Administration and Leadership, EMS Insider

What Makes a Great EMS Organization?

I was recently again asked to describe what defines a great EMS organization. My answer to this question for decades has always consisted of a time-tested recipe associated with High-Performing EMS agencies that utilized “smart” business practices to empower what I have come to call the “EMS Success Triad:” The ability to balance patient care, employee well-being and long term financial sustainability.

Most of my career has been focused on perfecting one of these three pillars: Long-term financial sustainability. To me personally, this was the most important of the triad domains, as the other two couldn’t exist in my mind without this one fundamental element being first met. 

Although I espoused to everyone the need to balance all three in order to be considered successful, in practice, I was unable to help the EMS agencies I led to fully achieve this balance—mostly because I didn’t completely appreciate nor did I comprehend how to successfully achieve the other two pillars. 

I understood their importance and believed I had a good grasp on these domains, but I fell prey to the concepts of unconscious and conscious incompetence: Not knowing what I didn’t know, and knowing what I didn’t know but doing nothing to fill this knowledge gap. 

If You Can’t Measure It, Can You Manage It?

It wasn’t until recently, when I was challenged by the true masters of the other domains to consider their impact, that I was awakened to methods that objectively achieve and measure success in these obscure but fundamental success pillars.

Being a pragmatic “if you can’t measure it, you can’t manage it,” kind of leader, the other two pillars seemed “soft” to me. Measuring success was undefined, academic and subjective in nature, couldn’t be measured, and therefore couldn’t be professionally managed.

Boy was I wrong!

Healthcare has long understood the importance of measuring things. While not perfect, healthcare’s incessant focus on measured quality outcomes and measured employee engagement have opened my eyes onto the ability to practically measure what we once thought was unmeasurable in EMS. 

Morale can now be quantified through measuring employee engagement; clinical value can now be quantified and defined in terms of measuring care processes and outcomes founded in evidence based clinical practice alignment.  Value and return on investment can now be further defined beyond margin, response times and Utstein return of spontaneous circulation (ROSC) rates by highlighting downstream cost and quality impacts.

Although it’s an amazing time to be in EMS—especially for those of us that traditionally manage by measures—it’s also an amazing time to apply smart, scientifically-based methodologies to what were often considered “soft” or “soulful” skills for EMS leaders.

Being a Soulful Leader in a Soulful Organization

The concepts of developing a successful culture and having great organizational morale—what many consider the foundation of successful employee wellbeing—were once an evolutionary side effect of naturally talented leaders caught by the EMS bug. These concepts can now be quantified and taught to those of us for whom these skills may not come naturally.

The masters of this domain call this being a “soulful” EMS agency and leader. This concept wasn’t in my arsenal until I realized that to be truly smart, you also need to be truly soulful. 

Leadership science (the study of what elements make up successful leaders and organizations) has come of age, and the findings and teachings of this acumen should be in the arsenal of every business-savvy EMS agency and leader who desires to have a truly balanced, succcessful agency—especially for those of us where this acumen doesn’t come naturally.

Developing Yourself

As I have learned, the first element towards moving your organization into its soulful shoes is to know yourself. Self-development and  embracing leadership science to assist one’s self-development appears to be key in addition to having a mentor.

Have you ever taken an IQ test, the Myers-Briggs Type Indicator test, the Emotional Intelligence 2.0 test, the 360 Evaluation or Strength Finder 2.0 tests? These evidence-based tools can be used to help you better understand your personal traits, but more importantly, help you define what personal traits can be improved upon and which ones cannot. 

For example, leadership science suggests that you can’t change your personality or IQ, but tests can be used to help you better understand your strengths, and more importantly, your blind spots and weaknesses—as well as those of others on your team. However, leadership science also suggests that having a strong level of emotional intelligence is considered a key variable of most successful leaders (regardless of personality or IQ), and the best part about emotional intelligence is that it can be improved upon over time. 

Additionally, having a mentor (or a few mentors) is an important variable in self-development. It’s a mentor’s job to provide a haven for learning, sharing of experience, confiding and providing a safe space to think through personal and public challenges and situations in a consequence-free environment.

Developing Others

Once you have worked to know and develop yourself (a lifelong journey in my opinion), you can then start the necessary work on developing your team and the organization. Like self-development, this work must be intentional and engineered in process. 

We recently started down this organizational journey with our team. It’s been fraught with potholes, bumps, bruises and hurdles, but what worthwhile change doesn’t include these?

Thus far, I have found that soulful organizational development requires three key ingredients

  1. Individuals who have been working to develop themselves and have been able to significantly raise their individual levels of emotional intelligence;
  2. A framework to follow that creates a shared vernacular and roadmap; and
  3. A vision of what they’re trying to achieve as a team and as an organization, from a cultural and performance standpoint. 

With these elements in place, a journey toward achieving the soulful side of the success triad can begin, and becoming one of the best EMS systems is now possible. 

I encourage all EMS leaders to challenge their own personal development as well as that of their team members, and use the tools I have highlighted in this issue of EMSOLOGY for further development. Using these key points will set the foundation needed to develop the soulful part of their organization, and position you for success. 


EMSology: The Art & Science of EMS

This is the fourth article in Jonathan Washko’s EMSology series, which aims to share the wealth of knowledge and wisdom that Jonathan has gathered in his 30-plus years in EMS. 

He’s worked with countless EMS agencies at both the bottom and top of their games from around the U.S. and other countries.  This series covers a variety of topics, along with best practices learned from other leaders in the industry. 

EMSology includes commentary on a variety of important topics, including: 

  • Healthcare models and policy changes;
  • Leadership and mentoring; 
  • Process improvement; and
  • High-performing teams.

To learn more about how you can integrate your EMS system into a coordinated healthcare system, look to NAEMT and AIMHI on the web for resources, follow @EMSOLOGY or @JonathanWashko on Twitter for for quick insights and links to other resources.