or the staff member being elevated before starting the recruitment process (Urgo, 2017). It is also good for the leader to know the main reasoning for leaving. This brings the issue of good communication and listening (Thomas, 2012). The leader should ensure he person leaving speaks more as he or she listens and asking relevant questions like what aspects of the job they found interesting or frustrating or what improvement they think should be important in the wards or places of duty to create more satisfaction. That way, a leader is able to understand the amendments necessary or look for better recruits with the right capacity or experience to handle the same situation.
Towards recruitment the leader’s role is establishing or reviewing the appropriateness of the description of the vacant position (Thomas, 2012). Then working with the existing staff or the HR department in formulating good advertisements and application packages. Teamwork is still needed during the interview. The chosen team to conduct the interview should not be ethically compromised (Valentim, 2016). They should be free from any corruption allegations or history to ensure that the recruitment is free and fair as dictated by legal frameworks of different jurisdictions. Ethical leadership, interdisciplinary and interprofessional collaboration applies in recruitments to ensure success. A leader may choose the interdisciplinary collaboration to get the right panel for conducting interviews. The leader should ensure that the whole recruitment program is results-based on acquiring the best employees for a post to ensure the achievement of organizational goals of healthcare (Urgo, 2017).
Conclusion
It is indeed true that leadership is an evolving discipline, capricious and intricate. This is influenced by the fact that healthcare is also a changing context. Leadership should be a way of discovering the way forward and influencing the other members to follow that. A good leader is not judgmental. Neither is he dictatorial. He or she should exercise authority through cooperation and teamwork. This is because the leader is the first person to the attainment of the organizational or department’s goals of care.
Leadership is not like management which is based on authority and formality. It is itself based on influence and sharing, takes an informal role, is part of all the staff working in the healthcare facility, is an initiative and is based on independent thinking. Leadership looks like it is both an art and a science. As a science it incorporates many non-technical and technical skills which are not present in books and as an art because of its changing nature. Aspects of charisma, character, communication skills, passion, and listening skills all inform leadership.
For an improved quality care in the health facilities these cultural, contextual and personal aspects of leadership must be put into practice in their respective places.
References
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