Leadership challenges of directors of emergency medicine: An Australasian Delphi study

Abstract

Objective Emergency medicine (EM) is an emerging profession with complex clinical and leadership demands. However, studies of leadership in EM are in their infancy. The present study makes a novel contribution to empirical research in this area by examining the leadership challenges faced by Australasian directors of emergency medicine (DEMs). Methods An online Delphi study was conducted with 87 Australasian DEMs. To structure the process, participants were sorted into four panels reflecting their leadership experience and geographical location. Using a three‐phase Delphi process, participants were guided through the process of brainstorming leadership challenges, narrowing down these challenges, and ranking these challenges from most to least important. Results Four leadership challenges were shared across all panels, regardless of experience and location; namely, administrative overload, overcrowding and access block, managing challenging colleagues and engaging with hospital executive. However, the low consensus achieved within and across panels highlights the complexity of leadership in EM and cautions against simplistic approaches to addressing leadership challenges. Conclusion The recommendation for DEMs is that they need to engage in programmes which will support the development of the leadership and non‐clinical skills required to enable them to cope with responsibilities of hybrid role of physician‐leader. The development and delivery of specialised leadership programmes attuned to the hybridity of the director role and the complexity of hospitals is vital for ensuring high‐quality patient care and successful running of EDs.

Review article: Systematic literature review of leadership in emergency departments

“…The most cited skills were communication and interpersonal ( n = 18), teamwork ( n = 17), organising ( n = 10), decision‐making ( n = 4), delegation ( n = 4) and conflict resolution skills ( n = 3), as well as emotional intelligence and the ability to remain calm under pressure ( n = 3). Three studies highlighted the importance of system‐based leadership skills 8,18,19 . Only one study focused on skill associated with specific type of leadership, in this instance, adaptive leadership 15 …”

“…Given the prominence of organisation‐level issues (e.g. overcrowding, engaging with hospital executive) in the challenges facing ED leaders, 8 organisation‐focused medical leadership warrants closer attention in future research. Moreover, the challenges posed to EDs by systemic issues (e.g.…”

“…managing the ED, staff workload, patient flow, interdepartmental communication), generally, but not invariably, performed by those with a formal leadership position, such as the director of EM. 8,18,19,25,34,35 Activities and roles…”

“…Three studies highlighted the importance of systembased leadership skills. 8,18,19 Only one study focused on skill associated with specific type of leadership, in this instance, adaptive leadership. 15 Second, 17 studies highlighted the importance of different areas of knowledge.…”

“…Although these challenges are not unique to EM physicians, there are nevertheless features of EDs that create unique clinical and leadership challenges, such as those resulting from ED crowding 6,7 . Addressing the challenges of EDs 8 calls for clinical and medical leadership, respectively.…”