Emergency Medical Commander: a multimethod case study applying the lens of Path-Goal leadership theory

In 2020, the Gold Coast University Hospital emergency department (ED) established a Medical Commander role; a medical leadership position with a focus on optimising patient flow. The objective of this study was to understand how the role executes leadership tasks to promote patient flow and its impact on staff working in and with the ED.

A multimethod case study approach combined data from documents, observations staff interviews and surveys across a breadth of stakeholders. Data were deductively themed and triangulated through the analytical framework of Path-Goal leadership theory to provide a comprehensive analysis of the Medical Commander role functions and impact.

The Medical Commander role dynamically exhibits a combination of directive, supportive and participative leadership behaviours to enact and deliver patient flow leadership across a breadth of stakeholders. Path-Goal theory illuminates the environmental and personnel characteristics that have contributed to the role's perceived successes in patient flow and employee motivation. In addition, the application of this theory identifies several crucial enablers, including role characteristics (ie, clinical and service seniority, division-wide oversight and absence of clinical load) that support the dynamic use of leadership behaviours observed in this study and their effect on staff morale and patient flow.

As rising demand and complexity increase the risks associated with delays to patient care coordination and flow, the senior-level oversight and enabling leadership behaviours provided by the Medical Commander role represent a viable and effective intervention to manage these gaps.