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EMS Leadership Part 5: Idealized Influence Transformational Leadership in EMS

This is the fifth in a series of columns on EMS leadership. Dr. Breaux will cover leadership applications such as behavioral, managerial, situational, path-goal, leader-member exchange, full-range transformational and transactional leadership. Other areas like conflict management, effective communications and organization structure will also be addressed.

EMS dispatches ambulance 104 to a major vehicle accident at Post Road and Sinclair Street, with two injured at the scene. Responding time is logged at 1840 hours. EMS Director Linda Thomas in Medic 1 reports to dispatch that she is also responding to the scene. Dispatch replies that her responding time is 1841 hours.

Both ambulance 104 and Medic 1 arrive at the accident scene within five minutes, and Thomas requests law enforcement at the scene for safety and fire to assist in extricating the injured. The two injured were in the same vehicle, which had gone off the road and hit a power pole. Thomas asks the ambulance team, Betty and Jim, to perform initial patient assessment, including spinal stabilization, oxygen and IV treatments, while she manages scene safety. Betty and Jim do not hesitate to perform their duties because they have full trust in Thomas from their previous experience with her on similar EMS calls. They know her objectives are ambulance crew and patient safety; she consistently shares vital operational and environmental risk information with them as needed; she applies appropriate and positive moral and ethical standards and expects the same from other EMS staff, and she is not a power-hungry leader who ignores their personal and professional interests. Thomas is always there for her crews, patients and their families.

Thomas directs traffic until law enforcement arrives, then provides a brief but comprehensive summary of the extrication requirements needed to on-scene fire department personnel. The injured are extricated responsively and safely from the vehicle, stabilized and transported effectively and efficiently to the nearest trauma center while Thomas provides the center with patient-related vital signs and injury assessment obtained from the medics and works with law enforcement to secure the patients' personal property.

Patient outcome was positive and the trauma center staff thanked the ambulance team for their outstanding patient care, which directly influenced patient treatment success. Both Betty and Jim related to hospital staff that they should also thank Linda Thomas for her supportive leadership and effective scene management skills and expertise that she always shares with her EMS staff. Like others in their EMS organization, they believe strongly that supportive, mentoring and empowering leadership is needed to ensure organizational success, as well the success of patient care and providing positive community service support. This is known as "idealized influence" leadership.

Idealized influence is considered an important part of the full-range or transformational leadership model espoused by Bass, Burns and Avolio in 1978. The full-range leadership model includes four leadership factors, also known as the four Is. Transformational leaders, regardless of their organizational position, should apply "individualized consideration," "intellectual stimulation," "inspirational motivation" and "idealized influence" to influence and motivate others from a distance.1

According to Bass and Avolio, transformational leadership is seen when leaders:


  • Stimulate interest among colleagues and followers to view their work from new perspectives
  • Generate awareness of the mission or vision of the team and organization
  • Develop colleagues and followers to higher levels of ability and potential
  • Motivate colleagues and followers to look beyond their own interests toward those that will benefit the group.


"Idealized influence" is defined as having transformational leaders who behave in ways that result in their being role models for their followers. These leaders are admired, respected and trusted. Followers identify with the leaders and want to emulate them. One of the things leaders do to earn this credit is consider the needs of others over their own personal needs. Leaders share risks with followers and are consistent rather than arbitrary. They can be counted on to do the right thing, demonstrating high standards of ethical and moral conduct, and avoid using power for personal gain.1

According to Daft, female leaders were rated as having more idealized influence, provide more inspirational motivation, are more individually considerate and offer more intellectual stimulation.2 Idealized influence means that followers identify with and want to emulate the leader who is trusted and respected, maintains high standards, and is considered to have power because of who she is rather than what position she holds.

A fair amount of research has been conducted in support of transformational leadership, including idealized influence, in regard to medicine. The following example studies emphasize the application of "idealized influence" as a major factor of transformational leadership.

A research study conducted by McGuire and Kennerly in 2006 surveyed nurse managers and staff nurses from 21 not-for-profit hospitals in the Midwest region of the United States. Results showed that nurse managers rated themselves higher than staff nurses regarding their application of idealized influence and identified the positive outcome and job satisfaction from this transformational leadership factor.3

Interviews conducted by Moe, Pappas and Murray in 2007 on healthcare staff at the King Hussein Cancer Center (KHCC) concluded that idealized influence, as part of the transformational leadership model, had a significant impact upon the positive attitudes and motivation of staff within KHCC. Idealized influence was highly recommended as a leadership methodology to be applied in globalized healthcare environments.4

A research study conducted by Olsen, Eid and Johnsen in 2006 of 172 Norwegian naval officer cadets concluded that post-conventional moral reasoning and moral identity were positively correlated with transformational leadership, especially in the application of idealized influence. The research data further indicated that individual differences in moral reasoning and moral identity significantly affect leadership behavior and may have implications for training and selection of leadership potential staff.5

In an article in Nursing Economic$ in 2007, author J. M. Bally recommended that the transformational leadership model, including idealized influence, be emphasized in nursing leadership environments.6 Bally said that to enable nursing staff to achieve the organization’s goals regarding mentoring, all nurses should commit to role-modeling these goals and values in all endeavors so they can share experiences, best practices and encourage mentoring excellence.

In a 2006 research study conducted by Chen and Baron on 175 Taiwan nursing leaders, idealized influence was indicated as instrumental in ensuring nursing followers and their leaders were moderately satisfied with their jobs, and attributed the practice of idealized influence as having a positive effect on organizational leadership style.7

Transformational leadership with emphasis on "idealized influence" is a model of leadership that, when applied, will lead to successful healthcare teams and organizations in local as well as globalized operational environments. This in turn will lead to high-quality and responsive healthcare being provided, which benefits patient and organization, as well as other supportive and protective organizations and the community.


1. Bass BM, Avolio BJ. Improving Organizational Effectiveness Through Transformation Leadership. Thousands Oaks, CA: Sage Publications, 1994.

2. Daft RL. The Leadership Experience. Canada: Thomson Southwestern, 2005.

3. McGuire E, Kennerly SM. Nurse managers as transformational and transactional leaders. Nursing Economic$ 24(4):179-185, 2006.

4. Moe JL, Pappas G, Murray M. Transformational leadership, transnational culture and political competence in globalizing health care services: A case study of Jordan's King Hussein Cancer Center. Globalization and Health 11(3):1-14, 2007.

5. Olsen OK, Eid J, Johnsen BH. Moral behavior and transformational leadership in Norwegian naval cadets. Military Psychology 18 (Suppl.), S37-S56, 2000.

6. Bally JMG. A short course in leadership skills for the rehabilitation team. Nursing Economic$ 25(3):143-149, 2007.

7. Chen HC, Baron M. Nursing director's leadership styles and faculty members' job satisfaction in Taiwan. The Journal of Nursing Education 45(10):404-411, 2006.

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.


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