EMS Leadership Part 8: Behavioral Leadership Considerations for EMS

Ben had just been hired to take over as EMS director for Red Hawk County. Before assuming the position, he was told that the organization was receiving consistent complaints about response time, patient care and cooperation with other emergency response organizations. He spent the first three days watching what was going on and listening to EMS crews, as well as patients, aeromedical, fire department and emergency room staff. What he heard was not encouraging.

Ben spent the weekend revising policy and protocols with the county medical director. Monday morning he called a meeting and required all EMS staff to attend.

"Based on my observations last week, we are not working as teams, and definitely not being effective and efficient in our patient care and response environment," he told them. "This is going to change. Get ready to take notes, because we have a number of policy and protocol changes that you will adhere to in all emergency responses. There are significant changes in ambulance upkeep, ongoing training, relationships with patients and other emergency response teams. We are also going to reduce our current response times by half. We have the worst response times in this part of our community, and that will change immediately. I will be keeping a close eye on what is going on and will be involved in every aspect of this organization and its mission. If you cannot live up to these new policy changes, it's time to look for another job opportunity. For the next few months, we will definitely be task-oriented and get this organization back on track. Are we clear on our focus?"

A low but affirmative response came from the attending staff. Ben then spent the next two hours going over policy and protocol changes.

Ben remained very active in his involvement with the operational environment. In the first three days after the staff meeting, the response time was cut in half. Ben let two EMTs go because they refused to follow policy and protocol. While the first month was challenging for everyone, complaints were reduced by 85%. After the second month, only compliments were coming in from patients and other emergency response organizations. Ben was seeing a sense of pride in his ambulance crews and administrative support team. The operational environment was running much more smoothly, and individuals appeared to look forward to working with Red Hawk County EMS.

By the third month, Ben was changing his leadership approach to building positive and supportive relationships with his organizational staff. He was scheduling and attending birthday parties and promotions celebrations. While the monthly meetings and training environment were basically task-oriented, positive relationships were building between Ben and his staff, as well as within ambulance crews. EMS staff were offering proactive recommendations regarding response times, patient care and relationships with other emergency response organizations. Red Hawk County EMS was back on track, and a sense of pride was evident in all aspects of the organizational mission and operational environment.

The "Leadership Style" or "Behavioral" theories that were identified in the late 1950s and early to middle 1960s still apply today. The inability of researchers to define effective leadership based solely on personality traits led to looking at the behavior of leaders and how it might contribute to leadership success or failure.1 Northouse's theory was that leaders have an impact on followers through the tasks performed, as well as the relationships created. According to Northouse, leadership is composed of essentially two general kinds of behaviors. Task behavior relates to goal accomplishment; relationship behavior relates to helping subordinates feel comfortable with themselves no matter in what situation or operational environment they work.

Hemphill and Coons' Ohio State Studies provided research on behavioral approaches that emphasize structure and consideration.2 According to their studies, structure describes the extent to which a leader is task-oriented and directs subordinates’ work activities toward goal achievement. This includes organizing work, giving structure to work context, defining role responsibilities and scheduling work activities. Consideration describes the extent to which a leader is sensitive to subordinates, respects their ideas and feelings, and establishes mutual trust. It includes building camaraderie, respect, trust and liking between leaders and followers. The Leader Behavior Description Questionnaire (LBDQ) was developed as a result of Hemphill and Coons' research.

In 1960, Cartwright and Zander conducted what is known as the University of Michigan Studies.3 Their research established behavioral approaches that emphasize employee and production orientations. Employee orientation mirrors consideration; production orientation mirrors structure. In the studies, employee orientation describes the behavior of leaders who approach subordinates with a strong human relations emphasis. They take an interest in workers as human beings, value their individuality, and give special attention to their personal needs. Production orientation refers to leadership behaviors that stress the technical and production aspects of a job.

The Managerial Leadership Grid established by Blake and Mouton in 1964 emphasizes concern for production and concern for people.4 Their grid portrays five major leadership styles, including authority-compliance, country club management, impoverished management, middle-of-the-road management and team management. The managerial leadership grid is an example of a practical model of leadership that is based on the two major leadership behaviors: task and relationship. According to Northouse, it closely parallels the ideas and findings that emerged in the Ohio State and University of Michigan studies.

The five major Leadership Grid styles include:

Authority-Compliance (9,1)

This style is results driven, where people are regarded as tools to that end. The 9,1 leader is often seen as controlling, demanding, hard-driving and overpowering.

Country Club Management (1,9)

This style represents low concern for task accomplishment coupled with high concern for interpersonal relationships.

Impoverished Management (1,1)

This style is representative of a leader who is unconcerned with both the task and interpersonal relationships. This type of leader goes through the motions of being a leader, but acts uninvolved and withdrawn.

Middle-of-the-Road Management (5,5)

Describes leaders who are compromisers, who have an immediate concern for the task and an intermediate concern for the people who do the task. The 5,5 leader avoids conflict and emphasizes moderate levels of production and interpersonal relationships.

Team Management (9,9)

This style places a strong emphasis on both task and interpersonal relationships. It promotes a high degree of participation and teamwork in the organization, and satisfies a basic need in employees to be involved and committed to their work.

Leadership Grid

Where do you think Ben falls within this behavioral matrix? He basically started off as a 9,1 (Authority-Compliance Management), where his emphasis was on task orientation. Once he got organizational staff back on track regarding the new policy and protocol changes, he moved to 9,9 (Team Management). While his focus was still on task accomplishment, he modified his behavior and leadership style to build strong, motivated, cohesive, collaborative relationships both within and outside his EMS organization.

According to Daft,5 the behavioral approach says that anyone who adopts appropriate behavior can be a good leader. Behaviors can be learned responsively and enable leadership to be accessible to all members of a team or organization. Our behavior as EMS leaders is important, and we must be aware of how we apply our behavior and how it is perceived by our EMS team members. The behavioral approach provides us with a broad conceptual map that is useful in gaining an understanding of our own leadership behaviors.1 I believe you will agree that negative behavior is counter- productive to building and sustaining an effective operational environment. Our patient care and emergency response teams need to function in an environment conducive to organizational success and building respectful relationships. Your behavior as a leader is very important in maintaining a successful and effective EMS organization and team environment.


1. Northouse PG. Leadership Theory and Practice, 3rd Ed. Thousand Oaks, CA: Sage Publications, 2004.

2. Hemphill JK, Coons AE. Development of the leader behavior description questionnaire. Leadership Behavior: Its Description and Measurement. Columbus, OH: Ohio State University, Bureau of Business Research, 1957.

3. Cartwright D, Zander A. Group Dynamics Research and Theory. Evanston, IL: Row, Peterson, 1960.

4. Blake RR, Mouton JS. The Management Grid. Houston, TX: Gulf, 1964.

5. Daft RL. The Leadership Experience. Canada: South-Western as part of Thomson Corporation, 2005.

Paul Breaux, PhD, LP, has a doctorate in Leadership Studies and conducts research in EMS, firefighting, law enforcement and military leadership environments. He is in his 11th year as a volunteer licensed paramedic (LP) for Bandera County Texas EMS, and is an adjunct professor at Our Lady of the Lake University. His full-time leadership job is in applied electromagnetic research and development with Southwest Research Institute.