Management and leadership

Emergency health systems, consisting of community first responders, ambulance services and emergency departments (EDs), are busy microcosms of the healthcare system and, as the interface with and the ‘front door’ of many healthcare organisations, they are directly affected by increasing demand for services from well-informed consumers, continuous reform of the care delivery systems and demands for safe, high-quality care from consumers, government agencies and regulatory bodies. The challenge for managers in this environment is to manage services in an efficient and cost-effective way, to build high-performing teams from what are often disparate groups of professionals, to refocus care on patient needs and to develop innovative ways of improving service provision and patient outcomes. While it is acknowledged that the emergency health system is comprised of many healthcare professionals, including physicians and allied health providers, the emphasis here is on emergency nurses and paramedics who collectively comprise the first point of contact with emergency patients and their carers. This chapter examines what it means to be a nurse or paramedic manager and leader in the current healthcare environment. It provides a summary of some of the leadership theories in order to understand the difference between a manager and a leader and what characteristics are required to be an effective leader. A number of important contemporary leadership issues are discussed, including the need for nursing and paramedical leadership in health politics and policy development and in the implementation of clinical or shared governance and evidence-based practice.