Learning from History

EMS organizations are as culturally diverse and change-averse as the United States itself. From generational differences in the workplace to the current rapid-fire economic and political changes across the country, EMS leaders often struggle to lead and manage their organizations. Leadership styles across the EMS profession also vary significantly. The leader often takes what he or she knows from experience, or what comes naturally, and “goes with it.” However, as evidenced by EMS organizations in crisis, leaders don’t always know or practice the best leadership style.

Looking throughout history, many believe the kings and monarchs of old had it made. These autocrats simply made edicts and they were carried out—or bodies were left in the streets. This leadership style was focused on self and not the good of the people. Do you know EMS organizations that still use this style of leadership? How successful are they? It is likely few remain, but some may still have autocratic tendencies.

This method of leadership prevailed for thousands of years until the people started to rebel and eventually overthrow the monarchies in favor of more democratic governments. However, businesses were often run like dictatorships, with the boss at the top and everyone else pooling below. Leadership experts Gregory Stone and Kathleen Patterson wrote a paper called The History of Leadership Focus. We will discuss their historical timeline throughout this article.1

Organization and Efficiency

In the early 1900s, the industrial revolution forced businesses to develop leadership styles that could work with large numbers of workers. While the boss remained at the helm, what is now known as classical management theory (CMT) and scientific management theory (SMT) was born. Both theories focused on the organization rather than self and fixated on efficiency, often at the expense of the workers. CMT developed the hierarchical structure and bureaucracy we often see today, while SMT evaluated worker-specific positions for efficiency. Time-motion studies and performance evaluations are a product of SMT. These theories first introduced the concept of management by objectives, now a foundation of the incident command system used in emergency services.

The Human Factor

From the 1940s through ’60s, new theories began to emerge that emphasized the human factors involved in performance. Researcher Henry Landsberger analyzed research that identified that if the worker knows something is being watched, performance improves, terming it the Hawthorne Effect. Psychologist Abraham Maslow developed his Hierarchy of Needs that posited workers cannot achieve high performance unless their basic needs are met first. Psychologist Frederick Herzberg developed his Motivation-Hygiene theory that showed setting goals and offering incentives in both work environment and specific job factors drove performance.

Chester Barnard was the first to include executive behavior as a component to effective organizational leadership by “accomplishing goals with and through people.” In other words, the workers and management are a team. It was shown that focusing on behavior, human need, personal relationships and working groups improved output. Collectively, these theories pursued increasing wealth for the organization as the primary driver.

Situational Considerations

From the mid-1960s to the mid-1980s, the culture in leadership and the country began to move toward social rights and equality, rather than just personal wealth. Ironically, this is the time period in which modern EMS was born. In this time of sweeping change the old leadership styles simply did not work. The situation theory was developed for executives to handle each new situation differently and appropriately based on the level of job experience and psychological maturity of the worker. A second contingency theory was developed which further stated that it’s not employee maturity that makes a difference, but the executives’ skills at leadership. This is where it was first suggested that the boss is not the only leader and different leaders may be better suited to handle diverse situations. These theories may correlate to why EMS systems are so diverse today.

Moving from Management to Leadership

All these theories can be polarized with transactional leadership on one end of the continuum and transformational leadership on the other. Transactional leadership exchanges rewards for compliance and is often considered “management.” It focuses on the here and now. You may have heard a supervisor say, “That’s what I pay you for!” The opposite is transformational leadership. It is a collaborative decision-making process used to bring individuals together for the good of the organization long into the future. This style takes great leadership, motivation skills, employee empowerment and vision. The next step of transformational leadership is servant leadership, which was highlighted in the May 2011 Leadership Best Practices column, “What’s a Leader to Do?” Servant leadership focuses entirely on meeting the needs of others.

While most EMS agencies and companies subscribe to the transformational leadership theory, only 5% of EMS organizations fulfill their vision.2 Could it be that EMS leaders are still using old styles of leadership? If so, why? Research has shown that engaging and empowering your workforce is better for the employees, the organization, society and the leader. It is time to take off the crown and put away the scepter before your organization follows the path of previous kings and countries that no longer exist.


1. Stone GA, Patterson K. The History of Leadership Focus. School of Leadership Studies, Regent University. www.regent.edu/acad/global/publications/sl_proceedings/2005/stone_history.pdf.
2. Evans BE, Dyar JT. Management of EMS. Upper Saddle River, NJ: Pearson, 2010.

Troy M. Hagen, MBA, EMT-P, is director of Ada County Paramedics in Boise, ID. He has more than 22 years of EMS experience, is president-elect of the National EMS Management Association and is a member of the EMS World editorial advisory board.