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Relationships by objectives: Bridging the gap

This model takes a page from unions to allow EMTs, paramedics and firefighters to provide input on their agency’s long-term vision


By creating RBOs and allowing all members of the organization to interact and collaborate, by nature of human behavior, succession planning becomes actualized.

Photo/Fort Bend County EMS

For as long as hierarchies have existed, there have been gaps between those who give orders and those who are tasked with executing those orders. This holds especially true the larger the organization or system becomes. Even the greatest leaders have struggled to get their vision and message to their followers, all the while receiving valuable and constructive feedback from those on the frontline in return.

However, with the gracious help of Battalion Chief (Ret.) Anthony Kastros, our organization, Fort Bend County EMS in Texas, has taken a formative leap by deploying a model called Relationships by Objectives (RBOs). This model isn’t new by any means. In fact, in the most fundamental structure, union representation is at the core of RBOs. Unlike union shops, RBOs have no political following and are plentiful within a single organization. The idea is relatively simplistic; allow those operating at the task level (firefighters, EMTs and paramedics) to provide input into the long-term vision of their respective organization. The end goal is to have the task-level providers have a sense of ownership and therefore be heard from “the streets.”

By creating RBOs and allowing all members of the organization to interact and collaborate, by nature of human behavior, succession planning becomes actualized. When leaders start seeing the vision of their subordinates and validating their skills as future leaders, the first step of building commences. When administrative leaders work alongside field providers, a culture of teaching, mentoring and fostering growth is born. Not only is knowledge and experience being shared, but leaders can also begin to identify future leaders with passion, drive and initiative who share the organizational vision to succeed. Once you see a flourishing talent in your organization, the goal is to embrace the change and stimulate the action potential.

Guiding principle

Here at our agency, we have deployed this model and formed several different RBOs, including:

  • Employee mental health and wellness
  • Employee morale and events
  • Safety/loss prevention
  • Apparatus/equipment
  • Recruitment and retention
  • Special operations

The Chief of EMS has outlined “rules of engagement,” a guiding principle, objectives, goals and boundaries for each RBO. The rules of engagement are quite simple; build and foster relationships and remember that no project or product is more important than the people or the relationships. Our guiding principle is truly defined and highlighted by our core values. While keeping those guidelines in mind and the “why” we do what we do, this helps mold the hierarchy of RBO needs – first, what is best for our patients, the citizens and visitors of Fort Bend County. While working, the RBOs must keep that in mind as the top priority, followed by the organization, the general staff and themselves as individuals. So as the groups work through their projects, those ideological concepts must remain intact. Everyone has an opinion in our industry, however, the ideas or suggestions that only benefit one or two individuals will be superseded by those ideas that represent the best interest of the communities we serve, followed by the organization as a whole.

Empowering future leaders

Working for a county entity has some inherent boundaries most field level providers and even some administrative staff are unfamiliar with, such as purchasing policies; budgetary constraints; and other federal, state or local governmental regulations. Every EMS agency, regardless of service model, has constraints to some degree or another.

Most of the boundaries our leadership has placed on the RBOs have been centered on these types of parameters. However, we were careful and diligent to place some boundaries around some of the progress that the organization had already made. For example, over the last several years, the command staff has worked to rebrand the physical image of our apparatus and thus, a massive overhaul or change is a boundary that cannot be breached. However, besides policies and laws (minus the minor exceptions) the only hard rules are; listen, respect and leave your baggage at the doors.

We believe we have a solid foundation and recipe to empower our future and current leaders. This model we hope will breed success in all facets of the organization for multiple administrations to come. As we embark into a new era and launch a new generation of EMS leaders, one of the most important lessons we must remember is to not eat our young, as many of our peers came to as we grew as providers and leaders. Build with trust, confidence and support in this continued revolutionary period of our industry.

Read next: Why the best EMS leaders are actually teams

Xavier A. De La Rosa is chief clinical officer for Harris County ESD 11 Mobile Healthcare. He has held multiple roles including for-profit EMS, 911 EMS, flight medicine and EMS-based fire service, and as a lieutenant in the Training Division of Fort Bend County EMS in Texas.

He has a degree in Emergency Health Sciences from the University of Texas Health Science Center San Antonio and a Master’s of Business Administration from Johns Hopkins with concentrations in Private and Public Sector Leadership; and Health Innovation, Technology and Management.