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Why EMS should resuscitate imagination

If we are to break out of the confining boxes that inhibit adequate funding and find a fix to the broken reimbursement system, we need to imagine how things might be different

Updated June 2015

“I can’t imagine it being different,” an EMS chief declared at a recent session of the EMS Leadership Academy. He was talking about the ongoing cycle of budget cuts, internal morale issues and the perpetual feelings of frustration that surround leading a struggling ambulance service. The chief’s choice of words, “I can’t imagine,” invites some rumination.

Imagination is not a word or concept given much attention in emergency services. In working with more than 900 leaders from around the nation over the past five years in the Leadership Academy, we have observed that the EMS leader’s capacity to imagine, create and innovate is often limited. In a small group exercise, we ask leaders to imagine an ideal future EMS system, vehicle and frontline worker. Many struggle to imagine anything more than a variation of what already exists. Little out-of-the-box imagining shows up.

This isn’t surprising. Most EMS leaders come up through the ranks of a training and work paradigm that kills imagination. In the unstable environment of emergencies, field providers need to be creatures of protocol and direction—we don’t, after all, want them innovating in the field. The critical nature of the work demands that they follow algorithms, seek direction and implement established processes. We drill and skill the imagination out of them.

Imagination is simply the ability to conceive of something that does not exist and interestingly, EMS was birthed in wild imagination. “Imagine” is the first word of the 1996 video “Making a Difference,” narrated by Jim Page, about the history of modern EMS.

Everything from citizen CPR to the idea of taking cardiac care to the streets emerged from people who dared to see what had yet to be created.

Yet following that brief period of early development, EMS has seen little imagination. One exception was the work of Jack Stout, who was not an EMS provider but an economist. Stout imagined efficiencies through predicting demand and completely up-ended conventional thinking about resource use and deployment.

We need to resuscitate our imagination. If we are to break out of the confining boxes that inhibit recognition, adequate funding, cooperation, a fix to the broken reimbursement system, replacement of the volunteer subsidy and an appropriate valuation of the EMS workforce, we need to imagine how things might be different. Paraphrasing Albert Einstein, we can’t solve our problems using the same thinking that created them—and we need imagination more than we need more knowledge and research.

While we often talk about innovation, imagination is the critical first step in a continuum that also includes creativity and innovation. When a geeky young EMT dreams up a fantastic design for a tricorder-like assessment device, he is exercising imagination. If he actually sits down and makes a model or prototype of the tricorder, he is exercising creativity. If his tricorder actually advances the practice of assessment, we have innovation. But the whole process depends on the fertility of imagination to seed it all. Of course, not everything that is imagined—and perhaps very little—moves on to become innovation. But here is the important thing: There is no innovation without imagination. We need to imagine richly and wildly to solve our current problem.

Seeding and feeding imagination in a climate that kills imagination is not easy. However, following the work of experts and building on what we’ve seen, I’m convinced that imagination can be cultivated and nurtured. It is both an act and a practice that emerges when you slow down and feed it.

Here’s a suggestion. At a staff or leadership team meeting, make a list of current challenges facing your organization. Then stop and, as a group, watch the first hour of Tom Hanks’ 1998 HBO miniseries From the Earth to the Moon. After that, having primed the pump with the imagination that was needed to put a man on the moon, host a discussion about how to solve your challenges. Just watch what happens.

John Becknell is the founding publisher of Best Practices and a consultant and partner at SafeTech Solutions.

Produced in partnership with NEMSMA, Paramedic Chief: Best Practices for the Progressive EMS Leader provides the latest research and most relevant leadership advice to EMS managers and executives. From emerging trends to analysis and insight, practical case studies to leadership development advice, Paramedic Chief is packed with useful, valuable ideas you simply can’t get anywhere else.