EMS leadership is a “thing” now. It was not a stand-alone topic 20 years ago. EMS agencies had bosses, but the field was too young to say whether they had any definitive practices. When I was growing up in EMS, you could take classes on car accidents (it was MVA, not MVC) but to “learn” how to manage people was left to Wall Street. Today EMS management is not just a title or classification, but a vital component to an organization’s success.
As we mature as a profession, it is important to recognize that often a bad boss can impact the performance of an entire department and the individual providers. They will take that impact with them elsewhere, and much like our good old friend Ebola it becomes viral, inserting negativity or poor performance wherever it goes and forcing other EMS managers to combat it at the ground level before it can be allowed to spread.
Over the course of a few months, I polled people from a variety of EMS delivery systems: fire-based, hospital, municipal, volunteer and even military. Providers were asked to share their views of leadership from a line perspective. Similar themes immediately surfaced. Considering how much support is offered to newly emerging managers and those looking to improve, it is a valid topic and one worth visiting.
Whether you are creating and meeting benchmarks on paper or implementing operational change on any scale, the perspective of the employee is important and directly impacts agency performance.
You may think you are doing a good job as an EMS manager, but how do you know? At the end of the day, how is the line viewing your actions? Are you making an impact? If so, is it positive or negative? Review the following list and ask yourself: Am I guilty of any of these—even if only in appearance?
1. Lack of Communication
The simplest definition of communication is a reciprocal relationship in which a message is sent and received. That relationship starts with an ability to speak with your staff. Until a relationship is established, trust cannot exist. Do you invest time meeting with your staff? Do you speak to them, even casually? Do you know their names?
Rules should be applied in equal measure. Expectations should be clear, and reinforcement (both positive and negative) should be offered fairly. To have rules that only get invoked only when a sentinel event occurs or when a particular employee is involved is obvious to the staff and detrimental to morale and trust.
When a problem or any other item requiring a decision is brought to your attention, do you address it in a timely manner with appropriate feedback? When a department requires an incident report from staff with no mechanism in place for feedback, it is then easy to conclude that in most instances nothing will be done. Do you respond to emails and other communications with definitive answers? Do you provide follow-up to staff you meet with? Failure to follow through sends a message that the issues are unimportant or the easiest process is to simply wait. When enough time passes, most issues fall to the wayside in order to make room for new ones. Eventually the staff will stop bringing them to your attention.
It’s EMS, not missile launch codes. When everyday business is conducted behind a series of closed doors, hushed voices and secret-squirrel code-speak, of course the staff is going to mistrust you. Allow your staff to see how business is conducted. Does it align with the mission statement and goals of the department? Is it consistent? Will it inspire those looking ahead to moving to management to learn more about the inner workings of the department?
5. Chain of Command
When all roads lead to one manager, the operations of a division eventually bottleneck into an unmanageable workload. Span of control is a basic concept right out of Chapter 1 of the ICS book. Are you micromanaging? If you delegate, do you provide feedback and regular follow-up? If your subordinates responsible for supporting the rules of the organization fail to do so, do you address it and/or demonstrate what your expectations of them are?
There are accepted practices where good employees are rewarded. Just because you do not know an employee, however, does not mean they are not worth the same consideration. When you treat individuals markedly different, it is not only noticeable, but sends negative messages through the department, impacting morale and work relationships.
7. Constructive Criticism
Cut and paste employee evaluations are a waste of time and calories. It is possible to correct an employee in a manner that will not always be equated with discipline. If a staff member is not meeting expectations, then they need to be told that. First, they need to know what those expectations are, and then they should be given a measure by which to improve. Marking everyone satisfactory across the board just for showing up tells the staff that it does not matter if they do well.
Do you know what a career in EMS will get most people (besides a bad back)? A built-in lie detector. Everyone from patients to families to bystanders to managers lies to us. Don’t fib to your staff. They know it when you do. Once you do, then as far as they’re concerned you always do.
Are too many man hours being lost each week to investigations? Is there no mechanism in place to investigate incidents? Are operations impacted by reactionary enforcement of policies in response to an issue? When you make no investment into prevention, then you will spend all your time putting out fires.
10. Lack of Vision
What are the core values of your organization? Do your overall operations support the mission statement and demonstrate support for the vision of your department? What are the long term goals and future performance measures that you seek to obtain? Is all of this clearly communicated with your staff? If not, then how can you expect them to get behind it?
A good EMS organization is a dynamic, living thing. The very nature of the people who do the work make them both at times impossible to manage and awesome to work with. When you are dealing with a vibrant mosaic of acutely intelligent people who rely on their ability to assess information and make critical decisions every day, to keep them in the dark and treat them like children impacts morale and will hurt the level of operational performance of which a department is capable. A good EMS manager is more than a boss, they should be both shepherd and mentor.
It is easy to lose that reciprocal relationship with your staff when you are buried in the administrative aspects of keeping a department afloat. However, without good personnel none of it really matters anyway. Talk to your staff, open your door and see how your investment will improve theirs.