EMS Insider, Expert Advice

Bottom-Up Leadership

When EMS professionals think of leadership we envision the typical top-down, paramilitary leadership structure that most of us have served under.

Top-down, chain-of-command style leadership is so prevalent in our profession that many of us cannot think of how alternatives would work. This structure has long alienated competent, engaged and determined EMTs and paramedics. Employees, especially those “in the trenches,” want to feel that their challenges and issues are being solved. Unfortunately, top-down leadership is not about good ideas coming from the bottom up.

The goal for contemporary EMS leadership is to bring some semblance of collaboration to the table. After all, we expect our personnel to be educated and professional problem solvers. Steve Jobs, an incredible businessman and co-founder of Apple, Inc., said, “It doesn’t make sense to hire smart people and tell them what to do; we hire smart people so they can tell us what to do.” Creating a collaborative EMS agency will empower your employees, build a sense of belonging and increase morale as a teambased approach is adopted.

Within a collaborative agency, leadership is present at all levels, especially the bottom. Once good ideas are received, it becomes incumbent on upper management to strategically plan for those objectives to become goals. Bottom-up leadership in no way reduces the status of upper management; in fact it propels it to new levels. EMTs and paramedics rely on upper management to create the organizational atmosphere that is conducive for both external and internal customers. Simply put; they send good ideas up, and you figure out what and how.

So how can EMTs and paramedics become bottom-up leaders? The answer is something that I believe rests inside most EMTs and paramedics. We are used to critically thinking on our feet, making fast decisions and utilizing the resources that we have at our disposal. These same core characteristics are what bottom-up leadership is all about. We cannot accept the “I’m just an EMT or paramedic” attitude, nor should we be organizationally reduced to the “I just work here” attitude. Bottom-up leaders know the ins and outs of their organization and industry. Bottom-up leaders read EMS articles, foster fellowship with other EMS professionals and take part in the many EMS conferences that are offered around the country. Bottom-up leaders strive for education, both higher learning and hands-on experience. Bottomup leaders take pride in mentoring new EMTs and paramedics because they know the vital importance of teaching good habits and ensuring commitment to our patients and organization. Lastly, the most important characteristic of a bottom-up leader is a positive attitude. Maintaining a positive outlook on your profession and your organization is paramount to overall success. It is easy to pick out the employees who are committed to making their organization work.

Leading from the bottom will not always be a pleasant experience, however small defeats cannot deter you from seeing the larger picture. Not all ideas and solutions may be practical or included in the organizational strategic plan. Bottom-up leaders have to remember that they do not know all the variables upper management faces. Budgeting, political pressures and resource allocation will always weigh heavily on the decision-making process. The more bottomup leadership remains committed to learning this process, the better they will be at determining the practicality of their solutions.

Top-down management worked during the Industrial Revolution when factories produced numerous products en masse. Factories required their workers to produce all day with minimal breaks or interruptions. For the past two decades, however, management structure has evolved. This change facilitated placing human capital as the chief product of all organizations. EMS organizations are no different.

Today’s EMS leadership needs to look at their organization and decide if they are truly a collaborative workplace, or if their dynamic is based on the antiquated factory model. EMTs and paramedics can make significant contributions to their agency, as long as they are afforded the opportunity. EMS has evolved significantly over the past few decades, but our human capital cultivation has remained stagnant. Consider trying to build a collaborative workplace and see the dramatic changes it can bring in.

Roy J. Ward, BS, is a firefighter and paramedic with District of Columbia Fire and EMS.