Wellness - organisational

My “Perfect ED” – Making ED Great Again. by Melanie Rule

Melanie Rule
Dr Melanie Rule – Emergency Physician, The Prince Charles Hospital, Brisbane @rulesrule1


I have had the pleasure of working in eight different Emergency Departments during my career and so far no two places have been the same. My training years allowed me to move around and experience the good, the bad and the many differing ways that Emergency Medicine can be practiced.

However, when it finally came time to apply for a consultant job, I don’t think I gave much thought as to what made an ED a great place to work. I chose my current workplace for other reasons: it’s location, a consultant group that included many respected colleagues, and the opportunity to work in my areas of interest.

It is only some years later that I have come to understand just how important choosing a great workplace can be. We spend long hours at work, away from our family and friends, so our workplace needs to be somewhere we experience engagement, have genuine connections with our colleagues and feel a shared sense of meaning and purpose.

So what is it that makes one ED a great place to work, and another not so great?

In preparation for Wellness Week 2019, I have spent some time reflecting on this very question and have created a list of criteria for my “Perfect ED”.

My “Perfect ED”:

Delivers high quality patient-centred care

Caring for patients is the most important function of every ED. I have no doubt that every member of the ED team goes to work with the common goal of genuinely wanting to provide the best care we can for our patients.

Lack of resources, overcrowding, understaffing, access block and corridor medicine all impact on the quality of care we can provide to our patients and as a result, negatively impact our job satisfaction. An ED within a hospital that could somehow achieve solutions to these problems would be a wonderful place to work.

Prioritises Staff Wellbeing

Working in ED is inherently demanding and stressful work. Staff must have access to adequate breaks, sustainable rostering practices and appropriate resources to be able to perform well in their job. Supports should be put in place to ensure that the demands of the job do not follow people home unnecessarily to impact on their time away from work. Compassion must be shown to staff at times of need and access to leave provided at times of personal or family illness, stress and critical events.

My “Perfect ED” considers its staff as its most valuable resource, cares for their wellbeing, and in turn allows those staff to better be able to care for their patients.

Provides a psychologically safe work environment

My “Perfect ED” has a culture of safety, both physical and psychological.

Much emphasis has been placed in recent years on protecting staff from occupational violence caused by patients attending the ED. Whilst this is extremely important, comparatively little importance has been placed on the more frequent, yet equally damaging interpersonal conflict that goes on between staff.

Workplaces set their culture by drawing a line at the worst behavior they are willing to accept. Clearly defined expectations and strong leadership from all members of the team are required to call out behaviour that doesn’t conform to these accepted standards.

My “Perfect ED” would have a zero tolerance policy for bullying and incivility and stamp out these damaging behaviours immediately when they occur.

Encourages a growth mindset

Emergency Medicine is an ever-changing specialty; we can never stop learning new things and seeking to improve our practice. My “Perfect ED” supports a culture of learning for improvement for all staff and recognises the need for sufficient time and resources to be invested in this important area.

Practices like protected education time, mentoring and coaching would be the norm in my “Perfect ED”, as ways of fostering greater learning, understanding and furthering the development of individuals in the workplace.

Offers flexibility of work practices

I strongly believe that the key to countering the increasing rates of burnout in our profession is not to work less, but to change the way that we work. Working fulltime in ED should be sustainable for the duration of one’s career if we can make changes to the way we go about our work.

We are seeing generational change in the way people are choosing to work, with increasing numbers of staff of all ages and genders choosing to work part time for lifestyle, health, career sustainability and family reasons. ED is an attractive career for many reasons but the ability to be able to work in a flexible manner is a significant advantage. Allowing staff to pursue professional interests as part of their paid role provides meaning and improves engagement of staff, as well as value to the employer in terms of innovation and service delivery.

My “Perfect ED” would have flexible work options to accommodate the needs of staff at all stages of their career, to allow them to have a sustainable career right through to retirement in our wonderfully rewarding but demanding specialty.

Values Diversity and Inclusion

My “Perfect ED” values diversity and recognises each individual’s unique strengths. Diversity of gender, race, age, sexual orientation, religious and cultural backgrounds is encouraged and differences are embraced and celebrated.

My “Perfect ED” would allow all staff to have a voice and feel empowered to share their ideas about how the workplace should operate.

Works collaboratively with the rest of the hospital

My “Perfect ED” cannot function in isolation. It works as part of a bigger hospital team and functions in harmony with the rest of the organization. I strongly believe there is no role for tribalism in hospitals and we should all aim to develop a better understanding of how other groups work and strive to work respectfully together, despite our differences. My “Perfect ED” practices respectful intertribal interactions and has leaders who role model this and promote collaboration as a way of breaking down these tribal barriers.


I am fortunate to have experienced many of these aspects in the various EDs where I have worked but I have yet to find one that fits all the criteria of my “Perfect ED”.

My hope in writing this list is not to suggest that I have all the answers, but to start a series of conversations. Conversations about what makes the ED a great place to work, and how we can start to find some solutions to the challenges that are currently affecting our workplaces.

Yes, I am proposing we have the conversation of how to #makeEDgreatagain.

To do this, we first need to find our voice. We should aim to be powerful advocates for change in our departments and our organisations. It is time to speak up for what we want and need, and use our shared passion and considerable expertise to help make the improvements that WE want to see.

Secondly, we need to recognize that all staff, not just those in senior positions have a role in building a better culture in our workplace. We need to be the change we want to see in our own workplace and be role models to those more junior than us.  We can all be responsible for changing the culture of our own workplace as individuals, starting on our very next shift.

One day I hope to have the opportunity to work in my “Perfect ED”, but in the meantime I plan to invest my time into making my current ED the best version of itself that it can be. I plan to have a long and fulfilling career in this specialty and I hope you will all join me on this quest to make ED great again.
















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