Christina Powell, OMS-III

In the past, a sentiment existed among some emergency physicians that arriving on time and covering the shift with 100% effort was sufficient for success. However, in the face of increasing competition in the field, changing insurance models, and expanding expectations, physicians are being called to a higher level of leadership, with a unique set of both clinical skill and professional management. Many emerging leaders start their careers in healthcare or transition to a new role in the department without the leadership skills to succeed. Developing and cultivating interpersonal skills needed to listen to and lead multiple strong personalities is no simple task. These skills are acquired over time by trial and error, or through personal mistakes that cost the department down the line. It is the aim of this article to focus on the leadership responsibilities involved with preserving psychological health in our emergency departments, leading to positive outcomes and an overall improved work environment. An engaged, pro-active, solid physician leader creates a more resilient team focused on improving patient care.

In general, being a good leader boils down to trust and respect. To maintain trust with your staff, hospital administrators, and the IT guy down the hall, one must a) care, b) be optimistic, and c) continuously and actively develop the art of leadership. Below are some leadership behaviors that build trust.


Behavior #1: Know Your Staff

When you first meet a new staff member, what do you talk about? Expectations for your department? Do’s and Don’ts of the specific ED they are entering? Despite the time constraints you may face at that instance, resist the temptation to go directly to practical questions. Instead, let them tell you a little bit about themselves. Listen to their story. What brought them here? What goals do they hope to achieve? Where do they see themselves in ten years? Details aren’t as important as themes. Some personal life details you may want to avoid completely; however, the main point is to demonstrate that the new member of your team is respected and valued as a person. Once these questions are asked, the key is to actually listen to the response. Write down significant facts if needed, to remind yourself of what that new relationship uncovered. Know your staff and the administrators. Build the relationship.

Behavior #2: Be Visible

When you are not concealed behind a computer screen completing charts, or interviewing a patient, it is important to spend quality time in the nurse station. If you are taking a coffee break, or the patient volume is slow, arise from the blue light of the workstation and be visible to the staff. Devoting time is the ultimate expression of respect. Ask your staff how you can assist them – how can you inspire them, challenge them to grow, and mentor them as a health care provider? You may not be afforded the time to do this often, but this is a great way to find out what is really going on. A quick visit down the hall holds more value and gains more insight than hours of emails. Another benefit of maintaining visibility and transparency with your staff is decreasing intimidation in the workplace. If your staff is intimidated by you, they won’t be honest with you. There is an increased risk of mishaps and cover-ups when staff members are intimidated by those they report to. It is important for your staff to trust you both during times of excellence and times of challenge.

Behavior #3: Show Dignity and Respect

A Harvard Business Review article in 2015 polled over 20,000 employees asking which leadership behavior was the most important for garnering commitment and engagement in the workplace. The #1 leadership behavior was to be treated with respect. “Being treated with respect was more important to employees than recognition and appreciation, communicating an inspiring vision, providing useful feedback — or even opportunities for learning, growth, and development.”1 How often do we focus on maintaining respect in the department?

Ask yourself this question: how do I react to bad news? We dedicated countless hours training medical students and residents how to give bad news tactfully, but not as much training on how to respond to bad news within our emergency department. Do you react with anger? Judgement? Condescension? Emotional liability? Fear? The first goal, when bad news arises, is to resist the urge to shoot the messenger, as tempting as it may be to use anger as your primary leadership tool. Responding inappropriately devalues the relationship you’ve been building with your staff by decreasing trust and increasing intimidation. Give each staff member respect despite the circumstances. When bad news is brought to your attention, show neither shock nor anger – or the bad news will stop coming, and you’ll find out the hard way. The culture you create is dictated by your behavior as a leader. Build dignity and respect into your department.

Behavior #4: Don’t Ignore Good or Poor Performance

Always set expectations. Expectations for medical students. Expectations for residents. Expectations for nursing staff. Expectations for the attendings. Defining ‘what is excellence’ is key to helping your team achieve it. If they meet the standard for excellence, tell them! Especially praise their performance in front of others. This will not only reinforce their admirable performance, but also encourage others to seek a higher level of achievement. Set a department culture of improvement and affirmation. Taking time to say “thank you,” both verbally and in notes or by sharing positive patient reviews are excellent ways to show appreciation. If there is poor performance, do not ignore it! Seek first to understand. ‘Can you help me understand why you are making these mistakes?’ Where do you think the problem lies? Is it a lack of training? A lack of sleep? Maybe a simple solution exists. Carefully assess and take action. The goal, as always, is to maintain respect in the workplace.


Colin Powell described the importance of enthusiasm and optimism, and how this can be an emotional contagion with his phrase: “perpetual optimism is a force multiplier.” Powell circulated lessons on how to demonstrate leadership, and how optimism will drive your followers (or in our case, staff and peers) to share the positive attitude. Optimism is not a prediction of success or some view of an unknown reality to attain- rather it is how you forge forward in the face of difficulty, maintaining the belief in your purpose and goal. Alternatively, a pessimistic leader can cause as much harm as an absent leader. If we mope around the ED, complaining about the slow triage tracker, or how no one informed the doc that there was a hard stick in bed 5 and it has been 30 minutes since the blood cultures were ordered, the tone of the department declines overall.  Fear is also the ugly sister to pessimism. Fear can easily paralyze us as students, residents, and physicians. Fear can prevent clear and rational analysis of the conundrum in front of us. If we do not learn to control and prevent fear, we cannot effectively lead others to do the same.

Maintaining an optimistic attitude can become difficult depending on the situation at hand, but the downstream effects of one attitude adjustment can exponentially change the emotional effect of those surrounding the situation. Optimism and pessimism can easily produce the same outcome. As Yvon Chouinard stated: “There’s no difference between a pessimist who says, ‘Oh, it’s hopeless, so don’t bother doing anything,’ and an optimist who says, ‘Don’t bother doing anything, it’s going to turn out fine anyway.’ Either way, nothing happens.” If you have read the book Good to Great by Jim Collins, you may have come across the idea called the Stockdale Paradox. The Stockdale Paradox is named after Admiral Jim Stockdale, who was held as a prisoner of war in Vietnam for eight years. He interestingly commented on how it was the most optimistic of captives that failed to make it out of the situation alive- they held such blind optimism that when their timetable for freedom came and left, they died of “a broken heart.” The Stockdale paradox demonstrates a specific type of optimism, one that can easily be applied to the emergency department, where the outcomes are not always as desired and self-delusion is fatal. Optimism in this sense is 1) maintaining strength that you will prevail in the end, regardless of the difficulties, while also 2) confronting the nature of your current reality with brutal honesty.  The first half of the Paradox is easy; it is the second half that we must apply in our practice of medicine: combining optimism with admitting the truth of the current situation and a willingness to act. Admiral Stockdale knew his situation was grave, but instead of succumbing to defeat, he stepped up and did all that he could to improve the morale and prolong the lives of his fellow comrades.


In medicine, we are lifelong learners. While we spend hours on pre-clinical or clinical medical education and CME credits, we do not dedicate as much time to process of professional development and the art of leadership. I would challenge each of you to add a book or podcast to your yearly list to cultivate personal and professional development as a leader.

Suggested Books:

Good to Great – Jim Collins

Touch Points – Douglas R. Conant and Mette Norgaard

Mastering Civility: A Manifesto for the Workplace – Christine Porath

First, Break All the Rules – Marcus Buckingham

The Art of Medical Leadership – Suzan Oran and Scott Conard

7 Habits of Highly Effective People – Stephen R. Covey

Primal leadership – Daniel Goleman

The Leadership Secrets of Colin Powell – Oren Harari

The leadership behaviors presented here can be applied to any area of life. The principles may seem simple, but they are easily forgotten during times of severe stress and limited resources. Do not ignore their value and I implore you to remind yourself of them daily. Your emergency department will benefit from continuously cultivating the art of leadership. Regardless of which stage of the journey you reside in, as a medical student, a resident, or an established physician, professional and personal development should never cease. As health care providers, we must always rise to new challenges, not only as they relate to clinical knowledge or expertise, but as they relate to individuals working together towards a common goal. Be reminded to always lead from the front. Be the first person to make a change in the culture of the department, and see the productivity and overall outlook transform.

Portions of this article were inspired by Ret. USN CAPT Mark Brouker of Brouker Leadership Solutions and Assistant Professor of Leadership Studies at Chapman University. Visit CAPT Brouker’s website at






  1. Porath, C. (2017, July 31). The Leadership Behavior That’s Most Important to Employees. Retrieved August 15, 2017, from