In case you haven’t noticed, times are changing. EMS is being challenged like never before. The medical community is still questioning whether we make a difference, reimbursements and overall funding continue to fall behind the cost of providing service, more rules and regulations are always required, and the public demands optimal service and tolerates few mistakes (as seen by all the lawsuits against EMS agencies and providers). For some the trials may appear insurmountable. For others they present tremendous opportunity. While many EMS agencies have answered the challenges with cuts in services or by quitting altogether, pockets of excellence have emerged, providing innovative solutions and redefining their agencies and the profession of EMS.
Why do some agencies fail while other progress? As with all successful businesses, progressive EMS agencies have been able to transform themselves to adjust and stay ahead of the challenges. Agencies that are successful in the long term are often considered learning organizations. Businessdictionary.com defines a learning organization as one that “acquires knowledge and innovates fast enough to survive and thrive in a rapidly changing environment. Learning organizations (1) create a culture that encourages and supports continuous employee learning, critical thinking and risk-taking with new ideas; (2) allow mistakes and value employee contributions; (3) learn from experience and experiment; and (4) disseminate the new knowledge throughout the organization for incorporation into day-to-day activities.”1
In his book The Fifth Discipline: The Art and Practice of the Learning Organization, business strategist Peter Senge describes five characteristics that embody learning organizations:2
- Systems thinking. This is understanding how everything works together—how all the parts influence one another to comprise the whole. Systems thinking is often a challenge for EMS agencies, where leaders may view response time performances or even cardiac arrest survival rates as measures of how “good” they are, while ignoring other clinical excellence, customer satisfaction, safety and financial performance factors. A well balanced review of any EMS system must evaluate its components together as whole.
- Personal mastery. Individuals must learn for organizations to learn. Personal mastery of skills and knowledge is a journey with no final destination. It is more than just building skills and competencies, involving a hunger for knowledge and continual improvement. It is no accident that performance improvement initiatives such as Six Sigma or total quality management (TQM) are cyclical. There is always room to get better. Personal mastery is no different, and agencies should support and empower individuals to grow.
- Mental models. Senge defines this as “deeply ingrained assumptions, generalizations or even pictures and images that influence how we understand the world and how we take action.”2 To become a learning organization, EMS must break through its preconceptions and strive to learn from alternative points of view. How do other healthcare players or the general public view EMS? We must drop our assumptions and defenses, and ask and understand that question before we can learn and move forward.
- Building shared vision. Vision is more than a statement, it is a shared future. When all of your staff believe and see the vision, it can become reality. A shared vision creates excitement and synergies to work toward common goals. Imagine the possibilities if all EMS providers shared a common vision for the future. In the best EMS agencies, it is clear the employees share a common vision, and all strive to achieve it.
- Team learning. Team learning begins when individual assumptions are abandoned and an organization’s members begin to think together. This requires a culture of understanding and openness. Hoarders of information and knowledge have no place in learning organizations. The idea is for everyone to share what they know and build on the sum knowledge of the entire team. This simple step will rapidly produce results and better position an agency to achieve its shared vision.
Leading a Learning Organization
In Senge’s learning organization, leaders are designers, stewards and teachers.3 The leader must design a system through strategy, policy and procedure that fosters real learning and supports a just culture and safety for employees to take risks and innovate. The leader must be the steward of the shared vision. The vision is not owned by the leader, but he or she must safeguard it and ensure that activities help fulfill it. As this is reinforced, the shared vision becomes “larger” than any individual vision. The leader does not have to teach people how to create their vision, but can instead teach them how to think from a system perspective and see the “big picture.”
A Chinese proverb says, “Give a man a fish, and you feed him for a day. Teach a man to fish, and you feed him for a lifetime.” As a leader, one must teach others to learn from an organizational perspective. One must cultivate staff at an individual level to encourage personal mastery, but then develop systems so all individuals can openly share their knowledge from a systems perspective and develop a shared vision for the future. This open team learning environment will encourage growth into true learning organizations in which the opportunities are endless. Only then can EMS successfully navigate this time of rapid change.
1. Businessdictionary.com. Learning Organization, www.businessdictionary.com/definition/learning-organization.html.
2. Senge PM. The Fifth Discipline: The Art and Practice of the Learning Organization. London: Random House, 1990.
3. Smith MK. Peter Senge and the Learning Organization, www.infed.org/thinkers/senge.htm.
Troy M. Hagen, MBA, EMT-P, is director of Ada County Paramedics in Boise, ID. He has more than 22 years of EMS experience. He is president-elect of the National EMS Management Association and an EMS World editorial advisory board member.?