The Children’s Emergency Department is a busy, challenging, and dynamic environment. The skills needed to deliver the best possible outcomes for children and young people are multifaceted and constantly evolving. They involve a mixture of clinical, communication, and leadership traits.
Having recently moved from a leadership position within the Children’s Emergency Department to a more system-based role involving children of all ages, it’s apparent to me how transferable my experiences on the shop floor have been to this new strategic leadership role.
Here are eight key leadership lessons inspired by real-life interactions and reflections from Paediatric Emergency Care
1. Communication is as Visual as it is Verbal
Communication is not just about speaking words; it’s about connecting, understanding, and being understood. Whether interacting with children, young people, or even colleagues, the nuances of communication turn exchanges into meaningful dialogue.
Communication is the sum of many parts:
- • The way a person’s posture changes when they’re angry or anxious.
- • The tone of their voice, even when the words seem neutral.
- • The things they say, and perhaps more importantly, the things they choose not to say.
Despite being constantly told the importance of non-verbal communication, we often overemphasise verbal content while neglecting the visual cues that speak just as loudly. Recognising and responding to non-verbal signals is crucial in ensuring you truly understand someone. There is little difference between being able to read the body language of a six-month-old to determine if they are irritable than there is in reading the body language of a chief executive to understand whether your report is being well received. One may argue the former is much more important to get right, though.
2. Recognise and Respond to Those with One Theory of Mind
Theory of mind (ToM) is the ability to understand other people’s mental states, such as their desires, beliefs, and intentions. The literature will tell you it’s a complex cognitive ability that allows people to predict, understand, and influence the behaviour of others. Some individuals, particularly those with autism, may struggle with understanding perspectives other than their own. This isn’t stubbornness or defiance; it’s simply how they process the world.
“ToM” issues mean that explaining the same thing repeatedly (“Let me look at your hand”) won’t help because their framework for understanding differs from yours. Those with experience working with Children and Young People whose ToM may differ from ours will stop being persistent and try precision and empathy. Ultimately, repetition will frustrate both the patient and ourselves, and it is better to focus on strategies that align with the patient’s way of thinking.
While it’s less likely you’ll come across challenges over ToM in the board room, in my experience, it’s common to witness the same poor behaviours played out whenever the same difficulties are encountered. If an organisation or person has a particular mindset, regardless of whether it is maladaptive or not, adopting the same persistent (and almost always unsuccessful) strategy to deal with that behaviour is futile.
3. Be More Overt in Providing the Relevant Logic Than You Think You Need to Be
One approach to dealing with Theory of Mind challenges is emphasising the importance of linking actions to logic. It’s not just about saying what you’re doing to a child—it’s about why it matters to them. For example:
Instead of saying, “We’re giving you painkillers, Liam”, explain, “Liam, this will help the pain in your hand go away.”
You must be simple, direct, and explicit. What seems obvious to you may not be clear to someone in distress. Taking this extra step can make all the difference in cooperation and understanding.
This may seem a world away from TEAMS call, but it can be amazing how many actions are mistranslated if not specifically defined in an increasingly online world. It’s also very easy to presume that others, particularly if working in different healthcare settings, understand your frame of reference. Your computer system, discharge processes, staff rotas, and governance approaches are all different, perhaps only subtly, but different nonetheless. Being clear about why you are doing something and why it’s logical for your department, organisation or system to do that is critical.
4. Maladaptive Behaviour May Be the Only Control a Person Has
Prof. Russell Viner, a past President of the Royal College of Paediatrics and Child Health, insightfully observed, “Control is a doctor’s measure but a young person’s emotion.”
Some individuals may assert control only by engaging in maladaptive behaviours, such as shouting, withdrawing, or refusing to engage. When they feel powerless, these behaviours are often their last line of defence.
Rather than trying to control the situation, ask yourself, What control can I give back? Small choices, even about something as simple as where to sit, can make a difference in fostering trust and calmness.
However uncomfortable this may be to admit how often do you see difficult and sometimes unprofessional behaviours play out in meetings where someone has, or feels, they have been backed into a corner? Have you ever had a teenage tantrum over something you felt was taken out of your hands? I suspect everyone has one example they are not particularly proud of.
5. Prove That You Are Listening
It’s not enough to listen—you must show you’re listening.
Using someone’s name throughout the conversation is a small but impactful step. For individuals with communication difficulties, this reinforces that your focus is on them.
For instance:
“Liam, I understand that this is hard.”
“Liam, I’m here to help you.”
Proving your attention builds a sense of connection, which can be the foundation for effective communication.
I’ve personally always found it impactful to name the person who contributed a specific point when summarising an agenda item. It costs nothing in terms of time but highlights you’ve noted all points of view, even if the direction of travel isn’t what that person was hoping for.
6. “Be Kind, for Everyone You Meet Is Fighting a Harder Battle”
This quote, often attributed to Plato or Ian Maclaren, is a timeless reminder that behind every face is an unseen struggle. Kindness costs nothing but has the power to transform interactions.
Kindness can bridge the gap between what’s said and what’s meant in moments of frustration or misunderstanding.
This applies equally to the recently made redundant father who has just kicked off in the waiting room complaining that their child has waited too long to be seen, as does the divisional director, who snaps when reviewing the latest financial figures.
7. Intentional Leadership Is Just Management
The management bingo answer is that Leadership isn’t just about steering the ship but guiding individuals. It’s about stating that true leadership requires more than intention—it requires action.
There is something more subtle at play here, though. The journey from student to trainee, then to functioning professional and finally expert moves you from unconscious incompetence to unconscious competency. The best child health professionals aren’t actively thinking about which communication, distraction or procedural technique to employ with a child; they are just delivering what they believe is the best approach based on the years of pattern recognition they have from similar situations. Knowing WHICH patients will respond to an inflated latex glove is THE skill (the skill is not that you can blow up a latex glove and make it into a chicken)
Leadership should be unconsciousness. Reading Body language in tense meetings, phraseology when making referrals, and quick corridor conversations when hospital capacity is at a premium may all result in improved outcomes but are rarely intentional. Setting agenda items, process mapping, and allocating responsibilities – these are the conscious management tasks that take place day in and day out. There are many domains to leadership but my day-to-day observation is that many traits are so implicit the moment we start thinking about being a ‘leader’ we might be doing anything but.
Good leaders manage situations with empathy and clarity, not just ambition.
8. Be Careful with Humour
Working with children is fun. Paediatric environments are brightly lit and fun environments to work in. Laughing with children and young people is a strong medicine.
So Humour can be a powerful tool—but it’s a double-edged sword.
What seems light-hearted to you might be perceived as dismissive or confusing to someone else. This is especially true in sensitive situations or with individuals who interpret communication literally – this applies whether you are dealing with a two-year-old with something in their ear or trying to bend the ear of a chief operating officer.
Use humour wisely and always gauge the context. When in doubt, focus on clarity and kindness instead.
Final Thoughts
For effective leadership, read effective communication. This isn’t about following a script; it’s about adapting to the moment, the person, and the environment.
After all, communication isn’t just an exchange of information. It’s the bridge that connects us all.
