EMS management: Moving responsibility upward
Many management systems that perceive a lack of discipline in their field crews are actually missing a lack of effective leadership
By Kelly Grayson
The beatings will continue until morale improves. -Anonymous Middle Manager
A few weeks ago, a Confessions of an EMS Newbie podcast listener asked my opinion of EMS agencies that adopt a rigid, quasi-military rank structure and chain of command.
My first instinct was to answer that such hierarchies are rather silly and a poor fit for EMS. But rather than spout an uninformed opinion based on secondhand knowledge, I did what any good instructor would do when a student stumps him with a question for which there is no easy answer — I consulted my sources.
I know a number of law enforcement and military officers who also serve as civilian EMTs, and I know a number of EMTs who served in the armed forces. To these men and women, I posed these questions: "Given your military experience, are quasi-military command hierarchies a good fit for EMS, and do such rank structures encourage or discourage personal initiative in the rank-and-file medics?"
Their answer was an emphatic and unequivocal, "It depends."
No, they weren't waffling. Cops and soldiers are nothing if not direct. Almost all of them thought the military style rank structure would be a good fit for EMS… if it is implemented fully.
That's a pretty big "if."
The problem with many of these systems is that they implement such rank structures because of a perceived lack of discipline in their field crews, when what is actually missing is a lack of effective leadership. What they wind up with is all of the drawbacks of the military rank structure and none of its benefits, because they lack the one element that makes such hierarchies work — responsibility upward.
As one former EMT and current law enforcement officer was told when he was commissioned as an Army lieutenant, "Rank hath its privileges, rank hath its responsibilities, and rank hath its obligations. The responsibilities and obligations always outnumber the privileges."
Too many supervisors forget that.
As one source put it, "Responsibility upward is what makes the rank system work. Without it, your troops may be obedient, but they'll never be motivated."
People are more easily led than driven. - David Harold Fink
Whether your agency adopts a laissez faire management style or a more rigid command hierarchy, neither one will succeed without effective leadership. One of the basic tenets of leadership is never order a subordinate to do something that you are not capable — and willing — to do yourself. If you aren't, believe me, your subordinates will know it.
More importantly, their performance will reflect it.
A leader is more than a supervisor. He's a coach, a mentor, a teacher, a disciplinarian, and an advocate for his subordinates. He sets clear goals, gives his subordinates the tools to accomplish those goals, and then he gets the heck out of the way. So much of leadership is simply making it easier for your subordinates to do the right thing than the wrong thing.
When those subordinates make mistakes — and they invariably will, because improvisation is the name of the game in EMS — the leader also reevaluates his mentoring, coaching, and teaching, and modifies his approach accordingly.
And if that approach was flawed, he practices responsibility upward by telling his superiors, "It's my fault, and my responsibility. I'll fix it."
Believe me, just as your subordinates know when you can't walk the walk, they'll also notice when you take the heat for their mistakes, and they'll bend over backwards to never put you in that position again. Their performance improves right along with their morale. They know you've got their backs, and as a result, they'll have yours.
They'll make you look good to your superiors, who in turn will look better to their superiors…
That's responsibility upward, folks.
A few weeks ago, my partner got lost on the way to a call. Through a confluence of factors, it took us a lot longer to reach the scene than it should have. Compounding the mistake, she relied on the proximity feature on our automatic vehicle locators to mark us at scene. It didn't, making an excessively long response time look even longer on paper. To make matters worse, she left the portable radio in the rig, and thus never noticed dispatch frantically trying to reach us.
And most of that was my fault.
Yes, she was driving. Yes, she was unfamiliar with the streets in her service area, and made a wrong turn. Yes, she continued on that wrong turn far longer than she should have, mistakenly relying on the turn-by-turn directions from our GPS navigator rather than the cross streets in the call notes. Yes, it was her responsibility to carry the portable radio.
But she was also a rookie, and still naïve enough to think that the technology always works like it should. There were half a dozen things I could have done to better familiarize her with the streets, none of which I did. And it's not like I didn't carry that portable radio quite a bit myself. She was still new enough that she looked to me for guidance on just about everything. Whatever the reason, on this call, that guidance was flawed and ambiguous.
I said as much to my supervisor as I signed the disciplinary form. "It's my fault, my responsibility. I'll fix it." There's no reason to spank the rookie and quell her initiative when the senior medic could have prevented the mistake.
That's a lesson I learned from some good supervisors early in my career, people who lead by practicing responsibility upward. I try to follow their example.