Serving Those Who Serve
This paper reviews the existing literature regarding theories and values in leadership, specifically servant leadership as it relates to emergency medical services (EMS). The literature indicates that serving leader values affect leader behavior, employee behavior as well as organizational performance. The paper also provides an overview of servant leadership theory by discussing the historical models and how it applies to EMS. The paper theorizes that by training leaders and staff in the serving leader concepts, it can increase productivity, meets the organizational goals and missions and improve customer satisfaction scores (e.g. Press-Ganey).
As you are reading this, you can recollect one (if not many) supervisors (aka “leaders”) that you have worked for or with. I am presuming you only remember that supervisor for the bad experiences. Maybe it was a supervisor who took credit for the work you did? The one who blamed the team to protect their reputation and self-esteem? Or one that passed on unfavorable remarks about your team to the entire office? You’re not the only one experiencing this – so don’t you think it is time for a change? The time has come where you have just been promoted from a paramedic to a shift supervisor at XYZ Ambulance Company. Your organization never sent you to any formal leadership training so you continue to do things the way it has always been done.
You have a battalion of 16-20 employees working under your command at a given time. A team member suggests an idea, you shoot them down, disparage them for approaching you, then take the idea to senior leadership as your own. On another occasion, a crew member provides constructive feedback on the way a scene was handled and you sent them home for insubordination, and you developed a personal distaste for them for critiquing you. This response is a fast track to losing your entire team before you even start. You realize that no one from your shift socializes with you any longer and you begin to feel ineffective and lost. You realized this is not the way to go, so you start doing some research on your own. Why did you want this position as a leader? Was it for the promotion, position of power or pay raise? It shouldn’t be. It should be to achieve a greater purpose, the “why.” To achieve that purpose, take care of your team. If you take care of your team, you will lead them to be successful and motivated to attain purpose.
- The Value of Servant Leadership
- Leadership Sector: Are You a Servant Leader?
- Identifying Toxic Leadership in EMS Organizations
Leadership describes the relationship of interaction between leaders and subordinates that influences the way subordinates behave toward completing tasks.1 Supervisors within organizations are typically focused less on the individuals and more on the company goals. This needs to change, not only for the growth of the company but for both the professional and personal growth of a leader and his or her team. There are several types of leadership theories based on research, with most transitioning toward the well-being of the employee. One theory of leadership that has taken flight over the past 15 years is the theory of “servant leadership.” The active serving leader promotes accountability, transparency and empowerment within the team they lead.
The servant leadership theory encompasses “everything the team does that is right is their fault, everything the team does wrong is the leader’s fault.” This is due to the leader not providing enough training, resources, or failing to lay out the expectations. Instead of placing blame on a team for a mistake, a serving leader looks back and determines if better education, training or simplifying the process could have changed the outcome.
Introduction to Being a Serving Leader
A servant leadership approach is not widely adopted as it is conceptually counterintuitive, a living paradox. I mean, the entire concept is serving those who serve the organization. So how does that define and make a leader? Servant leadership is a leadership style differentiated by the focus on caring and developing employees with an altruistic approach, thereby earning the loyalty of the employees.2 It is driven by high moral and ethical standards and focuses on individual followers’ and societal needs. This desire to serve first and put the interests of others ahead of one’s own is a unique aspect of a serving leader. Think about it as an upside down pyramid. The serving leader is “unleashing the strengths, talents, and passions of those he or she serves.”3 Sometimes, especially for new and well-established leaders, this is a puzzling concept to understand. Through stewardship and service, serving leaders can shift the paradigm of leadership2 from the traditional top-down approach to a bottom-up approach.
For example, I am sure you have heard of Chick-Fil-A and their renowned customer service in fast food. In a 2012 treatise written by Michael Mishler, customer service is attributed to the adoption of servant leadership in the organization. Successful leadership principles such as serving leaders have led to the rapid success of the organization. Strong employee-employer relationships with positive outcomes such as employees’ extra effort, employee satisfaction and perceptions of organizational effectiveness were found in Mishler’s research.4
Servant leadership emerged from the transformational and authentic leadership theories and they are similar in scope, although transformational leadership’s focus is the primary benefit of the leader, while servant leadership’s focus is on the benefit of the follower.5 The transformational and authentic leadership theories also share some common ground with serving leadership styles: integrity, trust, respect and authenticity.
Serving leaders have been written about from the beginning of time. Even before Robert K. Greenleaf first penned the modern concept of servant leadership philosophy in 1970, the concept was mentioned and theorized in many writings in the Bible.
What Is Servant Leadership?
Retired AT&T Executive Robert K. Greenleaf was the originator of servant leadership and defined it in 1970, “The servant-leader is servant first. It begins with the natural feeling that one wants to serve. Then conscious choice brings one to aspire to lead. The best test is: do those served grow as persons: do they, while being served, become healthier, wiser, freer, more autonomous, more likely themselves to become servants? And, what is the effect on the least privileged in society; will they benefit, or, at least, not be further deprived?” In simple terms, a serving leader is a leader who is concerned for the growth of the people he is serving.2 “You’re in charge to charge up others!”3
Mark G. Ehrhart put forward a seven-characteristic model to measure servant leadership. The model includes (a) forming relationships with subordinates, (b) empowering subordinates, (c) helping subordinates grow and succeed, (d) behaving ethically, (e) putting subordinates first, (f) having conceptual skills, and (g) creating value for those outside the organization.6
More than that, written in Concepts and Connections, the newsletter of the National Clearinghouse for Leadership Programs in 2000, lists a set of ten characteristics for the servant leader that was of critical importance. They are: listening, empathy, healing, awareness, persuasion, conceptualization, foresight, stewardship, commitment to the growth of people and building community.7
No matter what concept you read, servant leadership all comes back down to the people side of leadership. This includes aspects like: helping, serving, being honorable, authentic, and empathic, behaving ethically, healing, and accepting.
First, a leader must form relationships with their subordinates. Being a serving leader means that everyone has a say at the table and there is not one single person who gets the “big chair” or the “little chair.” Each voice matters and there needs to be equality formed between the partners or team. A serving leader needs to be open to this collaboration to listen and reflect on what is said. When working out a solution for the deployment of the new cardiac monitor to the field, all partners who will be impacted should have a say and as a team, a solution should be formed and rolled out to leadership. A leader can quickly lose accountability if they are provided that recommendation from the team and changes the deployment method to fit their needs versus the team. If a leader excludes the employees from being part of a solution or all out disregards input from the employees, it leads to distrust and lack of feedback when it is called upon in the future. When a leader can put his or her ego aside, it builds the self-esteem of the team and allows them to work together in harmony – and use the cardiac monitor that they selected!
Next, a serving leader must empower their team to be autonomous. I know what you’re thinking, my team sometimes makes bad choices, then I must ensure they do the right things. Ever hear of the term micromanaging? The primary reason that managers micromanage is a lack of trust. Whose responsibility is it to teach them how to make choices that encourage efforts to meet the goal and mission of the organization?
It is the serving leader’s responsibility to teach this. You should not have programmed robots that follow orders. The idea of following directions has been embedded in us since kindergarten. Is being a robot beneficial in EMS? Not really! You should have people who can think, solve problems and take action – the ideal clinician. This theory should be supported by the leader and not discouraged. When you have a micromanager in charge of a group, this beats the team down and eliminates any self-thought and autonomy. The micromanager now has to deal with the minutia of daily operations versus administrative tasks and the greater vision of the organization. Not only does it bog down the leader, empowering junior members of your team to make decisions builds trust, self-esteem, and confidence – all parts of a developing leader. Think of it as a cascading, teaching waterfall! The serving leader must move the boulders out of the way of that waterfall to eliminate any distortion in the flow so that the message is uninterrupted from one team to the next. One example is a leader passes on to his team that community engagement along with free health screenings needs to start again post-COVID.
Once the team receives this goal, they come up with a plan but have roadblocks such as funding and lack of personnel. It is up to the leader to remove those roadblocks or seek alternative pathways to ensure that the waterfall continues downward. Once these roadblocks are neutralized, a plan of action can now be deployed by the team, which was peer-developed, and thus they have ownership of how that plan is executed. Once community events start taking place, our providers can now teach our customers (patients) how to get involved in the health care system and possibly provide direct referrals through a local health system. This maximizes customer satisfaction and uses multiple teams within a health system to achieve the mission of community engagement and accessible health screenings.8
What happens when you water and nurture a plant? It grows and leads a flourishing life. A serving leader needs to constantly water their team and provide whatever training and resources they need to fertilize them. This will allow them to mature and empower the decision-making process that clinicians require daily. Have you ever had an employee with a bad attitude, the one always blaming other people, always being counseled? If nothing else has worked, try putting that employee in charge of something that matters and that will provide a challenge. I know it seems counter-productive, but it may be that the employee is bored and not being used to the best of their ability.8 You may be surprised by the results! Healthcare organizations, such as Cleveland Clinic, take this a step further and enrolls every nurse through serving leader training.9 By doing this from orientation into the organization, it already begins to water the seedling, and as it matures through tenure, the concepts of being a serving leader is already embedded into a daily routine.
A serving leader must lay out the expectations of his team in the beginning, so they know what is to be expected.8 Once the expectations are known, the team members can then begin to make ethically sound, autonomous decisions without seeking time-delayed approvals from leaders. In EMS, sound, autonomous decisions are essential as many of our clinicians operate independently, removed from leadership and direction. Yes, we have medical direction, but sometimes a non-clinical decision needs to be made that cannot wait for approvals through the chain of command. A serving leader should ensure every person in the team knows how important they are to the overall goal and mission of the organization as part of this expectation.
Provide the high expectations of a team, don’t waiver when those expectations are met and you will see that the team will rise to the occasion. When you build your frontline team, they will, in turn, build up your customers – patients, emergency rooms, receiving facilities, etc. With enough dedication to the concept, the organization as a whole will build customer satisfaction and referral source scores. One example to promote high expectations are changes to performance-based merit/benefits. A blanket team versus an individual merit offering may drive team results. When a team member does not meet the expectations of a team, coaching may increase performance. After coaching, if the team member still does not perform well with the team, it should be up to the leader to find an alternative perspective position internally or externally.
A serving leader should never know everything. A leader who acts as if he or she knows everything quickly loses respect from the team.8 If you need help with something, ask for it. Stepping down and learning frontline skills shows compassion builds respect with the team. As a shift supervisor, you may not know what equipment the flight team uses, how to dispatch a 911 call or, operate the wheelchair lift of a mobility assistance vehicle (MAV) vehicle. Know and understand the capabilities of your team, without this, you cannot build trust. Without trust, you cannot form relationships.
To build trust, trust in your team. Start in small increments. Allow a 911 communicator to logistically manage two or three long-distance runs with limited resources in a shift. Allow the team to staff a special event and allocate resources as needed. When the employees are successful at a task, provide greater responsibility. Allow them to chair a committee to change the way a drug is given based on evidenced-based models or seek recommendations for new primary equipment bags. For any failures, provide some oversight and direction and get them back on track again. Mistakes will happen along the way, but use these mistakes as a learning opportunity. The more trust that is built, will lead to autonomy among the team. In general, people do not want to fail. When the team is making decisions that affect them directly, they are more encouraged to “do the right thing.” Without trust, leadership falls apart.
Build on the strengths of your team. You can never build your team when you put all of your focus on making the weaknesses better. All that does is make that weakness passable. What if you built on the strengths of what the team brings to the table? You make an already strong project, stronger. When all members of the team participate, that is where success happens. When you use the strengths of your employees, they will be more engaged, more proactive in the sense that they feel included in the overall mission or goal, whatever it may be.
Drennan and Richey said the importance of satisfying the human need for affiliation and creating a sense of belonging is needed to improve organizational performance. Those employees who do not feel a sense of belonging and affiliation were unlikely to contribute feedback and ideas to the organization.10
U.S. Navy SEAL and author Jocko Willink says in his book Leadership Strategy & Tactics that it’s “all on you, but it’s not all about you.”8 Being a serving leader is many things, such as: building and strengthening your team, transparency, being humble, trust in both yourself and the team, and eliminating obstacles that get in your way. Ultimately, a serving leader and the team he or she is affiliated with does all these things to achieve a purpose.3 The purpose is the foundation in which you build all the traits of servant leadership. That purpose can be a multitude of things: providing community medicine to specific parts of your area, incorporating social workers into emotionally disturbed person (EDP) responses, or as simple as being able to transport 10 discharges home during a shift to make room for an ED that has twice that many in admission holds.
It is not easy. All the traits of a serving leader make you vulnerable in front of those that you are supposed to be in “charge” of. Being a leader is not made to make you successful, it is making your team successful. If your team succeed, you win and the organization wins. Leadership is not for everyone, yet anyone can be a supervisor or manager. Do you need to be in a promotional role to be a leader? No, you can easily take any part of this brief introduction into this leadership theory and adopt it into your daily routine.
The opinions expressed in this manuscript are those of the authors. The author certifies that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.
There is no clinical trial registration number affiliated with this manuscript. This is not a research or study; therefore, no methods are included with this manuscript.
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- Greenleaf R.K. Servant leadership: A journey into the nature of legitimate power and greatness. 3rd ed. Paulist Press: Mahwah, NJ; 2002.
- Jennings K.R. The serving leader: Five powerful actions to transform your team, business, and community. 10th Anniversary ed. Stahl-Wert, J. San Francisco, CA: Berrett-Koehler; 2016.
- Mishler M. Eat More Chicken and Lead More People: Perceived Measures of Servant Leadership at Chick-fil-A. 2012.
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- Small D, Small R. Patients first! Engaging the hearts and minds of nurses with a patient-centered practice model. OJIN: The Online Journal of Issues in Nursing. [Internet]. 2011 May 1 [cited 2021 Mar 25] ;16(2):109-20. Available from http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-16-2011/No2-May-2011/Patient-Centered-Practice-Model.html
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