Delivering Safe and High Quality Healthcare in the Emergency Department

For effective fulfillment of duties by health care professionals which will, in turn, give a quality service to patients under their care, there is a need for effective inter-professional communication among personnel in a hospital environment. While the concept of territory exists within a sector, that, however, should not be a barrier to a fluid collaboration among health workers of different backgrounds. There is a need to formulate a working communication strategy to solve the lingering inter-professional problems in hospital environments generally, and particularly, in the emergency department. As important as it is, a look at inter-professional communication in emergency department shows a seemingly unfavorable situation among practitioners involved in this one of the most significant subsectors of health profession (Varjoshani, Hosseini, Khankeh, & Ahmadi, 2014). Among other numerous issues in the department, this paper looks at the problem of boisterous atmosphere in the emergency department, explores the contributing barriers to the lingering issue, and formulates a working leadership strategy needed to bring a lasting solution to the problem.
Effective healthcare delivery in the emergency department will need a team of carefully-selected qualified personnel, which includes nurses, physicians, and technicians. Just as it applies in every working environment, these inter-professional team members will need a highly committed team spirit to work successfully. Unfortunately, the rowdy atmosphere in the department has been a significant hindrance to effective inter-professional teamwork among these medical personnel. Varjoshani el al., (2014), highlighted the causes of the tumultuous environment to include overcrowded emergency departments; stressful emergency environments; ineffective management; and inefficient communication channels. For instance, an overcrowded emergency department is a major information barrier which prevents effectual data exchange between physicians and nurses, and in some cases, it causes frictions among the practitioners in the course of their duty. Apart from that, it usually leads to both physical and emotional stress for the personnel, which might in turn result in errors, overreactions, and other unprofessional conducts in the department. Record has it that among other departments in hospitals, the emergency department is where most medical errors occur (Varjoshani et al., 2014). The critical condition of patients will require many professionals to be present which can lead to communication failure, this in most cases is responsible for role conflict, ambiguity, interpersonal power and conflict, and other inter-professional scuffles commonly witnessed in the health sector. Studies have, however, traced the root of this to some factors which according to Morley & Cashell (2017), include “compensation schemes, professional practice regulation, institutional policies, and the physical environment factors which may be beyond the control of the team.”
To bring an end to these barriers responsible for an inadequate inter-professional working relationship in the sector, many studies have proffered solutions to help alleviate the effects of these barriers caused by the tumultuous atmosphere in the emergency department. One of the many recommendations, as suggested by Kessler, Cheng & Mullan (2014), was a debriefing after critical events. Debriefing, which is a reflection process in the cycle of experiential learning, helps in ascertaining areas of optimal and suboptimal performance to determine and formulate schemes for improvement in subsequent performances. If well harnessed, it would improve the delivery in the emergency department and bring a permanent solution to the lingering scuffles in the department as every stakeholder will reflect on their past actions, and agree on how to be better in their next performance. To improve communication between the healthcare professionals, Busari, et al (2017), suggested, among other things, that a competency-based approach to teamwork learning be adopted. Also, a call was made for a focus on group sessions as a platform for continuous appraisal. This, they believe will be suitable for the educational intervention for communication and continuous professional development. Different studies have offered solutions like these and many others. Unfortunately, despite all this, there seems to be no end in sight to the problem
Interestingly, the availability of the methods is not enough to drive the change process needed for efficient inter-professional teamwork. As useful as the suggestions are, they require a custom leadership approach to achieve them. This is where situational leadership comes in. To achieve a result while leading a group of people, it is required that the person in the position of authority possess a high degree of leadership qualities. Being a leader involves many things, which includes being visionary, thorough, ready to sacrifice, and being flexible. Situational leadership style is and encompassment of the behavior pattern (both directive and supportive) of a person who wishes to influence others (Northouse, 2016). To this end, it is expected of a leader to know the right leadership style needed to employ under different circumstances. The key elements to consider while in a leadership position include the personalities of followers, the mission at hand, and experience and skills of an individual follower. All these are attributes of the situational approach in leadership theory. Situational leadership is one of the most recognized approaches in leadership management, and it has been employed by many leaders to achieve results. As the name implies, it understands that followers’ skills and motivation vary over time, and as a result, a leader will be faced with different circumstances while discharging his leadership roles, and as such will need to adopt the strategy that best fits a given situation (Northouse, 20016).
Situational approach’s credibility cannot be overemphasized, having been effectively used by many past leaders like Patricia Summitt, Dwight Eisenhower and John Wooden. During her time as the head coach of the Tennessee Lady Volunteers for over 38 years, Summitt was faced with the challenges of having to build a new basketball team every few years, a situation that requires much flexibility for a leader. However, she recorded great successes and ended her career with a 10989-208 career record. Also, she was named the head coach for the U.S. women’s basketball team to the 1984 Olympics. Similarly, Eisenhower, who was the U.S. president after World War II, has a military background which equipped him with skills to order direct military exercise. However, due to his possession of situational approach of leadership traits, he was able to maintain his statesman status despite his military background, contested for president and won two terms in office ("What is situational," 2014).
In the situational approach, a leader is equipped with four major styles which are, styles to tell, to sell, to participate, and to delegate ("What is situational," 2014). Its premise is in the belief that followers, due to differences in personalities, and sometimes years of experience, and other personal and organizational factors, in many cases, will have to move from developing stage of low competence-high commitment; low to some competence-low commitment; and moderate to high competence-low commitment, before graduating to the highest developmental level, which is high competence-commitment, the developed stage whereby a follower can be said to be capable of achieving result without the leader’s interference of influence (Northouse, 2016). So, due to the ample opportunities, options and flexibilities, it presents to a team leader, in this case, in emergency department with personnel from inter-professional backgrounds, Situational leadership approach is my best bet having found myself in the position of authority. As a team leader, my approaches will include telling, participating and delegating as appropriate in different situations or with different individuals.
The practitioner-scholar model, which is defined as an advanced operational and educational model that focuses on practical application of scholarly knowledge would be beneficial in my current situation. Using this model enables a leader to see how effective or ineffective their leadership style is and they can make changes to suit their particular situation (Peterson, Donald, Abrams, Stricker, & Ducheny, 2015). With practical application of scholarly knowledge, one can see where there are gaps and they can develop strategies backed by research and theory that are aimed at filling these gaps in order to suit their current situation. A person who makes use of this model will have a problem-solving approach to their leadership style, which offers them the opportunity to reflect and assess the impact of one’s work. This way the leader can be able to gauge if they are effective in their leadership. Learning becomes the cornerstone of the leader, because they have to constantly recognize problems, examine the problems, and search for productive solutions to the problems.
Furthermore, knowing too well the negative impact of emotional and physical stress being faced by my team members as a result of tumultuous atmosphere usually witnessed in the emergency department, I will, as a selling leader, inculcate motivational approach to inspire my followers’ confidence. While the goal is patient-based, I, however will not allow that to deter
me from continually praising, encouraging and persuading them before, during and after every shift.
Moreover, having suggested debriefing as a working method for the improvement of emergency department performance, I will organize daily huddles with my team members. This will be where we will all have the chance to reflect on each of our tasks for the week with the view to improve our quality of service to patients, and welfares of my members, as it takes motivated practitioners to have happy and satisfied patients. The debriefing moments will not be a time for blame but it will be absolutely a time of reflection (Kessler, Cheng, & Mullan, 2014). This will be an opportunity for us to collectively identify our shortcomings, celebrate our achievements in the past week, and project a better approach for the tasks ahead. With this approach, I am actively leading my team by telling and motivating. However, delegation as an integral aspect of the situational leadership approach, will not be left out. As my team members are constantly encouraged, they will be moving up the follower developmental stages. This will allow me to confidently delegate talks according to individual’s ability, while not relenting in supervising and motivating as appropriate.
In order to effectively report progress, there is need to set criteria and goals that are based on the priorities of the organization. With our current issue of our emergency department. With a goal for a cohesive inter-professional collaboration measurement there is need to set a goal for cohesive collaboration. This would be measured based on errors due to miscommunication, conflict elimination or reduction, and reduction of inter-professional scuffles. As the team leader, it is essential that I set a criterion for measuring these items to assist in progress reporting. Reporting will be done on a weekly basis and it will analyze the past week as per the set goals. Communication will be reported as observed and as reported by some professionals. There will be written reports that are shared with the management and the team members (Gluyas, 2015), which will also include strategies to improve on what is ailing the team.
In conclusion, there is a serious need to improve inter-professional collaboration in the healthcare sector. With the empirical evidence staring us in the face, it is glaring that theory-based approaches will not bring an effective solution to the lingering problems affecting inter-professional efficiency in the health sector. There is a need for practical methodology in health sector generally and in the emergency department in particular. This practical solution is what the situational approach of leadership will adequately provide. It, therefore, becomes inevitable for leaders within the health sector to embrace this tested and trusted leadership style.
References
Gluyas, H. (2015). Effective communication and teamwork promotes patient safety. Nursing Standard (2014+), 29(49), 50.
Kessler, D., Cheng, A., & Mullan, P. (2014). Debriefing in the Emergency Department. Annals of Emergency Medicine.
Morley, L., & Cashell, A. (2017). Collaboration in Health Care. Continuing Medical Journal of Medical Imaging and Radiation Sciences, 48, 207-216.
Northouse, P. G. (2016). Leadership theory and practice (7 ed.). Thousand Oaks, CA, US: Sage Publications Inc.
Peterson, R. L., Peterson, D. R., Abrams, J. C., Stricker, G., & Ducheny, K. (2015). Training in Clinical Psychology in the United States: Practitioner Model. Wright, James D. International Encyclopedia of the Social & Behavioral Sciences, 517-523.
Varjoshani, N. J., Hosseini, M. A., Khankeh, H. R., & Ahmadi, F. (2014). Tumultous Atmosphere (Physical, Mental), The Main Barrier to Emergency Department Inter-Professional Communication. Global Journal of Health Science, 7, 1916-9744.
What is Situational Leadership? (2014). Retrieved from http://online.stu.edu/articles/education/what-is-situational-leadership.aspx