Responding to a critical call on a foggy night used to make me crazy. You couldn’t see the edges of the road, never mind 20 feet ahead. It was disorienting. We knew we needed to get there; we just weren’t sure how.
The pace of change that emergency service organizations are experiencing today is like driving a 4-ton ambulance down a murky rural highway with the accelerator stuck wide-open. When an agency’s processes are not fully transparent, it can be as disorienting to caregivers and customers as driving in a dense fog.
Organizational agility is about managing opportunities (taking the shortest route to the destination) and mitigating risk (not running off the road and crashing) in the midst of change. There are four key aspects to becoming more agile: awareness and alertness to changing dynamics; the ability to lead change; the processes the organization implements to accomplish the work; and, last but not least, the creation of an organizational culture that supports and reinforces agility.
Now let’s take a look at creating a culture of openness and transparency through the prisms of the four dimensions of organizational agility.
Awareness and alertness
Many organizations fall to the bottom of the coma scale when it comes to being alert about why process transparency is important. In a word, it’s about trust. When organizations fail to make processes transparent, caregivers write their own script about the organization’s intent. At best it’s rarely accurate; at worst, staff can be downright disingenuous in reacting to situations when what they are told doesn’t match what they see. Agile agencies are hyper-alert to making sure process transparency shows organizational intent through the actions of its leaders and members.
Leadership orientation
Some leaders mistakenly believe they don’t have to be either transparent or accountable. A director I know recently told caregivers that despite his best efforts, funds for new stretchers weren’t approved and would be delayed until the next budget year. In the midst of the staff meeting, an EMT pulled up the city council’s finance committee minutes documenting that the stretcher replacement request had been approved and that the replacement of the director’s vehicle had been approved but not funded. The director subsequently admitted that he’d used his discretionary authority to reprioritize items and purchase his new vehicle, thinking the caregivers would never know.
In this case, the committee’s processes were more transparent than the director had anticipated. His credibility was destroyed, and he abruptly retired. Agile leaders work hard to be fully transparent and honest in word and deed.
High-value processes and structures
There is a saying among consultants that things that are objectively measured and reported get improved. And those things that get publicly reported get improved more quickly. This can be applied to a wide variety of emergency service processes. Leadership processes including human communication, clinical improvement, operations/deployment, technology and information systems, human resources and financial processes can be problematic if not transparent. When caregivers don’t understand why a process exists or how important it is, or if it does not appear to be consistently applied, then that process becomes opaque.
A great example is the annual “evaluation,” or the process of performance appraisal. In fragile organizations, this process is shrouded behind “HR mumbo-jumbo.” Most caregivers don’t understand how they are rated; what parts of the appraisal are subjective vs. objective, if it is objective; and, most important, why their co-worker got a bigger raise than they did. The lack of transparency behind appraisal processes is a trustbuster and can be a strong de-motivator.
CAD and ePCR systems are another example. They are obscure and hard to change, and the use of programming languages—code—to specify how they work makes them hard to understand to any but the most technically adept. Agile EMS organizations engage people at multiple levels to develop a broad understanding of what the systems do, how the processes work, and how they help both the caregiver and the agency do the job more effectively. While these systems may still be somewhat difficult, engagement helps clear the fog.
Development of a performance-based culture
For agile agencies, performance-based culture is a reflection of the organization’s values, which influence all actions and every decision associated with the execution of strategies and tactics at every level of the organization.
On a recent client project, I asked a mid-tenure medic, “What works well here?” She responded, “People care about their patients, and they do whatever it takes to serve them well.” My next question was, “So what needs attention or could be better?” Her response: “What you see is never what you get when it comes to our organization. Everything is secretive.”
It didn’t take a lot of probing for the floodgates to open. She said that frustration levels were high because no one really knew what was going on. “We know things are changing,” she said, “but we don’t know what’s expected.” This is a clear example of a fragile culture. Openness needs to be a cultural cornerstone in a truly agile organization.
Increasing transparency makes it easier to see how something actually works, which makes it easier to change how it works when needed. A faster response to a needed change improves overall organizational agility.
To sum up, make your processes more transparent and your culture more open and less secretive. Lift the fog of mistrust so leadership and caregivers can see both the edges of the road and a positive outcome—the destination—more clearly.
