How leadership transparency impacts EMS

Can you have transparency without honesty and communication?

By Andrea Abbas, MS, NRP, IC, CP-C; and Lyn Berghuisl

The EMS Trend Survey received a record number of responses in 2022, with over 3,000 EMS professionals answering questions about a myriad of topics impacting EMS operations today. The 2022 survey focused on leadership, and frontline care providers were asked specific supervision and management questions.

Respondents were asked to name three leadership behaviors or actions that mattered the most to them. The top three included:

  1. Honesty
  2. Integrity
  3. Transparency

Communication came in at a very close fourth. Fairness, leading by example and trust were among the top 10. These qualities beg the question: can you have one without the other? Can you have transparency without honesty and communication?


In the EMS Trend Survey, 3,195 people rated their agency’s transparency.

Roughly 50% believed their organizations are transparent, while a third thought they aren't. Opinions on transparency shift when the data is broken down by EMS role.

Direct-care providers see leadership as less transparent than those in higher leadership positions. Where else do opinions vary?

The data pattern for the length of employment shows leadership transparency improves over years of service. One could posit that trust builds over time. While the length of service doesn't wholly align with age, age may influence the appearance of transparency. Does transparency mean different things to different generations?

Transparency and generational implications

Transparency can be defined as the practice of being open and honest with others, no matter how challenging it might be. An open work environment encourages clear communication, collaboration and understanding of others without the presence of fear of retribution.

With five generations in the workforce today, transparency is ranked highly when it comes to what younger EMS professionals want from an employer.

The five generational tribes in the workforce today include:

  • Traditionalists: Born 1925 to 1945
  • Baby Boomers: Born 1946 to 1964
  • Generation X: Born 1965 to 1980
  • Millennials: Born 1981 to 2000
  • Generation Z: Born 2001 to 2020

What are the implications of having so many generations together in the workforce? The unique life experience of each person's generational environment creates a spectrum of firmly held values influencing perceptions. For example, what one generation may perceive as transparency, another may view as irresponsible. Further, each person may define transparency differently, creating complexity when it comes to cultivating a culture that values transparency within an organization.

So, what's unique about each generation? While there are many nuances to highlight, we will share just a few.

The Baby Boomers are also known as the traditionalist generation. Data shows a tendency toward a lifetime of loyalty when it comes to employer and shopping habits. Many boomers are nearing the age of retirement.

Generation Xers are more deeply in debt than many other generations due to student loans, family obligations and aging parents. Gen Xers spend much more time with their children than their parents did statistically. Many are in leadership positions or are on their way to moving into one in the workplace. They value ethical leadership and a focus on wellbeing.

Millennials are known for an unattached approach when it comes to a choice of an employer or where they spend their money. They choose products and employment based on an alignment of values. Generation Z places a high value on flexibility and professional growth opportunities. They have a desire for holistic wellness in the workplace as well as diversity and inclusion. They are the most diverse workforce generation in history.

Gen Z and Millennials now comprise 46% of the full-time U.S. workforce. According to Gallup research, the top three desires of Gen Z and young Millennials when looking for an employer were:

  1. The organization cares about employee's wellbeing
  2. The organization's leadership is ethical
  3. The organization is diverse and inclusive of all people

Interestingly, the desires of Gen X and Baby Boomers were similar with an organization's financial stability replacing diversity and inclusion in the top three.

The Millennial generation is the largest age cohort in the workforce today. Gallup's research found that 65% of remote and 61% of non-remote Millennial workers are highly engaged when their immediate supervisor keeps them informed about what's happening inside the organization. Managers influence 70% of the variance in engagement and are best suited to deliver individualized messages to personnel. In addition, millennials consider honest, frequent communication non-negotiable. This speaks to the importance of transparency within the workplace.

Poor leadership implications

Lack of leadership transparency, trust and communication will permeate all aspects of EMS operations. It is a game-changer for any organization in any industry.

When asked why you plan to leave your current employer, 23% chose "poor leadership." For direct-care providers, the percentage increases to 25%. Of course, everyone in EMS knows pay is a colossal dissatisfier, but poor leadership isn't far behind.

Another area impacted by leadership is employee engagement. In the EMS Survey Team National Employee Engagement Database 2022, EMSST compared six random organizations from their national database that asked employees to rate their level of agreement with the statement "Leadership is transparent in our organization."

Then, they compared the leadership transparency score to the organization's overall score (the aggregate of all items in the survey).

Those organizations with lower transparency scores also had lower overall scores. The qualitative data is equally impacting. Two profound comments illustrating the importance of transparency were: "Yes, great overall, I would work hard for strong leadership." And "Your ability to communicate to your employees and leadership will define your future." When leadership is seen as poor or not transparent, the employee engagement comments hinge on the following themes: poor decisions, breakdown in communication, unwillingness to change or try new things, lack of planning, disengaged/disconnected leadership, and poor morale (destructive or toxic workplace culture).

Developing trust

It's time for EMS leaders to communicate less over email and third-party resources, and more over face-to-face and video interactions. Creating the opportunity to interact more through daily ambulance bay walk-throughs, employee forums and in-person or virtual meetings is an important component of building relationships and developing trust. John C. Maxwell teaches to effectively lead people you must know 5 things to truly understand them:

  1. You must know their personality
  2. You must know their temperament and style
  3. You must know their dreams
  4. You must know their heart
  5. You must have a bond

What Maxwell is telling us is we cannot influence people without trust. We must first invest in the relationship to build a bond and understanding. This concept is bidirectional; by investing in our personnel, they too will know us, and a bond will grow. If we don't first cultivate relationships within our organizations, transparency may fall flat or be perceived in a negative light. Without influence, transparency cannot thrive.

At the heart of transparency is a willingness to be vulnerable and take risks, this is derived from a strong sense of self-confidence in leaders. Leaders that are perceived as less transparent tend to hold back out of fear they will be seen as less authoritative. Administrative constraints and time limitations can also influence perceptions leading to a perceived lack of transparency. When leaders are overscheduled and overwhelmed administratively, they may fail to communicate with staff and personnel. Over time, this can lead to unfavorable perceptions and decreased workforce engagement.

Today, transparency in the workplace is highly valued. While some may have a varying perception of what transparency looks like, research shows that honesty, integrity and communication are highly appreciated by the EMS workforce, impacting the perception of transparency.

Read more:

Read more:

What paramedics want in 2022

3,213 EMS providers speak up about job satisfaction, effective leadership, safety and innovation in the EMS Trend Survey

About the authors

Andrea Abbas, MS, NRP, IC, CP-C

Andrea is the owner and author of The EMS Professional. With over 20 years of EMS industry experience in various leadership roles, including field training officer, supervisor, quality assurance and compliance manager, EMS director and programs management, Andrea is skilled in system management, training, education, administration and project management. She has work experience in frontier, rural, suburban, and urban EMS systems. 

In addition to her leadership experience, she brings years of experience working in the ambulance and emergency department. Andrea holds her National Registry Paramedic license, Community Paramedic certification and Instructor Coordinator license in addition to her formal education and degrees. Her unique consulting approach is detailed, honest and highly personalized. Andrea offers a variety of EMS leadership and wellness courses to EMS agencies and departments. She’s an avid blogger, national speaker, podcaster and consultant. You can contact her at:

Lyn Berghuis

Lyn Berghuis is a performance improvement and data analyst with the EMS Survey Team.

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