Well-Being and Leadership Within the Emergency Department

Abstract

Description

This article looks at well-being and the role of leadership from the perspective of emergency medicine. The importance of leadership within the emergency department (ED), emergency medicine writing at large, and the prevention of burnout and compassion fatigue cannot be overstated. This article looks at the need for more research and measured interventions within the ED. It also highlights some measures that could be taken to help improve well-being from a leadership perspective to improve patient safety and outcomes within the ED.

Introduction

A cornerstone of health care, the emergency department (ED) provides access to life-saving services and acts as a significant safety net for communities. The well-being of all staff in the ED is paramount to the delivery of high-quality, patient-centered care. To date, only a few articles have looked at how leadership affects the well-being of staff specifically in the ED.

Well-being is an overarching theme of mental and physical state. This definition includes a direct correlation between compassion fatigue and decreased mental performance. It can be correlated to moral injury and the direct stress level felt by staff in the ED. Effective leadership can help provide a means to mitigate the effects of decreased well-being caused by working in the ED. This literature review aims to scrutinize the role of leadership and its impact on the ED staff’s emotional and physical well-being.

Leadership in the Emergency Department

Leadership in the ED falls into 2 broad categories: clinical and systems-based leadership. Clinical leadership pertains to the ability to move a team through a clinical scenario and is a skill learned and practiced daily.¹ This leadership category fits into the staff’s confidence and trust in each other. Trust among team members can lower stress and improve the well-being of everyone in the department. This responsibility falls to senior nurses, administrative roles, and physicians. A large focus is to improve patient care in high-stress situations, which is learned in simulation and during patient encounters.^2–5 Systems-based leadership promotes interdisciplinary activities between the ED and other departments, including administration. Leaders who focus on this leadership style develop a supportive infrastructure within the hospital by working with interdisciplinary teams and promoting system-wide changes.^6,7

Both clinical and system-based leadership styles work synergistically to help promote well-being in the ED. The emergency department is often described as a dynamic, fast-paced workplace. Therefore, an effective leadership structure can have a significantly positive impact on the well-being of staff members and on the quality of patient-centered care. Clinical leadership involves the manner in which an individual practitioner functions and leads within the ED. Examples of this leadership are resuscitation teamwork, coordinating patient care, and improving the flow-through of the department. A strong leader improves efficiency and inspires trust within the department. This improved efficiency and patient care lends one toward being a system-based leader. An example of this type of leader would be a department head or nursing supervisor whose role is to coordinate care at a hospital level or beyond. Leadership allows for improvement in throughput regarding to disposition of a patient in a safe, thoughtful, and timely manner. With both of these leadership frameworks operating at peak efficiency, patient care is noticeably improved and provides cost-effective care in a patient-centered model.

Leadership Strategies

The differences between a clinical leader and one focused on systems-based leadership are based on the style that applies to their personal leadership mantra. Leadership strategies should focus on building skills that support staff motivation, satisfaction, and the well-being of the department.⁸ Leadership has been shown to be successful when focusing on team building, effective communication, and conflict resolution. Simulation training within the ED has been shown to increase team trust and build effective communication.^2,3,8,9 This strategy can turn a high-stress situation in the ED into a coordinated effort toward patient-centered care. Additionally, senior leadership should be skilled at resolving conflict to avoid worsening toxic work culture.^10–12 Senior leadership also translates into strong organizational culture and its relation to well-being.

Organizational culture, both within the ED and interdepartmentally, can significantly affect staff well-being.⁴ A mission-centered organization projects values that promote safety within a department.¹³ These values also help prevent burnout by fostering a psychologically safe environment for patients and staff, thereby promoting emotional resiliency and staff longevity and mitigating burnout.^2,11,13 Improvements in this culture are most effective when adding a transformational or servant-based leadership style to departmental heads.^14–16

A systems-based strategy described in the literature is the jobs demands-resources theory.¹⁷ A well-supported ED improves patient outcomes, helps prevent compassion fatigue, and encourages well-being.¹⁷ The jobs demands-resources theory is less about providing physical resources and more about providing formal processes and tools to identify needs within a department or system.¹⁷ The process must be values-based and mission-driven to be successful. When demands and resources are balanced properly, individual well-being is optimized within a department, leading to improved workplace satisfaction and retention.¹⁷ The job demands-resources theory asks for a focus on resources that include advancement opportunities, decision-making autonomy, and co-worker support.¹⁷ After accounting for this systemic capital, another theme within the literature is supported: the self-determination theory.

The self-determination theory is the most researched psychological theory worldwide, which looks at the importance of self-motivation and autonomy.¹⁸ Autonomy from organizational to department leadership provides a trickle-down effect. Autonomy is earned when an organization incorporates high-quality, leadership-approved learning environments and courses. Training in this manner allows for an equal baseline for individuals entering a department. Training in the self-determination theory promotes trust within the hierarchical structure of departments and gives space for more open discussion on the demands versus resources within a department.¹⁶ High-quality leadership serves as a catalyst to promote the self-determination theory and heutagogy. A feeling of autonomy and belonging are key psychological factors that play a role in well-being.¹⁶

Conclusion and Future Directions

Effective leadership in the ED is vital for staff well-being. This article emphasizes the importance of various leadership styles and strategies that promote a supportive organizational culture and enhance well-being. To date, no research has been done on the structure of the ED and staff well-being. There have been no randomized trials in interventions focused on the job demands/resources and the self-determination theory within the ED. These interventions could be studied in patient outcomes, satisfaction, and staff well-being. Compassion and contagious leadership, as outlined in the article by Trzeciak et al, explored these topics within the greater health care industry that should be answered within the ED.¹⁹ Future research should explore compassion and contagious leadership further, guiding policy changes and education initiatives. Little has been done to look at effective training methods, curriculum development, and its effects on ED personnel and staff.