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Factors that impact your EMS future

An agile organization is alert to internal and external factors, opportunities and challenges

This is part one of a monthly series of articles looking at building organization agility in fire and EMS agencies. Building an agile organization allows leaders to be alert to both internal and external factors, opportunities and challenges, and to focus on the future rather than the past.

Have you ever wondered why some emergency services agencies glide through uncertainty and major change while others crash and burn? It’s an important question given what lies ahead.

One Midwestern EMS organization we work with continually seeks to improve its service capabilities; leadership wants to understand what’s coming, to be ready for the next wave of change. They proactively work with their internal caregivers, other public safety colleagues, local elected officials and their base hospital leadership.

They are widely respected and known for clinical and operational innovation. This organization and its people are growing, but it hasn’t always been that way. Leadership made a conscious decision to develop from almost being reactive (some would say comatose) as an organization to being fully alert, proactive and setting the pace for others.

This organization is agile. Contrast their results with another department just 30 minutes away that is struggling to escape its past, let
alone prepare for the future. Managers there feel victimized as service demand has soared without a corresponding increase in tax base. In short, they’ve paid lip service to change but now seem to be struggling mightily. Relationships internally and externally have soured and are frustrating for all concerned. They are not meeting response times, and trust levels are low. There is little energy or capacity to prepare for the healthcare changes ahead. This organization is fragile.

Origins of the concept
Let’s step back and look at the origins of the organizational agility concept. Initially coined in a flexible manufacturing context, it emerged as a business model as “Lean,” “Six Sigma” and other improvement processes were implemented in manufacturing, service industries and, more recently, healthcare.

An analogy may be helpful in understanding how agility works. Automobile racing, from the Indy 500 to NASCAR, is a fast-paced sport filled with uncertainty. The environment in which emergency services leaders find themselves today may be likened to the chaos that can occur during a car race. If one fails to pay attention and make the right moves, it’s highly likely you’ll hit the wall and lose any chance of seeing the checkered flag.

Whether you follow racing or not, what’s been consistent over the 125-year history of the sport is that successful drivers spot a fleeting opportunity and take advantage before the moment passes. Similarly, agile organizations consistently identify and capture opportunities more quickly than their rivals. In racing, just as in emergency services, technology and the pace of the race continue to
increase exponentially. And while the driver — the leader — is critical, it takes an entire crew, all working together, to be successful.

Researchers from diverse disciplines approach organizational agility from a variety of perspectives. Most agree that when organizations are not agile, they become “fragile” or less effective. Taken to the extreme, agencies become susceptible to factors that slow them down or can even be career-ending for their leaders. The illustration on page 2 shows a variety of factors that impact an organization’s agility. Each can be analyzed along four dimensions: awareness and alertness; leadership orientation; high-value processes and structures; and development of a performance-based culture. In this series, we will look at each factor, evaluating its effect on agility, through the prism of the four dimensions.

Dimension 1: Awareness and alertness
Like the first organization described earlier, leaders in agile organizations are constantly aware of, and alert to,
their future while others dwell on the past. But being agile means more than simply being aware. In emergency services, we are aware that reimbursement and system designs will change to match the dynamics of healthcare reform, but members of an agile organization are alert and thinking ahead about how to capitalize on those events.

Questions to consider when evaluating how well you score in this dimension include the following:

  • How alert is our organization?
  • Do we have the strategic foresight to see what the
  • next five years will bring, or are we still looking in the
  • rearview mirror?
  • How well prepared are we to deal with the full spectrum
  • of those changes?

The difference between aware and alert can be subtle but is important.

Dimension 2: Leadership orientation
Have you ever been around someone who, at every point in the conversation, drifts back to something that happened years ago? The conversation usually begins: “When I was a medic, we had those same problems, but ... ” I usually can’t wait to get away from these time travelers — they drain my energy. Future orientation about the change and the complexities we must master is a core element of leadership agility. Look in the mirror. If you are constantly telling stories about the past rather than talking about a preferred future, you could be a time-traveling leader.

Dimension 3: High-value processes and structures
Are your systems and processes the result of history and inertia? You may be using the latest ePCR, but if your improvement activities are focused on finding errors rather than building caregivers’ competency, capabilities and compassion, then your processes are not supporting agility. In a current example playing out as I write this, the Los Angeles Times is reporting daily on that city’s fire department response-time problems, highlighting fragile systems and processes. If your agency’s deployment and staffing approach is centered on strategies that have not been re-evaluated and modeled, or the validity of your data has not been tested in the past 24 months, you may be slipping from agile to fragile.

Dimension 4: Development of a performance-based culture
Tradition-bound organizations present performance and accountability as a strategy. These leaders have performance-driven culture in their heads or on their lips, but not necessarily in their hearts. Agile, future-oriented departments and agencies live a performance-based culture in which everyone from the CEO or chief to the logistics support team comprehends what performance and accountability actually mean in terms of philosophy, processes and tactics. It is part of the organization’s DNA, and it becomes inherent within every employee.

When working with a client in the eastern U.S. to develop a performance-based culture, we began by creating a compelling vision that included high levels of participation, empowerment and teamwork. Senior leadership understood that collaboration, decisiveness and candid, constructive conversation had to become the norm. In the months that followed, leaders had to live the vision and celebrate the little wins to build confidence. Different shifts became laboratories to create this type of culture, and shift leaders worked to promote and encourage this culture for the crews they led. With this approach, leaders not only coach their people, but they also actively solicit informal feedback and work to change their behavior
in ways that are beneficial to the organization and themselves.

When it comes to being agile, culture beats strategy every time. Leaders of traditional organizations often describe achieving performance goals or ensuring staff accountability as a game-winning strategy. For agile agencies, performance-based culture is more 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.

To recap, an agile organization is alert to internal and external factors, opportunities and challenges. Leaders face forward rather than focus on the past. They work hard to ensure that their operational, clinical and financial processes are adaptable to new models of service delivery. Performance and accountability are woven throughout all levels. Being agile means constantly expanding capabilities to use all available resources in a timely, flexible, affordable and relevant manner to respond to change positively.

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