Why an EMS leader's vision needs ‘grunts’ to buy in

Forming a strategic plan for your agency’s future is the easy part; the hard part is getting the people who will carry it out to believe in it as much as you do


“Culture eats strategy for breakfast.”  ~ Peter Drucker

My girlfriend is a bit of a management and leadership junkie. She comes from a business management background, and she spent years with a management service organization that provides staffing, training and consulting to volunteer EMS squads throughout Connecticut.

Whereas I, on the other hand, am a career street medic, the quintessential grunt. Even when I was a field supervisor or member of management, I approached my job with a grunt’s sensibilities.

As you can imagine, debates about EMS between us can get a little… lively. As likely to pepper her arguments with quotes from Peter Drucker or Jack Welch as I am to salt mine with pop culture references and quotes from Mark Twain, she gives me a run for my money. Sometimes, I even lose.

But one of her favorites is the quote that leads off this column, and it’s one I can’t refute.

Culture does eat strategy for breakfast

For those of you who have never heard of him, Peter Drucker was a management consultant who is widely considered “the father of modern management,” and what he meant was that leadership, strategic vision and a sound business plan mean absolutely nothing if the grunts don’t buy into it. What good is a visionary leader if nobody is willing to follow him? Forming a strategic plan for your agency’s future is the easy part. The hard part is getting the people who will carry it out to believe in it as much as you do.

In other words, the established culture of the agency makes all the difference in the world. If the leader is an excellent cheerleader and salesman, sometimes he can sell his vision to the troops, and the agency culture changes.

If it doesn’t, the only answer left is to fire all the unhappy people, and hire new ones that do share your vision. Obviously, that can be quite traumatic, and the agency might not survive the transformation.

Shaping an agency’s culture

What brought this Drucker's missive to mind is the recent news articles about misconduct and scandals at EMS agencies around the country. Whether it is firefighters using excessive force to restrain a patient, lurid stories of sex in firehouses amid allegations of sexual harassment and hazing, or the scandal du jour for DC FEMS, only so much of the blame for such goings-on can be laid at the feet of the chief.

Sadly misconduct can become part of the agency culture. And no matter how much the current chief – or the new one hired with a mandate to clean house and root out all the bad apples that his predecessor couldn’t – wants to transform the agency, if the grunts don’t share his vision, the plan is doomed to fail. The culture endures.

That’s a phenomenon I’ve witnessed myself. During Hurricane Katrina, I met and worked with EMTs from other parts of the country who wore the same uniform. Their ambulances had the same logo on the side. Yet their attitude, training, leadership … everything was markedly different. We were owned by the same national company with a shared strategic vision, but the culture of the old agency lingered despite new leadership from the big conglomerate that bought them out.

And often, that culture lingered until terminations and attrition replaced the old workforce with a new one who never knew what it was like to work for Old Company X. Only then did the agency culture change.

There’s a lesson to be learned there, for managers and grunts alike.

Change begins with you

For the grunts, the way to transform your agency starts with you. You shape the culture. Beating up a combative patient in retaliation for a punch will continue to happen until it is condemned in the ranks.

Sexual harassment of female medics will continue to happen until the males in the organization no longer subscribe to the philosophy of “Hey, it’s a man’s game. If you wanna fit in, you gotta act like one of the boys.”

Personal and professional accountability will not be a priority for the crews – or the unions that represent them – until the crews themselves decide that pencil-whipping continuing education paperwork, sharing test answers, rendering shoddy care to patients, or ignoring customer service, are unacceptable from their peers.

Don’t wink at problems or ignore the poor performers. Call them out. Peer pressure can work in positive ways, too.

For managers, it means that you have to do more than bludgeon your subordinates with the rank hierarchy and the policy and procedure manual. You have to lead. You have to practice responsibility upward. You have to sell the agency’s vision, and make your subordinates believe in it every bit as much as your chief does. And the only way to do that is to occasionally get in the mud with the troops, and share a little of their misery. They have to be convinced that not only are you willing to do everything they’re asked to do, but that you can do it better. That’s why they made you a manager.

Everyone contributes to culture change

In the early days of World War II, USMC Major Evans Carlson appropriated a Chinese term, “gung ho,” as the unofficial motto of the 2nd Marine Raider Battalion. In modern parlance, most people consider “gung ho” synonymous with “enthusiastic” or “overzealous.” In reality, the term means “strive together in harmony,” a somewhat heretical statement at the time for an organization with a rigid rank hierarchy and command structure like the U.S. Marine Corps. Indeed, many of his peers and commanders considered Carlson a kook influenced to an unhealthy degree by Chinese communist doctrine and philosophy.

The 2nd Marine Raider battalion’s raid on Makin Island was a tactical failure. Though they managed to annihilate the Japanese garrison on the island, few of the raid’s other objectives were met. Yet Carlson’s leadership concepts and tactics resonated far beyond a tiny atoll in the south Pacific. The Marine Raiders are now considered some of the forerunners of the modern U.S. Special Forces. Carlson abandoned the traditional USMC eight-man squad in favor of a 10-man squad composed of a squad leader and three-man fire teams, an innovation that the Marine Corps still uses to this day. Even with what is widely considered a rigid command hierarchy in the USMC today, every Marine, down to the lowest PFC, is expected to contribute to the planning process of a mission, and speak up if they perceive any flaws in the plan. Carlson was able to fundamentally transform a culture.

Not bad for a quasi-communist kook, eh?

As a manager, if you want to transform your agency’s culture, you have to employ the persuasion and force of personality of a man like Carlson. If charisma and salesmanship are not in your repertoire, then you need to identify subordinates who possess those qualities, and turn them loose to do your thing.

As a grunt, remember that you can be just like the Marine grunts. You may be the lowest man on the totem pole, but the profession needs you to contribute to the plan, and speak up if you spot flaws.

Only in this way will you transform your agency’s culture, and by extension, the culture of EMS. 

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