When an Emergency Room Gets New Management, Relationships Come First

It’s no big surprise that there is anxiety when a new management group takes over an Emergency Department. The question is, what can our group do to effectively confront that anxiety?

At midnight on December 31st, 2011, our group took over management of the emergency room at Bristol Hospital. The previous group had managed the ER there for 16 years, so naturally there was apprehension among the existing hospital staff as to what the change would mean for them.

For the past few weeks I have worked shifts along with Bristol’s very strong and dedicated nursing staff. Many of our senior physician partners have also made multiple trips to Bristol to work shifts. More than anything, we have striven to show the existing staff there our unique culture, and inculcate our belief that everyone in the Emergency Department, from the secretaries, to the nursing staff, to the senior partners, make up a team. And when the team works well, the ER works well.

Our culture expresses itself in a lot of ways. Most of the partners, for example, prefer to be on a first-name basis with hospital staff. When I introduce myself it’s as Noah, not Dr. Keller. We memorize people’s names before we memorize new protocols. We shake hands, we joke with each other, and in general try to open the door to communication as much as possible, in every way we can think of.

We bring excited physicians up to Bristol to work the shifts. These are our most outgoing doctors, the ones excited to go into situations where they’re meeting new people. They’re still doing their work on a daily basis – taking care of patients – but they’re also friendly and jovial. Personality at this early juncture may sound like a side issue, but it’s not. Establishing strong relationships in a new Emergency Department is absolutely key to everything that comes after.

Perhaps the most memorable event over the past few weeks had a huge symbolic impact. It involved a table the previous management group had set up where the physicians could stand at computers and dictate to emergency room staff. The table was very high, which meant the doctors literally looked down on the rest of the emergency room, because everyone else was sitting below.

The second night we were there, Dr. Mike Cetta and I, with the computers and the monitors still on the table, got underneath and began loosening the brackets, lowering the table on our backs as we did so. Lowering the table not only had the effect of opening up the room, it sent a message to our new colleagues.

Many of the staff came up afterward and told us they appreciated the message it sent. The message was, we are all on the same level. The doctors aren’t up on their pedestal anymore. We’re a team.