The EMS Executive's 7 Keys for Success

The EMS Executive's 7 Keys for Success

This article is the final in a series of three focusing on common pitfalls that may trip up EMS leaders. In keeping with the National EMS Management Association’s officer competencies, lessons have been divided into those for supervisors, managers and executives. Find Part 1, for supervisors, at; find Part 2, for managers, at

Organizations live and all too frequently die on the strength of their leadership. There are countless examples of this in sports, where good teams with solid contributors but no all-stars regularly win championships and others loaded with superstars somehow fall short. The difference between these teams is leadership, both at the coach/manager level and in the locker room. 

What that means for you is that not every true leader holds a position of authority. While you might be tempted to skip this installment because you are not an executive-level officer right now and perhaps don’t see that in your immediate future, consider that these techniques can apply to all leaders. In fact, the secret of this series is that all these tips apply to everyone, no matter your rank or position.

1. Respect People’s Time

It’s easy to be the boss in many respects. Your opinion carries a lot of weight, and people typically alter their workflow and structure to meet your needs, not the other way around. Given these facts, it’s not hard to start to think in those terms. People will make their schedules fit your time, so you can more often demand that meetings, calls and other activities be convenient to your calendar. To a point this should happen, but be mindful of how you can inadvertently alter other employees’ lives.

Perhaps you like to work late, so you frequently send e-mails after hours. Consider that your employees may feel obligated, especially in today’s connected workplace, to respond to you immediately. Or perhaps you like to have a morning huddle, but the most convenient time for the meeting is very early.

That can be difficult for some people, especially considering their other job responsibilities or family obligations. Whenever possible, consider their schedule before you drop an invite on someone. It (usually) only takes a moment to check but demonstrates enormous respect for the people you work with.

The servant-leader leads by example and works in ways that enable the team to be more productive. Simple time-management considerations, such as making a meeting mandatory vs. optional for certain people or having a meaningful meeting subject, can have an enormous impact on how effective your team actually is.

2. Commit Hard

It’s tempting to change direction at the slightest provocation. A progressive leader will frequently be asked to make hard choices, innovate new programs and try new ideas. Do your best to make these decisions well—get stakeholder input, have committees for development, pilot your programs, do your research, and have solid implementation processes. 

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Of course, when you do new things, changes can upset the status quo, and therefore certain people. Some will rebel against changes for those reasons, or because they disagree with your goals, or they will turn negative if you do not achieve your goals quickly enough. Some people will take these opportunities simply to test you.

Do not allow yourself to be blown with the prevailing winds—course corrections are essential, but they typically do not involve dramatic changes in direction. If you do your homework in the beginning and have a high-performing team to support you in the end, you will have more success in implementation if you commit hard and demonstrate solid support for new endeavors.

3. Admit When You’re Wrong

Sometimes you’re going to screw up. As much as clinicians at all levels make mistakes, so do leaders. And, as with clinical errors, you have to admit your leadership errors, at least to yourself and your team, and then learn from them. This sounds easy, but it may be one of the hardest things a leader does.

The worst thing a clinical provider can be called is a “bad medic” or the equivalent. We strive for perfection, even knowing it’s not achievable, for many reasons, but one of the most profound is that we do not want to seem incompetent or weak. As a result, clinicians and leaders alike often hide or deflect their mistakes.

The opposite is actually true: It is the mark of the strongest, most confident leaders that they admit their mistakes publicly. Again, like clinical mistakes, you try not to make the same mistake twice and try not to make a bunch of mistakes at the same time. But think about whom you respect more: the person who admits their error, takes responsibility for it, and strives to improve on it, or the person who blames others, makes excuses, and never gets any better? The answer is obvious.

4. Encourage Dissent

One of the most dangerous cultural traits in an organization is leaders who demand obedience. When Lt. Gen. Michael Flynn took over in 2012 as head of the Defense Intelligence Agency, the New York Times reported, he said “the first thing everyone needed to know was that he was always right. His staff would know they were right, he said, when their views melded to his.”1 This philosophy marred his tenure and ultimately contributed to his departure. 

You should instead encourage—in fact, demand—dissent from other leaders. If they think you’re wrong, they should have a place and time to tell you, and you should ensure there’s never reprisal, either tangible or implied, for speaking up. You will make better decisions, anticipate and resolve problems proactively, and elicit better overall teamwork when your leadership team members know they can tell you if they think you’re wrong.

That’s not to say dissent should be without limits. It must be behind closed doors and respectful. It should be based on facts and opinions about the issue, not animus or bias. And when the final decision is reached, hopefully by consensus, that absolutely must be the final word. The dissenters have to know they can have their say, but once the decision is made, they cannot allow that dissenting opinion to undermine the final course of action. When the door opens, the entire leadership team must carry the same message.

This is an important point about the organizational culture that you create, and it rests completely on trust. (Yes, this is a common thread in these articles.) Once again, you cannot immediately demand trust, but you can immediately destroy it. Your staff will only feel comfortable giving you their honest opinions when they fully trust you.

5. Have a Vision

We’ve all worked for organizations that felt like big cruise ships, steaming away in the ocean with nobody at the helm. The engines keep running, people keep having fun, but there is no direction. And worse, nobody seems to be keeping a lookout for that iceberg right ahead.

Effective managers have several critical traits—among them integrity, competency, consistency and communication skills. The effective leader includes vision in this list. You can be damn good at keeping the ship afloat and operating, but the defining factor between management and leadership is knowing where you’re going, making sure nothing gets in the way, and most important, ensuring every crew member knows the destination.

Organizations all stand for something. If you think about it, most EMS agencies specialize, or focus on something. As the leader of that agency, perhaps your focus is clinical, pushing the envelope with the medicine provided. Or perhaps your focus is on special operations and related activities. Maybe you demonstrate high-performance EMS at its finest or are looking at community-based needs and mobile healthcare.

While all organizations should strive to excel in all areas, you know your department is “known” for something. This also goes for individuals, who typically have areas they specialize in. That’s vision, and the most successful organizations and individuals have one they clearly communicate.

6. Get Out of Your Tower

Ivory tower syndrome is a cliché, but it’s a cliché for a reason. Organizational leaders have a lot of responsibility and in fact may work lots of overtime. It’s hard to get out and about when you’re on call 24/7, working from the moment you wake up until you go to sleep, and the responsibility of work impinges constantly on your personal and family life.

With all those pressures, something has to give, and often it’s the part where you get out of your office. Or perhaps your open-door policy has been sacrificed to the pressures of getting work done without interruption. Try with all your might to resist these pressures. Do not isolate yourself from the daily activities of the department, including the people. Get out and see what’s going on in the system, keep your door open and be welcoming to people who want to come in. When someone wants to talk to you, even briefly, make that time, even if it involves going to where that person is, rather than making them come to you. And if someone wants to talk and you don’t have time, there’s nothing wrong with deferring that meeting to the future, as long as you’re certain to follow up.

This is how you build trust, which is the currency of leadership. With trust, your employees will come to you with issues, concerns, problems and thoughts. They will give you solutions you never thought of and allow you to address little things before they become big things.

Today’s connected workplace allows us to communicate electronically by text and e-mail so easily that we forget the value of a face-to-face meeting or hearing someone’s voice on the phone. To be a successful leader, you must work tirelessly at this.

7. Never Stop Learning

Finally, given all these time pressures, it’s easy to grow stagnant. Once you’re the big fish in your pond, it is common to cruise around, eat the little fish, and not worry about anything else swimming. When you reach the pinnacle, you can stop pushing yourself as hard.

If you don’t keep growing, you start dying. Personally and professionally, always be looking for ways to better yourself. Learn about things that you’ve never heard of. Stay current in cutting-edge clinical practice even if you’re no longer providing care. Continue your professional growth by remaining at the top of your game and looking past your horizon at other areas and places for potential mastery. This is what leadership expert Stephen Covey calls “sharpening the saw.”

One of the best ways to ensure your continued professional growth, and that you don’t grow fat and lazy in your pond, is to network hard. Surround yourself with exceptional people, learn from them, share with them, help them when you can, and accept their help in return. Be choosy about whom you network with, as not everyone is worthy of your time and effort, and some people will trade on your reputation or do things that negatively impact you by association. You’re only as good as the people who trust you.


Finally, remember that your mouth is a potent weapon. Depending on where it’s aimed, it might do a great deal of good or be very destructive. When poorly aimed, your mouth can often cause the greatest damage to yourself.

Stop for a moment and think before you speak. The adage “only talk when it improves the silence” is famous for a reason. Another version of this is “better to keep your mouth shut and be thought a fool than to open it and remove all doubt.”

Hopefully you now have a series of concrete leadership points that can help guide your career, staff and organization. May you be successful in your endeavors.  


1. Rosenberg M, Mazzetti M, Schmitt E. In Trump’s Security Pick, Michael Flynn, ‘Sharp Elbows’ and No Dissent. New York Times, Dec. 3, 2016. Accessed via 

Matthew R. Streger, Esq., is a member of the EMS World editorial advisory board and a member of the law firm Keavney & Streger in Princeton, N.J. He has over 30 years of experience in EMS in a wide variety of roles and locations.

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