Two Buckets and an Emergency Department

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Teamwork won’t function without everyone operating together.

When someone mentions the name Coach John Calipari, people usually think of Calipari’s tremendous impact on emergency medicine provider engagement and performance. Okay, maybe that’s just me.

Coach Calipari is known for his incredible coaching ability, recruiting and talent management. Year-after-year, his teams have become staples in the NCAA basketball tournament. While I hold him in high regard as an all-time great leader, I mostly recall how one of his philosophies had a positive impact on an emergency department I led about five years ago.


I was charged with leading and improving the performance of an emergency department. Prior provider staff had a poor reputation with the hospital and patients, with lack of nursing staff collaboration and patient communication being the root of the issue. My instincts were that staffing a new team had to go beyond finding talented providers, so I added team chemistry and synergy to my focus.

Making the transition more challenging, many of the medical staff was jaded from their previous relationship with the emergency medicine group.

Within 90 days our team was ready to start and I recalled an article about Coach Calipari’s approach to managing high-level talent on his teams. I knew some of his teaching methods were unconventional, yet effective, in their visual tactics.


When Calipari coached at the University of Memphis, his team was stacked with talent. Even though they were expected to perform at a high-level, they weren’t meshing on the court.

To get his message across on how one bad attitude can affect the entire team, one day Calipari brought two buckets to practice — one filled with delicious, creamy ice cream and the other full of manure.

It was obvious which bucket was more appealing; however, Calipari explained that no matter how large and delicious the bucket of ice cream, even the smallest bit of manure added to it would ruin the entire bucket.  He said the same was true for their team. One bad attitude could ruin the entire team dynamic and performance.

The same applies to emergency medicine teams.  With teams of incredibly high-performing and passionate providers, it only takes one disengaged “player” to affect the team and its reputation adversely.


My emergency medicine team took to this analogy so much that they rallied behind the message and used it for years to come. Instead of festering whenever we faced a bit of negativity from one of our peers, we looked at our fellow provider and said, “Don’t be the poop in our ice cream.” This turned a stressful moment into a reminder to stay positive as a team.

This mantra even extended to our discussions with the hospitalist team and medical staff. To build our relationship with them, we encouraged them to let us know if we were “being the poop in their ice cream” as well. While they got a kick out of this and it lightened the tension that was previously there, it also served as a way for them to see that we valued their opinion and collaboration. This lead to more collaboration on quality of care issues between the medical staff and ER staff as well as meeting operational metrics such as LPMSE and door to provider for the first time in years at this facility.

I tell you this story because it created a huge win for the team, and maybe it can help your program too. So, next time you and your team face disengaged colleagues, remind them, “Don’t be the poop in our ice cream.”


Dr. Michael Presley is a board-certified emergency medicine leader with a long history of advancing the performance of emergency departments. As Sound Emergency Medicine’s chief executive officer, Dr. Presley is responsible for driving quality and financial performance of programs, developing physician leaders, and working with hospital leaders on emergency medicine department program design.

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