How to identify unmet expectations
Other departments have expectations for your ED that are not always evident, and vice versa. Those unrecognized — and, therefore, unmet — expectations can cause conflicts.
"Conflicts may be centered around the unmet expectations on both sides," notes Colleen Bock-Laudenslager, RN, MSN, a Redlands, CA-based consultant with Bock-Laudenslager & Associates, which specializes in ED issues. Establishing a forum to clarify expectations may be necessary, she recommends.
Other departments may have expectations for the ED that aren’t being met. "For example, they expect the ED to be clean. If housekeeping isn’t meeting those standards for whatever reason, their negative impression is of the ED, not housekeeping," she says.
Likewise, other departments may fall short of the ED’s expectations. Turnaround times are the biggest conflict in this area, says Bock-Laudenslager. "You expect timely results from radiology, and you expect security to be deployed immediately to the ED when you are responding to an assaultive patient."
Well-defined job descriptions may minimize conflict and ensure that expectations are met. "Managers of different departments working together to develop job descriptions would clarify what expectations are needed on both sides," she says. "So that alone will clear up a lot of issues."
Setting an expectation early can prevent future conflicts, notes Tamara Thomas, MD, FACEP, associate professor of emergency medicine at Loma Linda (CA) University and attending physician in the ED at Loma Linda University Medical Center and Children’s Hospital.
For example, if a hypoxic, elderly patient with pneumonia needs admission, clearly state the need for inpatient treatment in the following way, recommends Thomas: "I wanted to let you know about a 78-year-old diabetic woman who has a left-sided pneumonia and hypoxia. She looks ill and needs inpatient care.’
"This can save significant time for your ED and the patient by avoiding passive aggressive behavior by the medicine resident," Thomas says.
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