Understanding key strategies for exemplary leadership in high stakes emergency department clinical scenarios: a qualitative descriptive study.

Purpose: Emergency department (ED) care often requires the collaboration of team members who are recruited in ad hoc ways to preserve the lives of rapidly deteriorating patients. These moments are described as "high stakes" for their time-sensitive, complex, stressful, and emotional nature. The purpose of this manuscript is to describe how exemplary ED leaders and team members perceive optimal clinical leadership in high stakes moments.

Methods: Semi-structured interviews were completed with 15 exemplary emergency department staff (Eight physicians, seven team members), as identified by their colleagues. The participants were asked to describe their perspectives on effective leadership in high stakes clinical moments and to explore strategies that leaders can perform to optimize team function. Data were analyzed via a qualitative descriptive approach with thematic analysis.

Results: Exemplary ED leaders and team members jointly identified seven strategies that may be used in high stakes clinical ED care: (1) identifying and organizing resuscitation resources in anticipation of high stress moments, (2) declaring a single resuscitation leader, (3) checking in with team to gather input and feedback, (4) delegating tasks in manageable ways that reflect team member preference and competency, (5) maintaining a quiet room while exuding calm and confident energy, (6) adapting leadership strategies to fit the needs of the team, and (7) anticipating future directions while maintaining broad perspectives.

Conclusion: Strategies identified in this manuscript provide detailed descriptions of how exemplary leaders can optimize team function during high stakes clinical ED patient care. The analysis also uncovers nuanced differences between leader expectations and team member preferences that should be considered in future high stakes clinical moments. The lessons learned may be relevant to informing the ongoing training of current and future ED personnel who wish to improve their clinical and resuscitative leadership.