Our Greatest Asset

This week, I wanted to resurrect a piece that I wrote a couple of years ago.  For anyone interested in being a manager or a leader, there is nothing more important than knowing the people who work for you. . . 

In the past, I have written posts about the worst jobs in America.  I tackled both the 2009 and 2010 lists of the worst jobs in America, where EMS and being an EMT was way down at the bottom (or right at the top) and that is a huge issue.  It’s time to get out of that rut, and as Skip Kirkwood, Scott Brown, and a few other posters pointed out on JEMS Connect and LinkedIn, it all starts with leadership.

It’s time to acknowledge what our greatest asset is.  It’s not the trucks that we drive around, it’s not those $20,000 cardiac monitors in the back of those trucks, and it’s not our stretchers, our buildings or our contracts.  It’s our people.  We send them our everyday expecting them to do “do their jobs.”  We ask them to respond to calls of all sorts of types, transport patients, put their lives on the line, and take the lives of others into their hands, and then when they are ready to go home, we look at their body of work for that day, whether its large or small, shrug our shoulders and say “it’s their job.”

The first step towards this is improving our leadership, and improving how we handle people, or how we “engage” them.  Employee engagement is extremely important, and how well it is done depends largely on what your motivation is for doing it.

First of all, what is engagement?   I did some searching, and found my favorite definition written by Ken Scarlett, President and CEO of Scarlett Surveys International.  He defines employee engagement as “a measureable degree of an employee’s positive or negative emotional attachment to their job, colleagues and organization which profoundly influences their willingness to learn & perform at work.”  To put it more simply, an employee who is engaged is one who has invested in the ideas and ideals of the organization, and the investment an employee puts into their organization is directly connected to the investment the organization makes in them.

Some view employee engagement as a way of interacting with an employee, sort of an ice breaker.  A way of saying, “Hey, Bob.  How are you today?” (Cue Bob’s response) “That’s great, but have you heard about our new safety policy?”  This is a one way exchange that is masked as engagement, and masked as a conversation.  You need to take interest in those who work around you and under you, and listen to what they have to say if you ever want them to hear what you are telling them.

This post can also be found at EMS in the New Decade.

Here’s a simple test that I challenged a colleague of mine with last week.  Name ten employees who work for you.  Now, tell me three things about each of those employees that have nothing to do with work.  It’s not always an easy thing to do, but it’s so important.  It helps you understand what makes a person tick, and more importantly, it helps you understand who your employee is.  They’re not an employee number, or one half a crew on the street, they’re people with struggles, and hobbies, and skills that go far beyond being a care provider, and that’s more important than anything they do on the street.

Friday night, I sent him a list of ten employees that I came up with randomly off our schedule, and included three facts about each.  It was a tough task, but I was able to do it.  I sent it off with him, and as part of our dialogue that followed, he asked me, “So how did you learn all of this?”  It’s quite simple, actually, I started conversations.

I spend a lot of my day on the streets interacting with my crews.  My job at our station usually entails me handing out radios, keys, computers and drugs, and working on getting people out the door to pick up the next call.  When I get out, I have a better chance to spend some time with my crews on post and at the hospitals.  I pay attention to what people are listening to on the radio.  I ask open ended questions that I’m legitimately interested in: “How’s your day going?  How was your weekend?”  And I see what people say as a response.

Then it’s just a matter of making a mental note of their answers, which is easy if you invest in your people, and genuinely care.  Remember who has kids, or who is a sports fan and what teams they own.  Find out who owns that new motorcycle in the lot, or who played a great round of golf that weekend.  Next time you run into them, ask them how things are.  Follow up on what you talked about last time.  Make them feel important, not because you have to, but because they are.

You don’t need a notebook to do this, and you don’t need a spreadsheet.  You just need a mind, and a heart.  If you are in EMS, you should have, by default, the ability to care for people.  We do it every day, for complete strangers.  Take that energy, and direct it to your most important asset: the providers.

It doesn’t take money and benefits to make a great career, and an excellent work force.  The annual Top 100 Companies to Work For list will tell us that.  Being the highest paid doesn’t automatically mean that you are happy.  What it takes is a mutual investment.  We need EMTs and paramedics to invest in their careers, their services and themselves, but this is only achieved when their services and their leaders invest in them.

The Kids are Alright – A Follow Up

Last week, we talked about the problems and challenges presented to us by the young work force that some EMS leaders are having a difficult time adapting to dealing with.  I have been giving a great deal of thought to what the solution to this problem is, and I cannot help but feel that it is evidence of a need to change how we train.  No, I am not talking about adding hours to an EMT class, or teaching CEU classes on how to be what some would consider a better employee, I am talking instead about changing how we utilize our field trainers.

Any EMS service that cares about what happens in the street, and cares about how their patients and customers are treated has established some form of a field training program, usually staffed by experienced employees who are initially shadowed by and then later evaluate the new EMT or paramedic to make sure that they are ready to be cut loose and released to practice their trade on the unsuspecting public.  I have seen many different methods used over the years from a group teaching approach, or a one on one tactic where the new employee spends all of their time with one FTO.  Others use a system where the “student” is bounced around from preceptor to preceptor to prevent them from picking up just one person’s bad habits.  They each have their own merits and shortcomings, but the real testament to their effectiveness is what we do with our FTO’s and their new employees once all of their requirements have been met.

Far too often in too many systems, employees finish up their precepting time and they are given the “okay” to hit the streets.  From there, they are on their own.  They might get a follow up six months or a year out to say “good job, keep it up” but beyond that the contact is minimal.  Maybe what we need is to establish a stronger bond and relationship between field trainers and new paramedics or EMTs and instead utilize them as mentors.

When there is a problem in the field, we have many places to turn.  We can pick up a radio and call for medical direction, or summon a supervisor to the scene, but those two options do not always fulfill all of our needs, especially when those needs are more personal.  When dealing with the stressors of the field, or the nuances of a system and how it works, I feel that many people would benefit from still having that mentor to turn to in the form of the person who the spent those first few weeks (or in some cases months) tagging along with traveling from call to call.

While I feel progressive discipline has its place in the business world, when I was a supervisor I always looked for another way to deal with a problem, unless of course, that employee did not give me any other choice but that to deal with it.  Falling back on values like STAR CARE or reminding people of the need to “do the right thing” and think about their actions always seemed to be an effective tactic for me.  Of course, there were those situations where one reaches the end of their rope, and the only answer was to put pen to paper and run a problem up the chain to the next level, but for me that was always a last resort.

Again, here is another place where having a mentor instead of a field trainer could benefit both the employee and the system.  If a system’s leadership had the means to go to a mentor and say “Hey, Bob is having a tough time with ‘XYZ’” and allow that mentor to talk to them and try and straighten them out from a more appropriate angle than a supervisory one that might be forced to take action.

While this approach might not be appropriate in every instance, it could surely promote a more positive relationship throughout a service and could help deal with some of the interpersonal problems that seem to arise in EMS.  We are, after all, a field that is made up of people with very strong personalities.

While it might seem like I am just advocating a title change from Field Training Officer to Mentor, I feel that the mindset and toolbox utilized for each of these positions are completely different.  Instead of creating an FTO system that allows us to train and prepare employees for the field, let’s strive for one that creates a relationship within the system and gives them a better chance of achieving the positive experience that we want them to have.

This post can also be found at www.medicsbk.com

The Kids are Alright

One of the unfortunate things about having a new job is I fall at the bottom of the list when it comes to using vacation time.  With the days off that I could get I was forced to miss the last day of EMS Expo in Las Vegas this year.  While following on Twitter though, I caught Greg Friese commenting on a panel discussion by members of the National EMS Management Association (NEMSMA for short) during a program called “The EMS Situation Room: NEMSMA Administrators, Managers, and Chiefs Forum.”  To sum up the discussion simply, the focus of the forum turned to what we will refer to as the “youth movement” in EMS today.

As a former supervisor for a service that likes to populate itself with lesser experienced individuals, it has become clear that the work force is changing, and it seems like some of the “old guard” is having difficulty dealing with a lot of the new attitudes and changing needs of the work force.  The entire topic is something that has certainly raised my eyebrow, and it is really something that we need to look at from the first day of EMT class moving forward to someone’s last day with an EMS service.

When I was in Washington, DC this year for EMS Today, I was on a podcast hosted by Dave Aber where the panel included two of my paramedic instructors from Springfield College.  One of the main topics of discussion was the changes that they had witnessed in their student population over the years.  Fifteen or twenty years ago, when paramedicine was still in its infant stages, most of the student body was made up of people who had been practicing EMS for a number of years.  The vast majority of paramedic students were street smart, seasoned adult learners.  We staffed ourselves from the inside using people who were already integrated into the system and had a strong foundation and framework to help them through class.  As time has gone on though, both the work force and the pool of students have gotten younger and less experienced.  They are more of what people would consider a traditional student base.  Educators have been forced to adapt, and for the most part they have done well.

From the middle management supervisor stand point, I used to joke a lot that I should pack up all of the management books that I read and move on to reading parenting books.  The needs, wants, and desires of the younger generation have changed, significantly, and as a result, the way that those of us stuck in the middle had to deal with them changed as well.  Whenever one must deal with a workforce in their early and mid-twenties, there is always going to be that heavy focus on a social life.  Many in our field for whatever reason don’t understand the need to achieve balance between that and a professional life and it is up to us to help them through that.  It is part of being a professional, and encouraging professionalism within our environment.

Now, from the medical side, there has been a lot of talk about evolution.  We have changed how we run cardiac arrests.  We have added treatments, augmented how and when we do them, and we expect them as dedicated medical professionals to step up to the plate and do what is best for the patient.  Most of the time, they do exactly that, but sometimes people buck back with a “well, we’ve always done it THIS way” speech.  When they do that, we work with them, reeducate, and remediate them, and do what it takes to show them that we understand that this is a change, but there is a reason for it, and that reason is because it is what is best for the patient.

Much like the field provider learning to adapt to those new treatments, our leadership must adapt in turn to the people that they hire.  The attitude that educators, supervisors, and medical directors need to adopt is one that is largely be driven by “give and take.”  We need to make sure that we work with them, and we allow them to adapt to change rather than taking a “do it because I said so” approach and essentially jam change down their throats.

I feel like management and leadership today needs to be mindful of this, and just like the young EMT who needs to adapt to a new treatment modality, they need to adapt to the needs of their workforce.  It’s like a pyramid.  A few managers and supervisors provide for many EMTs and paramedics who then are expected to provide for an even larger patient population.  When it comes to patient care, their role is one largely of oversight, but when it comes to dealing with their workforce, that is where they need to make sure their focus lies.  The crop of EMTs and paramedics that are on the streets today are the ones that we need to care for and cultivate in hopes that they actually want to make a career out of this industry, and someday step up to the plate, step off the streets, and take the reins.

Sitting back, and saying, “I don’t get these kids” or shaking your fist at them in hopes that they get off your lawn, or magically grow up is unrealistic.  We can no longer rely on the hands off approach to management that many systems utilized fifteen or twenty years ago, at least for now.  Someday though, these “kids” will grow up and be the self-sufficient group that we want them to be but for the time being, we need to work with them and try to understand their personalities and needs.

Perhaps what we need to do is start focusing on the long term and structuring an industry that encourages personnel to make a career out of EMS rather than allowing them to use it as a stepping stone for something they perceive as being a loftier goal.  But I think that is a topic for a different post at a different time.

This post can also be found at www.medicsbk.com

The Importance Of A Smile


So simple and yet so very powerful. They alone have the ability to break through indifference, warm the emotions of others around, and when used at the right time can influence what others will do. Smiles are relatively cheap in comparison and virtually every budget is able to afford as many smiles as you need.

smiling blondeSmiles are one of the most important tools that you will have as both a provider and a leader when dealing with people from all occupations and social classes. Provided that our happiness in life will depend largely on how we interact and manage a connection with others, a sincere smile is the most effective way to establish a relationship and build a rapport and compatibility with others. A smile will maintain the attention of the person you are speaking to, helps boost openness through body language, helps reassure the other person of your attentiveness to what they are trying to communicate, and genuineness at being willing to help or aid them.

Smiles are also a true mood changer. Feeling negatively or being in a bad mood often results in similar body language such as frowns, furrowed brows, scowls, and lower lip biting. Consciously choosing to smile instead of displaying the aforementioned negative characteristics has the power to change the mood of yourself and those around you who may also be having negative feelings. Smiling in these moments will help lift your own spirit, improve your outlook on the situation, and lead you to making positive decisions using good judgment that is no longer tainted by the negative atmosphere.

Want to know the best part about a smile? Everyone has one, including you! Use it to your advantage in reaching your goals with others.

What Drives People To EMS?

What motivates someone to come into EMS?

After unscientifically scouring my notes from hundreds of interviews with prospective new employees, the vast majority who are looking for their first job in EMS, here are the top 3 answers provided:
Great Career Ahead

  • I want to save lives
  • I want/like to help people
  • I want a career in the medical field doing (insert something OTHER than EMS here) and EMS is a great place to start, or so I’ve heard

Looking at that list, let’s take a moment to be honest with ourselves about how likely each of those things are.

The Life Savers

In July of 2011 the Centers for Disease Control and Prevention (CDC) published a report on Out-of-Hospital Cardiac Arrest (OHCA) Surveillance(1). The report is derived from 31,689 OHCA cases submitted from locations throughout the country. The overall survival rate through hospital discharge was a mere 9.6%.

Now if the police department only enforced 10% of the laws and the fire department only extinguished 10% of the fires, could they claim that they are doing a good job? If McDonald’s only served their food fast only 10% of the time, could they claim that they are fast food?

The answer is no. So why do we continue to perpetuate that we save lives when statistically in any other industry, public service sector, or healthcare we would be considered a failure? Is “saving lives” the only thing we do?

I’m sure some of you are going to argue that the statistic above is because of how response times are measured and we only need to drive faster. Perhaps you’ll argue that rural areas cause longer times in general and so everyone should be forced to move closer. There can always be the argument made that those arrests include other variables of which we have no true control.

To those of you who wish to challenge the 9.6%, I offer that the Utstein Survival Report for OHCA Events Witnessed by a 911 Provider(2) has 3,367 OHCA cases submitted. Out of those 3,367 cases there was a total of 625 discharged from the hospital alive for a whopping 19%. Even with response time removed from the equation our percentage only increases by 10%.

The fact is that while we may tout ourselves, allow others to believe, and recruit under the guise of being lifesavers the cold hard statistics show that we are, at the very least, deplorable at doing it. This is a hard truth that those who come to EMS in order to be “Lifesavers” have trouble handling. Their expectations are never met, they often become bitter and burned out leaving EMS angry at the professionals who continue on and at the perceived deception they have fallen for. Sometimes they don’t leave but rather vent their frustration and bitterness out on others, including patients.

The Helpers

The other day I received a complaint from a woman about where one of my crews had chosen to park. They were in front of a clinic building just posting for a call when she asked them to move so she could park there and pick up her mother who had issues ambulating, was frail, and required assistance. The crew explained to her that she couldn’t park there because it was “Ambulance/Ambulette” parking only, which was the truth.

The woman exploded emotionally and verbally to the crew. One of the crew members, fearing for his safety from an angry woman, ran across the street to get the local law enforcement involved. Surprisingly to the crew, although not to myself, they really did nothing to the now more enraged woman other than ask her to back her vehicle up so the crew could respond to an assignment they had received while this was unfolding.

As expected, the woman called to complain. When I asked the driver, who the woman had specifically singled out in my conversation, as to why he didn’t just move the ambulance he cited the signs. I inquired if he was moonlighting as a Parking Enforcement Agent, to which he denied being empowered to enforce parking regulation. When I asked him why he didn’t move the ambulance to help this woman out, he said it was because she wasn’t a patient. He also didn’t recognize that the simple act of moving the ambulance, although it may have been inconvenient for him to do so, was helping someone.

I’m always intrigued by people who say that they want to “help others.” I think that if that were truly the case then they would have joined a mission or an order where vows of poverty and service are above board, open, and mandatory. Of course EMS may be the right place for them because they take those vows without knowing it, but I often wonder why they choose EMS as that venue. Some of them, upon further prodding, recall a time when either they or a loved one were helped by an EMT or a Paramedic. It was that display of compassion, caring, and empathy that motivates them to come to EMS.

I often find myself trying to explain that a desire to “help others” does not necessarily mean EMS is the right place for a person. The fact is I can walk out in jeans and sneakers with a sandwhich board that reads “FREE DIRECTIONS’ and an iPhone with Google Maps installed, go to Times Square, and help the gazillion people who are lost from using Apple Maps. I’m helping people just as much, but I’m not required to have a certification or an ambulance to do so.

The Medically Oriented

There are those who in the course of their lives are looking for something satisfying to do and the idea of working in healthcare is appealing to them, but they remain unsure. The best way to ensure that this is the sort of work they want to do is to get an entry level position and give it a test run. A number of these people choose EMS to test the healthcare waters.

This can be seen as both good and bad. It is good because their time spent in EMS will give them an idea what they are in for should they continue down the path of nursing, becoming a physician’s assistant, or even on the road to medical school. It can be bad because EMS ends up as a training ground for other professions and is constantly under the strain of a brain drain.

We need to be ready to constantly challenge these providers with new and interesting information, techniques, processes, and procedures. They are the Hungry Hippos of formalized education demonstrated in real world scenarios. While its true they may choose to move on, hopefully their experience will be positive enough that they will at least keep some level of involvement with EMS.

So What Do We Do?

There are so many debates about ourselves. Are we Public Safety or Healthcare? Should we be referred by our certification level or should one title encompass us all? Are we truly pre-hospital care providers or healthcare entry point providers? Do we save lives and if not (which I think I’ve already demonstrated through citation) then what do we do?

The truth is that we change lives. Fundamentally at our very core we are agents of change for the millions that call us each year, not necessarily being able to increase the quantity of someone’s life but rather always working to improve the quality of it. We need providers who are motivated to be agents of change for the better to those who are unable to do it for themselves. We need leaders who understand that motivation, embrace it, encourage it, foster it, and are willing to help it grow.

Motivation is an important factor to any organization. It is important that we identify the motivations of our providers and foster their growth using what we know about their motivation to challenge them both professionally and personally. Engagement and stimulation will help their performance thereby helping you as their leader and ultimately helping the agency as a whole.

Not sure what motivates your providers? Well then ask.


1. Centers for Disease Control and Prevention, July 29 2011 Out-of Hospital Cardiac Arrest Surveillance on the Internet at http://www.cdc.gov/mmwr/preview/mmwrhtml/ss6008a1.htm (visited January 6, 2013)

2. Utstein Survival Report Page 3 Cumulative Data October 1, 2005 – December 31, 2010 on the Internet at http://www.cdc.gov/mmwr/preview/mmwrhtml/ss6008a1.htm#Fig9 (visited January 6, 2013)

5 Ideas For Celebrating Victories

No matter how small we may think it is, we need to celebrate our victories. Here are 5 ideas for recognizing and commencing that celebration with your providers:

  1. A Written Letter of Commendation from “The Boss – Telling someone they did a good job is important, but taking the time to put it in writing helps increase the value of that message. Not only is it great that they can show their co-workers that you truly value their service, that’s something they can take home and show their friends and family. It can even be something that they display in their home, a source of professional pride, for others to see for years to come
  2. A “Thank You” Card – greeting cards have traditionally been used for close friends and family on special occasions. Isn’t a positive customer service report such an occasion? Don’t you want those who report to you to feel as if they are a part of something bigger, like an extended family? “Thank You” cards can go a long way to deliver that
  3. A Cup of Coffee with “The Boss – It will cost at most $21 (if you go to Starbucks) and 15 minutes of your time and undivided attention to make your Providers feel great about their performance, their career choice, and your Agency. Want to know the funny thing? Your time and undivided attention will often be appreciated more than the coffee…
  4. A Public Posting of Praise – It’s important to be sure that your Providers are recognized among on another. Whether it be a memo, flyer, or copy of the letter of commendation that you’ve written put up on a bulletin board, crew room, or locker room goes a long way to achieve that. It not only provides some recognition for those who have done a good job, but provides some incentive for others to do the same
  5. A Mention In Your Agency’s Social Media Stream – Is your provider on Facebook? Is your agency on Facebook? Hopefully they both are (if you’re agency isn’t, then read this post) and then posting a photo on your Agency’s Facebook Page and tagging your provider in it does two things simultaneously. First, it recognizes the Provider to your Agency’s audience as well as the Provider’s friends and family. Second, it gives your Agency some content for their Social Media Presence. It’s a win-win for all those involved

What does you agency do to celebrate the victories? Let us know in the comments…

The “B” Word

There is one thing that the Fire Service has universally created, fostered, and grown throughout its history that I truly admire, respect, and wish we could bring to the Emergency Medical Services.


You hear the word come out quite often from all levels of the Fire Service when discussions are about work conditions. You see the word in action during times of crisis, usually during a line of duty injury or death, to support and provide whatever is needed. You feel the word when you walk into a firehouse at dinner time and sit down at the kitchen table to break bread, laugh, and swap tales from calls long past.

This is what truly differentiates the Fire Service from both Law Enforcement and the Emergency Medical Services.

Why It Matters

There is a reason why the fire service is perceived to be as strong as it is. The unity that the sense of brotherhood provides has brought great power to bear when situations, both political and civil in nature, need to be resolved for the betterment of the whole organization. When I talk about the “whole organization”, I mean the Fire Service itself and not an individual department. Admittedly this is more of a global perspective that we aren’t necessarily used to looking from, but we need to start looking at it this way sooner rather than later.

Chief Mick Mayers of Firehouse Zen, one of my favorite fire service and leadership reads, recently had this to say in a post titled Labor Day Conflict:

When individuals choose to advance their personal values over the needs of the whole, they lose track with the reality that the organization is an organism which has many parts and systems. If any of those parts fails due to the neglect or lack of community with the whole, then the whole perishes. You can’t kill off a part to your benefit if you expect the whole organization to keep producing, and yet, it continues, mostly because of greed, selfishness, and ego.

KnockoutWe spend too much time and effort promoting and furthering ourselves and our individual organizations while putting other organizations with the same mission down. While some will cite commercial entities competing against one another as the inherent source of this evil nature, why then do municipal agencies and volunteer squads openly malign them for this capitalist behavior? If the commercial entities are the source, why then do the career municipal agencies join them equally in criticizing the volunteers for inexperience and providing a lack of consistent quality service? Why do the commercial entities and volunteers condemn career municipal agency members for the perceived lackadaisical response times and overall laziness in responding to calls? The only aspect in common with all three is that they equally rail against the other two.

As Chief Mayers pointed out, you can’t kill off a part and expect the whole to keep producing. This includes agency types. The sooner we realize that we are all part of the greater whole that is the Emergency Medical Services, the sooner we can promote some unity, the sooner we can develop ourselves into a caring brotherhood like the fire service, the sooner challenges will be able to be overcome with the power of that purpose.

So what’s stopping us? Let me know your thoughts in the comments…

Celebrate The Victories

Looking at the organization of a number of EMS Agencies we often see departments dedicated to quality. Whether it be a Quality Assurance, Quality Improvement, or Investigations units we take complaints pretty seriously.

How many of you have ever eaten at a fast food restaurant? Whether it be McDonald‘s, Burger King, Wendy‘s, Taco Bell or any of the countless others you would have had to deal with a cashier at the counter.

How many times have you gone into one of these restaurants, placed an order, paid your money, received back the correct change, and then have the cashier deliver the order correctly on a tray for you to take away and dine on?

Once at the table you see the order is correct, relatively hot, and from a food service perspective you received a good meal. Has that ever happened to you?

Thumb up with good job written on a blackboardIf you answered “Yes” to all three of those questions then please answer this one: Have you ever gone home and written a letter to the manager of that fast food restaurant for the service you received? Have you ever called the manager at the restaurant to commend the cashier for a fine job? Have you, on the way out the door, every stopped to speak to the manager and thank them for the job they and their staff have done for your meal? If you answered “Yes” to any one of those three questions then you are in the absolute vast minority.

Expectation of good service is part of our cultural DNA. There is a sense that it is owed to us for the patronage we provide to the establishment or service provider. When we receive it we think nothing special about it. When we don’t receive it, we make sure the manager or the establishment knows that we were unhappy.

As a society we are quick to complain and reluctant to commend when it comes to service.

When we do get a commendation or positive feedback we need to make sure that we celebrate that just as much, if not more, then when we investigate and discipline for a complaint. We need to put as much focus and energy on the good our providers perform alongside the questionable.

Ask yourself, who handles the good in your organization? If you have a department dedicated to investigations and quality control are they the ones who do it? Is it a function of Human Resources or does your agency have a separate Commendations and Celebrations Unit? If not, then you need to ask who does do it.

If the answer you receive is no one, then it’s time to step up and change that. If you wanted to be a leader, now is your opportunity to become one. If you already are a leader then you’re providers are overdue.

Always celebrate the victories. No matter how small they may seem to you, to those being celebrated it’s a whole lot bigger.

What If Gordon Ramsay Was An EMS Leader?

I am a big fan of Gordon Ramsay. I thoroughly enjoy his Kitchen Nightmares show and desperately want to be a diner in Hell’s Kitchen. So when John Harrington wrote a post on what Gordon can teach photographers, I began to wonder about what Gordon would do if he was an EMS Chief.

EMS is, in no uncertain terms, a service based industry. We do not create products for our customers, we create experiences. EMS can be related to the restaurant business in a simple comparison:

  • Servers – On an ambulance the servers are the EMTs and Paramedics. They need to be courteous and communicate effectively with both the customer and the “kitchen”
  • Food – The overall customer experience from the time the call is placed to the follow-up
  • Decor – The actual ambulance itself, both exterior and especially the interior
  • Hostess Stand – The call receiving center/dispatcher where the initial call is actually received
  • Kitchen – The dispatch center/garage where the experience is crafted before reaching the customer
  • Roaming Manager – The Quality Assurance follow up on the call and the satisfaction level of the customer

All of these areas are critical to creating the experience for the customer.

Ramsay in no uncertain terms demands excellence. When he does not see or taste excellence, he clearly communicates his displeasure. While his methods are usually brash, abrasive, and can be considered over the top, the fact is that he gets his displeasure and his demands across effectively and makes no apologies for them.

As brash as Ramsay may be, what he also does is provide positive feedback and praise when his demands and expectations are met or exceeded. This is a vital aspect often overlooked whenever discussion of his comparatively behavior ensues but an important aspect to understand. Providing feedback constructively, whether it is for a negative or a positive performance is something every EMS Leader (admittedly including myself) needs to do more of.

Do you think Gordon Ramsay would make a good EMS Leader? Let us know your thoughts in the comments…

The Shrinking Difference Between Leadership And Management

The difference between management and leadership used to be very easy to delineate. Alan Murray, the author of The Wall Street Journal Essential Guide to Management: Lasting Lessons from the Best Leadership Minds of Our Time, writes that “The managers job was to plan, organize, and coordinate. The leaders job was to motivate and inspire.[1]” Managers managed resources through edict or memorandum to a metric or a set of metrics, leaders led resources through inspiration to achieving an outcome or a goal. Some Agencies would go so far as to bestow titles on both their managers and their leaders, while others opted for a less structured organization.

In today’s world leadership and management have lost some of that separation. Murray contends that, “People look to their managers, not just to assign them a task, but to define for them a purpose. And managers must organize workers, not just to maximize efficiency, but to nurture skills, develop talent and inspire results.[2]” I can’t help but agree with him based on just the past 5 years of seeing freshly minted providers come into the field with less preparation as those who came in before them, and even the providers 10 years back really weren’t coming in too prepared.

When writing this post I originally titled it “Leadership vs. Management“. After drafting it, pondering, and editing I decided to change the title. Leadership and Management are not in opposition to one another. A leader does not necessarily have to be a manager and, similarly, being a manager does not automatically make you a leader. To be truly successful in this day and age you do need to have skills from both toolboxes.

What remains dangerous is the assumption that because someone is good at one, that they would automatically be good at the other. A good manager is not necessarily a good leader, and a good leader does not necessarily make a good manager. Making this assumption in terms of the food service industry, a good server does not necessarily make a good chef, and a good chef does not necessarily make a good server. While they both work in the food service industry, their roles in a restaurant are quite a bit different.

This is an assumption we often make in EMS. We think that a good provider who can manage an airway will make a good supervisor. We promote them, give them some basic instruction, and then wonder why they don’t know everything there is to managing people. We forget that they’ve had plenty of practice in the classroom managing airways to meet the standard of a model airway. When they got to the field they were able to manage the airway. Granted, that first, second, and probably third managed airway may not have been the prettiest airway, but they managed it, learned from it, and improved upon it. Each improvement brought them to the point where they were able to match the model of a managed airway that was already presented to them. If we just judged their ability to manage airways by that first and second airway, we’d be wondering why they don’t know everything there is about managing airways.

As the differences between managers and leaders shrinks we need to be able to marry the two. While it may not be pretty the first few times, we need to believe in those who have been selected to lead AND manage others. More importantly is that we must give them a model to strive for and set the example for them at every chance we get.

If the providers have been coming out ill prepared for the reality of working in the Emergency Medical Services, then we need to make sure their Manager/Leader is prepared to help them succeed. The failure of one results in a failure, at some level, of all.

[1][2]What Is The Difference Between Management And Leadership?
The Wall Street Journal
Alan Murray