Pinnacle 2021 Quick Take: Moments like these define successful EMS leaders

Jay Fitch delivered an inspiring and thought-provoking keynote address to EMS leaders on how to future-ready their organization


PHOENIX — Jay Fitch, PhD, a founding partner of Fitch & Associates, delivered an inspiring and thought-provoking keynote presentation on leadership and how EMS organizations can emerge from the pandemic stronger than ever to Pinnacle EMS leadership forum attendees.   

Fitch began his presentation by walking through the defining moments in the five-decade history of EMS. In the 1970s, Fitch became the 49th paramedic in South Carolina and the television show “Emergency!” ran on television. Then-Governor Reagan signed legislation enabling paramedics in California.  

On July 17, 1981, two skywalks collapsed in the Kansas City Hyatt Regency Hotel, an incident which defined disaster response and affirmed the need for regional planning and response. Fitch recognized two Pinnacle attendees who responded to that event whose careers were propelled forward from that career-defining moment. He also described the work of Jack Stout, the emergence of the public utility model and the rapid growth of private EMS during the 80s.  

“Never forgot your integrity. It is essential to your leadership and the long-term development of the profession,” Jay Fitch, PhD, said in a presentation at Pinnacle.
“Never forgot your integrity. It is essential to your leadership and the long-term development of the profession,” Jay Fitch, PhD, said in a presentation at Pinnacle.

Some of the defining moments of the 1990s for EMS were the acquisition and consolidation of private EMS agencies, the first EMS Agenda of the Future, and the growth of fire-based EMS.  

In the first decade of the 21st century, the “shocking events of September 11 were a defining moment in our history. Most of us can tell us where we were and what we were doing, even as we approach the 20th anniversary,” Fitch said.  

September 11, anthrax and ricin scares, and Hurricane Katrina underscored the importance of a national response framework in the 2000s.  

Fitch’s tours of defining moments continued into the 2010s. For EMS, a few of those defining moments included the start of the opioid pandemic and that “active shooters have become mainstream and commonplace,” Fitch said. More positively, the last decade saw the launch of community paramedicine and ET3.  

In the first two years of the 2020s, the defining moments of the COVID-19 pandemic and widespread civil unrest calling for social justice after the death of George Floyd have had a tremendous impact on EMS and the communities we serve.  

Memorable quotes on EMS leadership 

Each Pinnacle, Fitch outlines a broad leadership concept and interprets it in a way to inspire, educate and equip leaders with hands-on methods for improvement. There were many memorable quotes as Fitch examined the impact of key moments in the careers of EMS leaders and how those moments shape EMS systems and change leaders. Here are four memorable quotes from Fitch’s presentation:  

“The leadership legacy that you leave is the life you live.”  

“We have the opportunity to create defining moments for those around us every day.”  

“For us here today, ‘WTF’ means what’s the future.” 

“Leaders need to be seen every day. Use your head, heart and hands.”  

Top takeaways for EMS leaders 

A top theme of this year’s Pinnacle has been the significant headwinds EMS is facing, especially staffing and funding. It’s not an easy time to be a leader in EMS, but it is also a moment for EMS leaders to lead their organization into the future. Here are my three takeaways from Fitch’s presentation for EMS leaders.  

1. EMS can't fail 

Fitch outlined four fail factors threatening the future of EMS. Understanding and solving these factors is critical to EMS survival. Fitch's fail factors are:  

Staffing. First, EMS must figure out how to pay a living wage to our caregivers. Second, we must figure out how to lead younger generations. Third, we must improve our recruitment efforts.  

Fitch listed effective and not effective recruitment strategies. Effective strategies that work for Fitch clients include word of mouth, growing your own, referral and sign-on bonus, seasonal recruitment, cadets and explorers, website application and a cafeteria approach to benefits.  

Ineffective strategies include sign-on bonus bidding wars, open houses, LinkedIn job posts, newspaper ads, slow testing process and inflexible onboarding processes.  

Fitch believes caregivers want to work with other high-performers, want recognition for work done well, to work in systems that support them, have opportunities for professional development and to be led by a leader who cares about and values them.  

Artificial intelligence. EMS already is using AI, but opportunities exist for better use of AI for improvement science. “If you’re not thinking about improvement science today, you could be left behind,” Fitch said.  

Healthcare integration. Fitch called on attendees to get to “the table” with other healthcare providers to make sure EMS is better and appropriately integrated into healthcare. Integration is going to require understanding opportunities, writing a business case and building relationships. “We’ve got to be thinking we are healthcare even if we are wearing a public safety patch on our shoulder,” Fitch said.   

Funding. "Costs are climbing at an astronomical pace,” Fitch said when describing the dramatic increases for fuel, supplies and labor. “Our current fee-for-service models are simply not sustainable,” Fitch said. Every EMS leader needs to be advocating for increased EMS funding and sustainable reimbursement models.   

2. The paradoxes of EMS leadership  

Fitch recommended leaders need to be all of these things to succeed with today’s challenges and workforce. An EMS leader must be a: 

  • Strategic micromanager 

  • Nurturer of loyal dissent 

  • Traditioned innovator 

  • Hard-nosed humanist 

  • High-integrity politician 

3. Necessities for future-ready EMS agencies 

In the final section of his presentation, Fitch introduced a set of nine interconnected imperatives for future-ready EMS organizations which were categorized into who we are, how we operate now and how we grow. Fitch’s thinking on each imperative was shaped by a leadership book on the topic.  

Who we are imperatives: 

  1. Take a stance on purpose 
  2. Sharpen your value agenda  
  3. Use culture as your secret sauce  

How we operative imperatives: 

  1. Radically flatten your structure 
  2. Turbocharge decision making 
  3. Treat talent as scarcer than capital  

How we grow imperatives: 

  1. Take an ecosystem perspective 
  2. Build data-rich platforms 
  3. Accelerate fiscal dexterity  

Lead with integrity 

Though there are lots of “Aha” and defining moments in the history of EMS, integrity is one additional requirement for EMS leadership mastery.  

“Never forgot your integrity. It is essential to your leadership and the long-term development of the profession,” Fitch said. “The leadership legacy you leave is the life you live.”  

Learn more 

Three books recommended by Fitch for future-ready EMS leaders and organizations:  

  1. Start with why: How great leaders inspire everyone to take action”, by Simon Sinek 
  2. Time collapsing: The new art of speed, money, power and meaning”, By Ed O'Keefe 
  3. Scale or Fail: How to build your dream team, explode your growth, and let your business soar”, by Allison Maslan 

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