January 11, 2022

Leadership Skills

The Ten Most Important Things I Learned About Being A Good Boss

Jane O'Shaughnessy, MD, FACEP

1. Your credibility
In emergency medicine, nothing promotes administrative credibility like clinical credibility. Continue direct patient care throughout your career no matter how exalted and extensive your administrative responsibilities become. Work night shifts and weekend shifts, even if once a month or so. Keep up your clinical knowledge and skills.

2. Positive feedback
Challenge yourself to give positive feedback to at least five emergency department (ED) employees every day.

3. Goal orientation
Devote a minimum of 10% of every day to moving your ED forward. Do not wait for staffing levels to improve, the new computers to arrive, the latest inspection to be over, the new nurse manager to be hired, the budget cuts to be rolled back, etc. Push forward every single day, in good times and bad. Develop with staff how you want your ED to be different and better a year from now, and work on some aspect of that every day. Make it apparent to your staff that we are moving this department forward no matter what. Otherwise, all of every day can be consumed by problem solving.

4. Performance evaluations
Take these seriously. Have a written form or method and perform them meticulously. Put the evaluation in the context that everyone has strengths and weaknesses and all of us are motivated to be the best we can be. Start with lots of feedback on strengths, then move on to areas for improvement. Be highly specific. It's nice for an employee to know you consider her/him a good performer, but that in itself does not promote growth. It's devastating for an employee to know you consider her/him a poor performer unless you give specific guidelines on how to perform better.

5. Cutting your losses
Certain employees are unlikely to change. Chronic late-comers will continue to come late; physicians who in every problem situation find someone to blame other than themselves; the "high-maintenance" employee who is in your office once a week because of some kind of problem, issue, or complaint, etc. I used to think I could educate and reform these individuals, and it took me at least 10 years to figure out that it cannot be done. Set a reasonable time frame and ample opportunity for correction, then move on to move them out, respecting of course all necessary steps in due process, etc. With skill, you can convince them that this is not a good fit for their particular skills/temperaments, and they'll resign.

6. Manage by walking around
Close your office door only when you have to; otherwise, be receptive to walk-ins. Walk through the treatment areas multiple times every day, and address issues as you go through. Pull patients in from the waiting area. Intervene to get the computed tomography (CT) moving, etc. You cannot do this all day every day, but your staff needs to know that, on the one hand, you will lend a hand and help them solve problems, and, on the other hand, you expect a sense of professionalism and order in the department at all times. Show by example that no task is too mundane or disagreeable for you to do if that's what it takes for the team to get the job done.

7. Respect
Never tolerate pejorative language or attitudes toward patients, ("gomer") etc. Correct residents, attending physicians, or anyone else instantly if this occurs.

8. Stand up for your employees
When they're in the right, go to the wall for your employees with administration, other departments, or anyone else. When they're in the wrong, apologize for the department and let your employee know you hate to have to be in the position of apologizing for their behavior, please don't put you in that position again.

9. Support your employees
Sooner or later every employee who reports to you will have a personal problem: a divorce, illness, family problem, etc. When this occurs, support the employee in every way possible. Say, and mean, "Don't worry about the job, your family (health, etc) comes first." Do not mention the burden this will put on the department. Then make good no matter what it takes. Do this because it is your responsibility and the right thing to do. The pay back is that that in the future that employee will walk on coals for you.

10. Leadership
Do not be afraid to be the moral leader of the department. Be willing to talk without irony about the mission of the department and the pride we all have in emergency medicine. Be willing to call out the best in yourself and your employees. Be willing to give verbal reminders that we are here to serve, not judge our patients. Acknowledge and apologize when you fail to meet your own standards (in my case, this was frequently necessary!)
Dr. O'Shaughnessy is a recently retired emergency physician and medical director who is board-certified in both emergency medicine and internal medicine. She is kindly sharing some of her insights from her years of experience in the information above.

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