Azmat Husain, MD: Structure as Part of the Emergency Department Culture

In the final part of a 4-part interview with MD Magazine, Azmat Husain, MD, the senior vice president of clinical operations and chief medical officer of American Academic Health System, at Hahnemann University Hospital, discussed the overall challenges of making structure a part of the culture in an environment like the emergency department—one that is hectic by nature.

Husain also spoke about the need for the leadership to be present in these scenarios to empower the front-line staff, and for leadership to be involved on the ground floor—especially when implementing new processes and culture shifts. He also discussed the uniqueness of Hahnemann, and the staff’s overarching commitment to the institution and how it drives the success of the department.

Watch the previous installment, Part 3 of the interview, here.

MD Magazine: What's been the key to these vast improvements that have been seen here—espeically considering they've happened in such a short period of time? What makes Hahnemann different?

Azmat Husain, MD, senior vice president of clinical operations and chief medical officer, American Academic Health System:

We all recognize when we've been in departments that work and don't work. The key in the emergency department is to be able to provide structure in an otherwise chaotic environment. With structure, the problem is that adherence to the structure in this 24/7 environment is always the challenge. Nightshift comes on and administrators are not here. How do you make that structure part of, actually, the culture of the department? That requires a level of vigilance that we probably are not used to.

There are times when this process went live, where I would come in at 1 o'clock in the morning just to see how things are going. I think for nightshift staff, or for the staff as a whole, the leadership has to be very engaged. The leadership really has to be there on the front lines. When I've done this before, I would work more clinical hours than any physician, just to make sure that I was there and hand-holding through the process implementation.

Leadership engagement in enhancing the culture, the overall workplace culture, the buy-in, all those things are important. The process, at this point, is actually not as important as these other factors. Really, it's just adherence to the process. The leadership, the culture, all these factors are much more important to driving the success of a department.

I've been involved in 11 emergency departments before this, and I've never been in a department like this one. I can say this very honestly—I've never encountered a nursing staff as competent and as strong as this one. It's incredible to see the level of competency that the nursing staff here at Hahnemann University Hospital has. I just haven't encountered that level in an emergency department before. There's that level of competency.

What's also interesting about this institution is that the commitment to the institution—not just the emergency department, but across the hospital—is amazing. I've never seen it before. There are people who have been here since medical school and residency, this is their career and they've been here for 20 years. Our Chief Medical Officer has been here for 55 years. That is incredible. You don't see that anymore in institutions.

There's something about this institution, this patient population, this hospital—that it has such a committed staff. That's something that, to me, was very unique that I haven't encountered before. It's actually very pleasant to work in such an environment, where you have people like that. It's a challenging place to work, it's a challenging patient population. The department, at times, can be under-resourced, historically, but they still—this competent staff still stays. That, to me, is incredible.

I think it speaks to why the cultural shift, why the process improvement, was so fast. I think you had such as strong substrate here, they just needed a degree of structure and organization behind it. That's the leadership’s responsibility to identify that. When you identify that you have such strong clinicians—empower them. Really empower them. That was actually, to be honest about it, if I thought to say what is the one thing we did—we empowered our front-line staff. And they came up with a lot of the changes, we implemented them, and we're on track and we're on the path of success.

Transcript edited for clarity.