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Chief Insights: Our ultimate goal – the patient comes first

By ensuring all decisions are patient care-centric, we create providers who are passionate, motivated and excited to be a part of something bigger than any one individual


“Always be willing to do yourself what you ask of your employees,” Smith said.

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The following content is part of EMS1’s EMS Leader Playbook – aimed at helping new EMS leaders increase their effectiveness, enhance their leadership KSAs, develop trust among crewmembers, and build confidence. Through a handful of questions presented by EMS1, veteran chiefs reflect on their early days in leadership roles and offer advice, while newer leaders detail their experiences taking on a new position. Email to offer your insights for the EMS Leader Playbook.

The spark: What put you on the path to becoming a chief?

I have to give credit to our Assistant Chief of EMS, James Seek. He was my first full-time partner on the ambulance back when I was a rookie at MCHD. He showed me what it meant to be a high-performing paramedic who focuses on customer service and quality EMS care. By following those principles, I have found career success and continue to be motivated by the same ideals.

Look ahead: What’s something you want to accomplish in your first year as chief?

During my first year as clinical chief, I look forward to assisting with the implementation of a tiered ALS/BLS system. Dual EMT trucks are a new model at MCHD, and I am excited to see how they contribute to the success of the organization.

How will you create an organizational culture that people want to be a part of, to join and to stay?

My core cultural philosophy is one I can confidently say is shared by all who work at MCHD – the patient comes first. By ensuring that all of our actions and decisions are patient care-centric, we do not lose focus of our ultimate goal. In doing so, we create providers who are passionate, motivated and excited to be a part of something bigger than any one individual.

How are you going to support and stand up for your personnel to show that you care?

In order for our personnel to perform well in their roles, we must provide a clear avenue for communication, address their concerns and continuously work towards anticipating their needs. We do not expect perfection and use every opportunity as a means of learning.

Our providers are the key players in everything that we do as an organization. We support them wholeheartedly in both their personal and professional lives by demonstrating our core values:

  • Accountability
  • Compassion
  • Excellence
  • Innovation
  • Integrity
  • Unity

How do you demonstrate servant leadership?

Always be willing to do yourself what you ask of your employees. I strive to find opportunities to alleviate stress from those who I am honored to lead and empower them with the right tools and knowledge they need to be successful.

Leadership lightning round

  • What is a leadership book, podcast or seminar you’ve found invaluable? “Extreme ownership” by Jocko Willink and Leif Babin
  • If you knew the budget request would be approved, what’s a big purchase you’d make for your department today? Digital stethoscopes for every provider
  • How do you recharge/improve your resiliency? Unplug – travel, spend time with family and read

Nicolas Smith is division chief-clinical, for the Montgomery County Hospital District. He is a Houston native who began his EMS career in 2013. He has experience in various aspects of EMS including as a 911 dispatcher, communications training officer, paramedic field training officer and assistant operations chief. Chief Smith holds two Bachelor’s degrees: double science major at Texas A&M and a bachelor’s in computer science. He is currently working on a master’s degree in data science at Eastern University. Chief Smith has a passion for the clinical aspect of EMS and using data to enhance the care MCHD provides the community.