Personal stories from health and care professionals working in and around emergency departments reveal how staff dedicated to systems thinking, teamwork and leadership can deliver an outstanding service under pressure.
The stories, captured in the IHM publication The Winter’s Tale, highlight the courage, stamina and self-belief required to turn around a struggling service. The report conveys the wisdom that comes from passionate staff working on the frontline.
Among the many powerful messages was ensuring staff have the confidence to trust their own clinical judgment. Clinicians that feel overwhelmed, undermined and under threat become part of the problem they are trying to solve, by routinely admitting patients for ‘observations’ and other ill-defined reasons instead of sending them back out.
A big step to achieving this is putting the most senior and experienced staff at the front door, so they can identify quickly who is and is not an emergency.
Empowering professionals such as therapists, frailty teams and social workers transforms the performance of an emergency department. Frail patients who are not an emergency can be kept mobilised and supported to return to their own home quickly rather than being parked in a hospital bed to deteriorate. Discharge planning begins the moment they arrive.
Regularly bringing the whole team together – including social workers, therapists and ambulance crew – to identify where wasted time and effort can be taken out of the system saves money and time and can drastically reduce patient stress.
Clinical engagement is the thread running through the entire report. Making sure that staff – particularly consultants – feel they have both the power and responsibility to change the way things work changes people from complaining about the problems to owning and solving them.
Alongside the inspiring people-focused work, it is essential to get the details right. Staff said that collecting useful data and acting on what it told them shifted the department from management by anecdote to evidence driven change.
Relentless attention to process is key to changing culture. This can mean months of emotionally draining work asking the same questions of the same people until they get the message, but eventually the new way of working will bed down.
One piece of advice which is often forgotten is simply to look after yourself. Working to the point of exhaustion is martyrdom, not leadership. Ensuring you take the time to care for your physical and mental health shows respect for yourself, colleagues and patients. Finding a way to reflect on the day which is constructive and positive – rather than constantly turning over what went wrong and what should have happened – is an essential discipline.
Finally, being a leader in an emergency department means a never-ending journey of improvement. But if you feel you are part of a successful and ambitious team that will be part of the fun of the job – emergency staff thrive on the challenge of constant change.