A recent multi-casualty event in Memphis (Tenn.) had me playing different roles and wearing different hats virtually within minutes of each other. One second I was chairing a meeting; the next second my pager went off, and Communications told me we had eight stabbing victims at a national-chain grocery store where a disgruntled employee had taken out his anger on co-workers.
I responded to and assisted at the scene, and while driving back to my office I thought about how often other EMS managers suddenly find themselves in different roles and, as a result, may end up issuing orders in different ways. What we must keep in mind at all times is that the way we conduct ourselves in the office when providing direction to employees should differ from how we conduct ourselves on scene, issuing orders to crew members.
When you give orders, on or off scene, you're making a demand of someone. Telling one of your subordinates to "clean that ambulance" is a definite order. When you give an order, you eliminate any autonomy about what to do or how to do it.
However, this management style is traditionally not a good one because it doesn't allow your employees to determine the best way to figure out a problem or to take responsibility and learn for themselves.
Telling the subordinate that you "expect the ambulance to always to be clean" is another way of conveying the message without giving adirect order. When you say what you expect, rather than giving an order, you give staff the latitude to come up with a way to complete the task. It may not always be the best way, and you may have to do some monitoring and guiding, but there's also the chance that they'll come up with something better than what you had planned.
The point is that when employees are given instructions instead of orders, they have to think. They can't just do what they were told and say they were following orders. They have to consider ways to get the job done, decide which is the best way and invest themselves in the solution.
Also, when you provide instruction and let your staff decide for themselves how to accomplish a task, you're more likely to get their buy-in and support. If they've made the decision about the best way to approach the task, they will likely believe it's correct and valuable and will defend it against others who question it.
Going back to the clean ambulance example, let's say you have three shifts but one shift isn't keeping the ambulance clean. If you issue an order to only that one shift, the crew may feel unfairly blamed for a dirty ambulance, begrudge the unfair balance of work distribution and resent the other two shifts. Instead, what you want is for all three shifts to come together with a solution. Perhaps they'll recommend that one shift always clean the outside and wax, the other shift clean the inside and the cabinets, and the third shift clean the cab and handle preventive maintenance issues. If they come up with the solution on their own, they'll be more likely to stick to it.
Thus, orders are mainly appropriate for on-scene interaction when there is no leeway for debate and no latitude. "Transport this patient to XYZ Hospital" leaves no room for interpretation. You can take it further if you need to be clearer: "Transport this patient to XYZ Hospital as soon as possible, and let me know when you're en route." A good EMS manager makes orders clear so there's nothing to hear but their actual intention.
Your job is to get things done, and sometimes it means getting things done through others. But when you give orders, you limit the result to your level of expertise. On the other hand, when you give instructions, you let your subordinates add what they can to the solution. If the result isn't up to your expectations, it may indicate that your staff needs further training. However, if the result is better than expected, you have a subordinate who feels involved and motivated, and your whole team looks better for it.
So the next time you start to give an order and you're not on scene, give instructions instead. If you let your staff figure out solutions for themselves, the results will probably be better for both of you.
Gary Ludwig, MS, EMT-P, is a deputy fire chief with the Memphis (Tenn.) Fire Department. He has 29 years' experience and previously served 25 years with the city of St. Louis, retiring as the chief paramedic from the St. Louis Fire Department. He is vice chair of the EMS Section for the International Association of Fire Chiefs and can be reached online atwww.garyludwig.com.