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EMS Leadership Part 3: Intellectual Stimulation Transformational Leadership in EMS

This is the third in a series of columns on EMS leadership. Each month, 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.

Jerry Newman, EMS director for Bronco County, had just reviewed the county's response times for the last three months. There was definitely a problem that needed to be resolved, especially during the night shift. It was taking almost two minutes to respond to the initial dispatch and an additional five minutes for the ambulance team to get on the road. In a rural area, seven minutes was far too much time when most calls took on average 15 to 30 minutes to reach the patient from the station. Jerry called a problem-solving meeting for all ambulance crews.

Jerry started the meeting saying, "Folks, we need to improve our response time to dispatch calls, and I need your help. Let's put our heads together and come up with some ideas. Don't be afraid to provide any ideas you believe we should consider. We want you to identify innovative and creative ideas, which we will list, review and prioritize as a team. Many of you are proven critical thinkers in a crisis situation, and I definitely need you to apply your critical thought process to provide solutions to the problem we are here to solve."

The group came up with over a dozen ideas, which were reviewed and prioritized as a team. Everyone participated and no one was criticized for their ideas, even those Jerry was a little uncomfortable with because they went against established operational procedures. By prioritizing the ideas, there was buy-in by everyone at the meeting. All members of the brainstorming team agreed that the top three should be applied immediately and reviewed again in two weeks to see if they improved the overall dispatch response time.

Two weeks later the results showed that dispatch response time was down to three minutes from seven, and everyone agreed that there was still room for further improvement. All team members thanked Jerry for allowing them to participate and said they were proud of their results and looked forward to more problem-solving gatherings.

This is an example of "intellectual stimulation" leadership, which is part of the full-range or transformational/transactional leadership model espoused by Bass, Burns and Avolio beginning in 1978. The full-range leadership model includes eight factors. Transformational leaders, regardless of their organizational position, can use individualized consideration, intellectual stimulation, inspirational motivation and idealized influence to influence others from a distance.1 The transactional leadership aspect of the full-range model includes contingent reward, management-by-exception (active), management-by exception (passive) and laissez-faire, which relates to an individual who is not a leader in any way. All factors of the full-range model will be addressed in subsequent articles.

The viewpoint of leadership researchers is that indirect leadership is not confined to the realm of highly visible leaders. The belief is that leaders at all levels can influence the development and effectiveness of everyone within an organization regardless of whether they are in a formal leadership position.

Intellectual stimulation is defined as having a leader who encourages innovation and creativity, as well as critical thinking and problem-solving. Intellectual stimulation involves arousing followers' thoughts and imagination, as well as stimulating their ability to identify and solve problems creatively.2 According to Richard L. Daft, "people admire leaders who awaken their curiosity, challenge them to think and learn, and encourage openness to new, inspiring ideas and alternatives."3 These ingredients are essential to ensure team and organizational success.

A fair amount of research has been conducted in support of transformational leadership in the field of medicine, including intellectual stimulation. The following studies emphasize the application of "intellectual stimulation" in 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 intellectual stimulation and identified the positive outcome from this transformational leadership factor.4

Another example is Vandenberghe, Stordeur and D'hoore in 2002, who surveyed 2,617 nurses from 17 hospitals in Belgium. Results related that transformational leadership including the application of intellectual stimulation ensured followers putting in extra effort, showing satisfaction with their leader and overall job satisfaction, emphasizing goal attainment and supporting positive staff retention.5

Still another research initiative conducted by Hetland and Sandal in 2003 regarding 177 subordinates and superiors of mid-level Norwegian managers in five different healthcare organizations showed a positive correlation in their application of the intellectual stimulation factor, which was defined as where a leader articulates new ideas that prompt followers to rethink conventional practice and thinking.6

Finally, a study conducted by Ohman in 2000 of 125 nurses who are critical care managers in Minnesota showed a positive correlation regarding application of intellectual stimulation, which was defined as a leader who challenges staff to think in new ways and emphasizes problem-solving and use of reasoning before taking action.7

Transformational leaders intellectually stimulate their followers' efforts to be innovative and creative by questioning assumptions, reframing problems and approaching old situations in new ways. Additionally, creativity is encouraged and there is no public criticism of individuals' making mistakes. New ideas and creative problem solutions are solicited from followers who are included in the process of addressing problems and finding solutions. Finally, followers are encouraged to try new approaches, and their ideas are not criticized when they differ from their leaders' ideas.1

Transformational leadership with emphasis on intellectual stimulation is a model of leadership that, when applied, will lead to successful healthcare teams and organizations. This in turn will lead to provision of high-quality and responsive healthcare that benefits not only the patient, but also the organization and other supportive and protective organizations and the community.


1. Bass B M, Avolio,B J. Improving Organizational Effectiveness Through Transformation Leadership. Thousands Oaks, CA: Sage Publications, 1994.

2. Bass BM. Leadership and Performance Beyond Expectations. New York: The Free Press, 1985.

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

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

5. Vandenberghe C, Stordeur S, D'hoore W. Transactional and transformation leadership in nursing: Structural validity and substantive relationships. European Journal of Psychological Assessment 18(1):16-29, 2002.

6. Hetland J, Sandal GM. Transformational leadership in Norway: Outcomes and personality correlates. European Journal of Work and Organizational Psychology 12(2):147-170, 2003.

7. Ohman KA. Critical care managers change views, change lives. Nursing Management 31(9):32B-32E, 2000.

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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