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Addressing leadership and caregiver bias in EMS

The EMS leader’s task is to recognize and reduce negative impacts of bias as much as possible


Photo/City of Ankeny

By Todd Sheridan

Bias exists within all organizations and individuals. The EMS leader’s task is to recognize and reduce negative impacts of bias as much as humanly possible. The first step in that process is to understand what it is and how it impacts our decisions.

Bias is defined as “the action of supporting or opposing a particular person or thing in an unfair way, because of allowing personal opinions to influence your judgement.”

First and foremost, we must consider how caregiver bias could potentially negatively impact the patients we serve. According to the Joint Commission there is extensive evidence and research that finds unconscious biases can lead to differential treatment of patients by race, gender, weight, age, language, income and insurance status. The Joint Commission recommends the following actions to combat caregiver bias:

  • Having a basic understanding of the cultures from which your patients come.
  • Avoiding stereotyping your patients; see them as individuals.
  • Understanding and respecting the magnitude of unconscious bias.
  • Recognizing situations that magnify stereotyping and bias.
  • Knowing the National Standards for Culturally and Linguistically Appropriate Services in Health and Health Care (the National CLAS Standards).
  • Assiduously practicing evidenced-based medicine.
  • Using techniques to de-bias patient care, which include training, intergroup contact, perspective-taking, emotional expression, and counter-stereotypical examples.

In addition to reducing caregiver bias, EMS leaders may need to outsmart their own biases. An article in the Harvard Business Review explains the source of bias. It comes from “what experts call System 1 thinking – automatic judgments that stem from associations stored in memory – instead of logically working through the information that’s available.” In other words, when we are faced with a decision, we will often rely on our instincts rather than on objective information. This has many effects on leaders, including the bias of likeness. Likeness means that we tend to surround ourselves with people that think and behave like us.

Having grown up in EMS, I have watched this particular bias have a very negative effect on the profession over the years. Some of the most blatant examples of this bias are in the promotional strategies EMS employs. The first example is: “I was a good clinician, so we should only promote good clinicians.” In reality, there is no correlation between being a good clinician and being a good supervisor. This type of bias has led many organizations to overlook other skill sets, including organizational skills, planning skills and people skills that are important attributes for people leadership roles to possess.

Another bias is: “You have to come from within the profession to be a good leader.” This thought process has left our profession sorely lacking in innovation. Innovation comes from outside thought, and it comes from having leaders that challenge the status quo. Yet, we continue to promote from within without regard to the required skill sets. Most other professions have recognized the practice of leadership as an independent specialty.

We also see likeness bias in the lack of gender diversity at the top of the profession. We promote people like us, and, being a largely male-dominated profession has created a glass ceiling that does not serve us well.

So, what can we do?

Techniques for conquering bias in EMS

While the Harvard Business Review article suggested many techniques for leaders, let’s focus on a couple that are the most appropriate for our profession: allowing for uncertainty and thinking about the future.

Start by allowing uncertainty to enter the equation. This is something that emergency service leaders do very poorly, as it goes against everything we are taught. Our mantra, “Do no harm,” urges EMS workers to make the safe choice and go with what they know. But, since doing what we know is often biased, we need to do things a little differently.

One technique that can be used is the vanishing options test. This technique forces you to venture outside your comfort zone. When you have looked at a problem and decided on a course of action, pretend that the option has disappeared. This will force you to re-examine the other options that you readily discarded, to weigh the strength and weaknesses of the other options, or maybe even discover another option altogether. Try this when you are promoting someone. Take your list of candidates and strike the top two top candidates. This will force you to revisit the remaining candidates and take a closer look at qualities or abilities you may have overlooked because you had already chosen the person who most resembled you.

The other approach which can be used to combat likeness bias is to think about the future. This approach, as implied, means that you make decisions based on the future needs of the organization. This can be very difficult for leaders who were born into a culture that was based on eight-minute responses and a “faster is better” approach to EMS. When a leader is thinking about needs, their thinking should be as far in the future as possible. Sacrificing some immediate need for a better future outcome may add a level of uncertainty into the discussion, but it also allows for the development of an individual or ideas that can challenge the current bias and status quo.

In order for EMS to thrive, the industry as a whole has to hold a mirror to itself, ask the tough questions and challenge the natural bias inherent in the profession. The industry has to allow change to come from different perspectives, and break down caregiver and leader bias.

A good future strategy is to ask the question: Do our actions today reflect where we should be?

About the author

Todd Sheridan, a senior associate with Fitch & Associates, is a performance-driven leader with expertise in operations, organizational development and data analysis. Currently, Todd serves as a director of operations for Robert Wood Johnson University Hospital in New Jersey through an interim management contract with Fitch & Associates. Before joining Fitch & Associates, he served in various EMS and fire agencies including with the Richmond Ambulance Authority.

For more than three decades, the Fitch & Associates team of consultants has provided customized solutions to the complex challenges faced by public safety organizations of all types and sizes. From system design and competitive procurements to technology upgrades and comprehensive consulting services, Fitch & Associates helps communities ensure their emergency services are both effective and sustainable. For ideas to help your agency improve performance in the face of rising costs, call 888-431-2600 or visit