EMS Leadership Needed Now

Are you taking the right actions to prepare for the future?

There’s no doubt that EMS will look different a decade from now. There will be new system models, new government regulations, new reimbursement approaches and an explosion of data and new technologies with which to cope. EMS is also facing a major transition due to the increasing number of senior leaders reaching retirement age.


My crystal ball remains a bit murky. Changes to reimbursement, reform efforts, accountable care organizations and other key drivers are challenging to forecast. That said, forward-thinking EMS leaders understand that regardless of government reform initiatives, becoming more closely aligned with the larger healthcare system and focusing on outcomes is a winning strategy. It’s also the right thing to do for patients.


Progressive EMS systems have been working to define and improve quality and customer satisfaction outcomes in recent years, but there haven’t been compelling financial reasons to spend the time, money and effort to change. However, as future financial incentives evolve away from EMS being paid only for transport, the focus on managing processes (e.g. response time performance and protocol compliance) to improving outcomes will have a higher priority.


EMS agencies that leverage core competencies across the full continuum of care (including expanded roles in prevention, home health interventions and providing ongoing patient monitoring using its communications and data infrastructure) to help keep customers out of the hospital, healthy and happy have a higher potential for success. In contrast, organizations and leaders that think they don’t have to evolve or can simply continue to do what they’ve always done, will be significantly less competitive in the coming decade.


Thinking strategically, building strong relationships with care partners and demonstrating value are central to this evolutionary process. The days of the ego-driven EMS leaders are over. It’s not about you or your agency but how your agency fits into the larger system of care. The real question is: Are you taking the actions required to prepare for the future?


The prospect of dynamic change has produced an unusual amount of anxiety for EMS leaders and followers alike. Some have coped reasonably well. But others who fear change have developed a bunker-like mentality, and as a result, their EMS organizations are becoming terminally lethargic. They set safe goals, say safe things and make safe choices. Even worse, those deeply gripped by fear often flail around like someone encountering a bee, thinking the best way not to get stung is to wave hysterically.


The actions of those controlled by fear are often disproportionate to the actual fear being faced. When an EMS leader flails around in response to fear, both caregivers and the patients they serve suffer the consequences.


Our job as leaders is to reduce fear, moving our organization forward through empowerment to achieve sustainable outcomes.


According to Bill Johnson, author of the 2008 book Courage Goes to Work, “individually and organizationally, people can generally be divided into two camps: safety seekers and opportunity seekers. During times of heightened anxiety or uncertainty, such as now, Camp Safety swells with refugees. Just when our organizations need us to provide groundbreaking (and tradition defying) ideas, we are, instead, hunkering down beneath our desks.”


To move people from Camp Safety toward opportunity, we have to break down the leadership challenge into manageable, bite-size pieces. Johnson’s ideas include:

  • Be mindful of the risks of not risking: The risk of inaction is usually more perilous than the risk of action. As you consider an action, be clear about the dangers of not taking the risk, too.
  • Ask the holy question: What do you want to happen? Most leaders don’t take the time to answer that question with specificity. Those that do are in a much better position to figure out the actions they need to take to get the desired result.
  • Have something to prove: Take on challenges that cause you to have to prove yourself. When the going gets tough, having something to prove can be a source of energy and motivation.
  • Make forward-moving mistakes: Making no mistakes is just as dangerous as making too many. Have you ever tried to turn the tires on a parked ambulance? Changing direction and correcting mistakes is easier when it’s moving forward than when parked. As long as the mistakes are forward-moving, you are making progress.
  • Harness fear: Fear is a normal, natural and necessary part of the work experience. Although uncomfortable, fear has energy, and that energy can be useful when facing challenges. Harness your fear by spending time with it. The more you experience and confront the thing you are afraid of, the less of an ogre it becomes.
  • Jump first: The best way to encourage those around you to be more courageous is to be more courageous yourself–first! Ask yourself, “When was the last time I did something courageous that left a favorable impression on those I work with?” In other words, when did you last jump first?

Aristotle says, “Courage is the first of human virtues because it makes all others possible.” Aristotle was right. Courage is the primary driver of any action.


It takes courage in EMS to be a forward-thinking leader and to challenge conformity and tradition. It takes courage to get out of our boxes and service paradigms. It takes courage to come up with a new idea, pioneer it and implement it. It takes courage to develop and embrace the future leaders of our profession. Courage as an EMS leader is something we live, not something we tell others to live. And we do it by talking less about courage and acting with courage more ourselves.


The next decade for EMS will certainly be a time of transition. Will you seek safety or opportunity as you move toward the future?

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