Review article: Systematic literature review of leadership in emergency departments

Abstract

Emergency medicine (EM) is a discipline with complex leadership demands. However, studies of EM physician leadership and ED leadership are in their infancy. As such, there is a lack of clarity about the forms, antecedents, enablers, barriers and consequences of EM physician leadership. A systematic review of the scientific literature was conducted to reveal the different conceptualisations of EM physician leadership, the activities involved in the practice of leadership, and the knowledge and skills of effective ED leaders. Seven databases were systematically searched for peerreviewed empirical studies on the topic of EM physicians carrying out a manager or leadership role in an ED setting. Finally, 26 articles were included, and their findings were synthesised and analysed narratively. Two conceptualisations of EM physician leadership were found, reflecting clinical leadership and medical leadership, respectively. Clinical leadership is performed by all EM physicians, often informally, within their daily clinical practice, whereas medical leadership is performed by EM physicians who work at the management level within a hospital, in addition to or instead of their clinical practice. The focus of EM physician leadership and ED leadership research is team leadership, with much less attention given to wider organisation leadership. Consistent with the focus on team leadership, clinical knowledge and skill in orchestrating teams, especially trauma and resuscitation teams, emerged as the most important factors underpinning leadership effectiveness. Future research and training should make better use of existing leadership theory and research designs to illuminate the forms, dynamics, antecedents, moderators and consequences of EM physician leadership.

The age‐old question: Thematic analysis of focus groups on physician experiences of aging in emergency medicine

“…Workload demands, wellness and physician social equity, and concerns about value as a senior physician were described as major themes. Future directions for research include the role and type of leadership needed to mitigate the consequences of aging and increase the longevity of emergency physicians 40 . Research using a phenomenographic approach may also provide fresh insights into the value of senior physicians 41 .…”

Reframing leadership: Leader identity challenges of the emergency physician

“…Such relational dynamic does not jettison formal roles, rather it requires them to function as enablers. 1,4 That is, it enables followers to move into a more proactive space, putting them into parity with the leader, as is crucial in the EM context, where leadership is uncertain (not defined by a role identity) and fluid (not confined to a relational identity).…”

“…2 However, this conceptualising of leadership may not hold water in the liminal context of EM, where leadership is 'pluralistic, relational, dynamic and contingent'. 1 In order to shift from an oversimplified, transactional nature of leadership in healthcare, 3 the present paper recommends a novel understanding of EM leader identity based on social construction theory. 2,4 Specifically, in exploring EM leader identity as a socially constructed identity process, we outline salient concepts pertaining to emergency physicians' (EP) identity such as identity claims and grants, professional identity threats, hybridisation, identity workspaces and risk.…”

Advancing leadership in Australasian emergency medicine: Taking stock and looking ahead

“…As a result, our picture of medical leadership overall is low resolution, and lower still in different medical specialties. Given this, we commenced our research partnership with a systematic review of EM leadership 3 . Although this review highlighted the parallels between EM leadership and leadership in other medical specialties – such as the distinction between practice‐focused clinical leadership and management‐focused medical leadership, as well as the general management activities enacted as part of EM leadership – the literature is silent on the leadership that occurs beyond the ED, such as the hospital and health system.…”

“…However, developing these enablers calls for approaches to leadership that catalyse change, such as facilitative leadership – reflected in the promotion of respect and positive relationships between team members, productive conflict resolution, and open expression of ideas and opinions 7 – and system leadership – the ability to bring forth collective leadership 8 . The stark contrast between the types of leadership required to catalyse systemic change and the prevailing focus of the EM leadership literature on team leadership within the ED 3 highlights the blind spots of the extant EM leadership literature.…”