Are You Mindful of Your ED’s Team Performance? Maybe You Should Be. (Part 1 of 2)

Anne Bruce

Anne Bruce

Author and Leadership Consultant

Published May 01, 2014

Welcome to Mindfulness in Medicine, a monthly column by best-selling author Anne Bruce designed to cultivate leadership and collaborative relationships among hospital leaders, nurses, providers and ancillary staff. Mindfulness is a powerful leadership tool that enhances emotional intelligence in medicine. It is a tool that, when practiced, can help us develop and implement relational coaching skills and illuminate various ways to improve hospital operations and cross-departmental performance. Mindfulness also improves our capacity for decision-making and participatory medicine, all while enhancing our own health and well-being. Your comments and insights on these postings are greatly valued.

Unlike the prescriptions a physician or nurse practitioner writes, there is no magic pill that will guarantee the success of an emergency department's (ED's) team performance. Team performance has to be cultivated, nurtured, measured incrementally, supported by team surveys and data, encouraged and recognized with praise-in-progress — not six months or a year after the fact.

Today's Mindfulness in Medicine column, as well as >next month's part 2 of this article, can both be applied to emergency departments and their cross-departmental teams, including administrative departments, providers, ancillary staff, nurses, physicians and other hospital leaders. However, to keep things simple, I've used the emergency department here as a case study.

Two Simple Measurements of Success

An ED's team performance can usually be monitored in two ways:

1. Immediate improvement. For example, perhaps a team training session has taken place, with an outside consultant facilitating the process. After such an event, people feel renewed and energized. You may see immediate improvement, but this is often temporary. Old habits and behaviors die hard.

Perhaps you see immediate results when team meetings are held regularly and employee morale is infused with positive support by team leaders. If so, do more of this! Repeat what works. Many times EDs will roll back when they assume all is well. Don't assume anything.

2. Continuous improvement. This measurement and monitoring takes place over a lengthier period of time.

Continuous improvement requires that teams are tasked with objectively looking at benchmarks and goals and helping create strong improvement plans for more productive and effective team performance. This happens when prideful behavior and daily improvements (large and small) have been instilled and recognized in everyone on the team and now play out as part of daily practices within the ED. These positive ongoing behaviors then become second nature and also an important part of the ED's culture. What is the culture of your ED as it stands today? This is an important question to answer. Continuous improvement should result in teammates who are comfortable exploring feasible improvement solutions and want to be part of developing and implementing ongoing improvement planning strategies. A "we" not "me" mentality is prevalent when this happens.

One powerful aspect of avoiding ongoing systemic problems within the ED is in building stronger, smarter hiring practices. Details on this will be covered in part 2 of this article next month.

It All Starts with a Commitment to Improved Team Performance and Mindful Team Leaders

Here are some of the criteria and questions you may want to consider when identifying team leaders for your ED:

  • Medical director
  • Performance improvement director
  • Nursing director
  • Inpatient nursing director (med/surg)
  • Inpatient charge nurses (critical care and med/surg)
  • ED techs
  • Admissions supervisor
  • Lab and radiology supervisors/techs
  • Admissions (bed control) supervisors

Selecting Your Team: A Multidisciplinary Approach Ensures a Good Cross Section of Viewpoints

The obvious complexities of the ED environment often warrant team representation from several hospital departments. So the following list may seem larger than expected. However, interdepartmental representation automatically integrates team performance improvement into departments traditionally outside of an ED.

In most cases, teams should be made up of internal ED staff and staff from ancillary departments. This includes nursing departments that receive admitted patients from the ED. The goal is to ensure a solid cross section of ideas and build a solid understanding of the basic causes of current process failures or problem areas.

If there are problems within the department, or challenging issues arise, it is critical that team members see the ED as a facility-wide challenge, not just an ED problem area. Here are some suggested individuals to include on your ED performance improvement team:

  • Does this person have the ability to see the big picture? Can he or she envision the ultimate outcomes desired? Does this team leader possess a clear understanding of what it takes to achieve good results, and comprehend that it will take time and effort to achieve results, knowing that nothing happens overnight? In other words, is this team leader a patient person yet results-driven?
  • An ED team leader must be a super-fantastic listener! He or she has to be mindfully present and truly "hear" the needs and concerns of the people. How will you determine if a team leader is a good listener?
  • It is not required that every team leader in the ED have a direct stake in the team's improvement and outcomes. Depending on the goals, a team leader must be able to weigh accurate successes and failures in the context of the overall objectives and be able to continue to move the team forward despite stumbles along the way. The key here is trust. Is this person trusted?
  • A team leader must have a clear understanding of leadership competencies. Whether it is the ED director, performance improvement manager, or even an outside consultant, be sure that the team leader understands the importance of setting goals and objectives that are in alignment with the overall ED improvement initiatives. Again, the trust issue is a key factor in bringing this all together.
  • An ED's performance improvement team leader sets the tone for the entire team. He or she should be able to coordinate task completion, communicate well, like people, negotiate effectively, delegate work, listen carefully, and appreciate the perspective and competence each teammate brings to the table. Arrogance and attitude are not allowed. Great team leaders don't have to talk much. They observe. And they observe not from a critical standpoint, but from a caring standpoint.

As things proceed, team leaders should evaluate whether or not to change the group members according to the ongoing needs of each team and the specific goals of the ED.

Next month, check back for part 2 of Anne's article on a Mindful ED's Team Performance, where details on creating a results-oriented ED team plan and philosophy for greater performance results will be outlined.

Anne Bruce has provided training and performance coaching for Vituity. She also serves as MBSI's Employee Development Coach and Leadership Facilitator. Anne is a bestselling author with more than 20 books published by McGraw-Hill Publishing, New York. She considers her award-winning life-coaching book, Discover True North: A 4-Week Approach to Ignite Passion and Activate Potential (McGraw-Hill Publishing) to be one of her most "mindful" books to date. She also leads a popular Discover True North Expedition group on LinkedIn. Anne can be reached at 214-507-8242 or by writing to her at

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