The first week of January I was in Phoenix for the annual gathering of the National Association of EMS Physicians, always a rewarding meeting. While there, I got a chance to catch up with Troy Hagen, director of Ada County (Idaho) Paramedics, a member of the National EMS Advisory Council Finance Committee and a National EMS Management Association board member.
Troy told me about ambitious efforts in Idaho to reform EMS governance, inspired by the Institute of Medicine’s 2006 groundbreaking report “Emergency Medical Services at the Crossroads.” A key to fixing EMS, the report noted, was a more regional and systems approach. Ever since, leaders in Idaho have been trying to set up regional EMS authorities, in which individual entities (cities, fire districts, hospitals, ambulance authorities, counties) all have to give up something they value (usually control) for the greater good (ultimately providing better patient care, consistently).
Without this kind of structure, Troy said, the various EMS stakeholder entities in Idaho are set up for conflict and dysfunction, caused by overlapping jurisdictions, ambiguous and out-of-date statutes, inconsistent medical direction and inevitable funding disputes. Does this sound familiar?
“Voluntary collaboration hasn’t worked,” he said. “A structure like this forces collaboration.”
Cooperation and coordination vs. true collaboration
With the events of 9-11, everyone seemed to agree that better collaboration, however you accomplish it, is critical to improving EMS and public health, but what does that really mean? David Chrislip, co-author of the book Collaborative Leadership and a prominent expert on the subject, writes:
Collaboration is more than simply sharing knowledge and information (communication) and more than a relationship that helps each party achieve its own goals (cooperation and coordination). The purpose of collaboration is to create a shared vision and joint strategies to address concerns that go beyond the purview of any particular party.
Sherry Penny, Ph.D., director of the Center for Collaborative Leadership at the University of Massachusetts, once told me, “Collaboration is hard work. It is a process and a discipline.” It’s difficult, she said, to bring groups together and ask them to give up something for the good of their community—power, resources, territory or budget.
Russ Linden, a respected consultant, educator and writer, describes collaborative leadership as the art of pulling people together from different units or organizations to accomplish a task that none of them could accomplish—at all or as well—individually. “It’s an unusual person,” writes Linden, “who can get and keep the parties working well together, move the ball down the field and tend to the relationships involved as well as the business needs of the partner groups.”
After 9-11, we thought the concept of collaboration would be easier to sell—under those circumstances, what choice did we have? But that goal has proved elusive. We’ve heard that Idaho is at its own crossroads when it comes to regionalization and reform. Here’s hoping collaboration—forced or not—wins out.
Keith Griffiths can be reached at publisher@emergencybestpractices.com.
