This is a time of change for emergency medicine. Increasing volumes, increasing acuity, nursing shortages, EMTALA, decreasing collections, and the rising cost of liability insurance, as well as the demand for safe, inexpensive, convenient and expeditious patient care, are all challenges that require strong, effective leadership.
"We've been dealing with operational issues in ACEP and in emergency medicine for a long time-how to develop the specialty and how to get board certification. Now we need innovative leaders who can deal with the complex issues that face emergency medicine in a time of rapid change," said Tracy G. Sanson, MD, Assistant Medical Director, Department of Emergency Medicine, Brandon Regional Hospital, Brandon, Florida.
"The old model was for a leader to set a vision and for everyone else to follow," said Dr. Sanson. "Now, the role of a leader is to encourage the entire group to recognize problems and to mobilize them to tackle those challenges and take advantage of opportunities to make positive changes."
Emergency medicine residents are up to the challenge. They already have many of the qualities required of leaders in times of change, including flexibility and responsiveness.
"You don't have to be running a department to be a leader. Leadership is not based on your title and your rank in the system," said Dr. Sanson. "Residents lead all the time. They influence people in the emergency department every day. They influence nurses, techs, patients, and their fellow residents. They influence how the support staff thinks of emergency medicine and emergency physicians."
Emergency medicine residents have many opportunities to gain leadership experience both within their medical practices and within ACEP. The key to becoming a successful leader is to identify leadership traits, understand various leadership styles, and work toward developing effective leadership skills.
Good leaders have both intellectual and emotional intelligence. "Emotional intelligence includes self-awareness, as well as understanding others and how they work together. This kind of understanding enables a leader to develop a resonant, cohesive working group," said Dr. Sanson.
Medical training focuses primarily on intellectual intelligence. In order to develop leadership skills, residents must also focus on their emotional intelligence. Emotional intelligence is the ability to manage yourself and your relationships effectively. Dr. Sanson subscribes to well-known author Daniel Goleman's idea that emotional intelligence encompasses four fundamental capabilities:
Self-awareness is the ability to recognize and understand your own emotions and recognize their effect on your work performance and your working relationships. This includes self-confidence and a realistic evaluation of your strengths and weaknesses.
Self management requires several skills, including self-control, trustworthiness, conscientiousness, adaptability, optimism, initiative, and an achievement orientation.
Social awareness encompasses three areas. Empathy means sensing other people's emotions, understanding their perspectives and taking an active interest in their concerns. Organizational awareness is the ability to read the currents of organizational life, build decision networks and navigate an organization's politics. Service orientation is the ability to recognize and meet customers' needs.
Relationship management encompasses several factors, including the ability to provide visionary leadership, influence through persuasion, develop others, communicate, be a change catalyst, and manage conflict.
"An emotionally intelligent leader can create a climate of enthusiasm and flexibility. The key is to know when to be collaborative, when to be visionary, when to listen and when to command," said Dr. Sanson. "As you work to develop your own emotional intelligence, recognize what you're good at and what areas need improvement. For example, if you're not optimistic, then work on changing your outlook."
Daniel Goleman's book Primal Leadership, Realizing the Power of Emotional Intelligence, describes six leadership styles based on different emotional intelligence competencies. "There are advantages and drawbacks to each style," said Dr. Sanson.
Coercive leaders demand immediate compliance. This "do what I say" approach is appropriate in turnaround situations, during a crisis, or when working with problem staff. The drawbacks are that it inhibits flexibility and dampens motivation.
Authoritative leaders mobilize people toward a vision. This is a "come with me" approach. The leader states the overall goal, but gives people the freedom to choose their own means of achieving it. This style works well when a group is adrift, but it is less effective with a team of experts.
Affiliative leaders create emotional bonds and harmony. The hallmark of this style is an attitude of "people come first." It's effective for building team harmony and improving morale. However, if the focus is exclusively on praise, then poor performance may go uncorrected.
Democratic leaders build consensus through participation. This is a good way to generate fresh ideas and build organizational flexibility and responsibility. One drawback is that democratic leaders sometimes rely on having too many meetings.
Pace-setting leaders expect excellence and self-direction. They emphasize self-motivation and high levels of competence. The potential drawbacks of this style are that other staff members may feel overwhelmed by the demand for excellence, or may resent the tendency of the pacesetter to take over situations.
Coaching leaders develop people for the future. They focus more on personal development than on immediate work-related tasks. This style works well when people are already aware of their weaknesses and want to improve. It does not work well with those who are resistant to changing their ways.
"Each style is appropriate at different times and in different situations. There are times when you need to be a democratic leader and build consensus. And there are times in the middle of a crisis when you need to be a pacesetter-to be self-directed and show others exactly what to do. Then there are times when you have medical students or staff who need to be developed and that's when you use your coaching style," said Dr. Sanson.
"Leaders who have mastered four or more styles-especially authoritative, democratic, affiliative and coaching-usually create the best working environment and have the greatest effect on team performance," she said. "Evaluate which styles are already strengths for you and reinforce those while working on developing the other styles as well."
The type of people who choose emergency medicine are well-suited to become leaders and to move forward in times of change because they're flexible and responsive by nature and by training, according to Dr. Sanson. Emergency medicine residents already have the aptitude for making decisions in the midst of uncertainty, understanding that they will never have all the information. And they know that there are no one-size-fits-all strategies in emergency medicine.
"As a resident you're already influencing people and practicing many leadership skills. Take the time to develop those skills further and begin now. Leadership development is an ongoing process," said Dr. Sanson. "For example, learn the difference between giving direction and giving criticism. Direction points to the way things could be; criticism points to the way things were. Direction tells people what to do; criticism tells people what not to do."
Effective leaders take advantage of opportunities to provide direction and mobilize people to tackle tough challenges. And handling tough situations is one of the best ways to develop your leadership skills. "Tough calls are part of the job description of an emergency physician. They're not optional; they're a requirement," said Dr. Sanson. "I believe in John Maxwell's view of leadership philosophy. Make your decisions based on principles and values that you believe in. That makes your tough calls consistent with who you are, what you believe and what you want to teach others. As a leader, many things are beyond your control. The one thing over which you have absolute control is your integrity. When you follow the golden rule and live with integrity, you set an example that has far more effect than anything you say."
Change can be stressful, but in reaction to a stressful situation, a good leader looks for an opportunity to do something different and to make improvements in patient care, staff development or management style. "Ask: How can we benefit from the situation?" said Dr. Sanson.
"Prepare yourself for leadership by developing your strengths and improving in areas in which you are weak. Then, when opportunities for leadership present themselves you'll be prepared to step forward. And in the rapidly changing health care environment in which we practice, the opportunities will present themselves."
Tracy G. Sanson, MD, recommends these books on leadership: