By: Clark Staten, EMT-P
EMS District Commander
Bureau of EMS
Chicago Fire Department
Chicago, Illinois
Many authors and educators have discussed and compared both traditional and non-traditional EMS management styles. They have advocated various theories, and many different styles are in practice throughout the country. In recent years, however, EMS leaders have begun to question the validity and effectiveness of the more traditional methods. Examining the following models will lead to a better understanding of the implications of some of the easily recognizable "leadership" methods.
This system is characterized by methods routinely taught by the U.S.armed services. It is an autocratic system with a well-defined chain of command, predicated on strict adherence to prescribed rules, regulations, policies, and procedures. The system is highly structured and does not lend itself to change readily or quickly. Communication between senior administrators and entry level workers is frequently severely restricted by any number of layers of middle-level managers, who filter any flow of information either up or down the chain of command. These systems also frequently place a great deal of importance on rank insignia, uniforms, and other symbols of empowerment. The strengths of this model include continuity of command, well-defined expectations for employees, a structured environment and a generally well-developed disciplinary system.
The arrival of numerous private companies managing prehospital care in communities throughout the country, on a contractual basis, has begun to shape a trend toward conglomeration and corporate development A typical example is the ongoing practice of purchase of several ambulance entities by a major hospital and private corporations. While hospital-operated ambulance services are nothing new in the world of EMS, the recent trend of acquiring existing services to ensure control of patient flow, within a community, is a new development. Corporate image management is sometimes an attempt to achieve maximum utilization of emergency department personnel (nurses, technicians, and physicians), while maintaining control of prehospital care.
This method of leadership is frequently encountered in volunteer and less tightly structured rescue organizations. It is characterized by the lack of a clearly defined plan to meet the goals and objectives of the group. Laissez-faire management often falls into the trap of "management by crisis"; namely, the leaders of the group react to ongoing problems rather than take a proactive stance and anticipate problems...
Often standard operating procedures are passed from a senior rescuer to a recruit and interpreted on an individual basis. The leadership of these organizations is decided by popular elections that do not really consider the candidates' merit. The leaders, who are dependent on reelection in order to maintain their power base, are less likely to enforce existing policies because they may lose popularity. This system seems to have ongoing problems with staffing and continuity of control issues. This management style is also frequently tied to dependence on fiscal support from various publicly elected officials or boards, who provide for the financial needs of the organization, when it is politically expedient. The strengths of this system are great flexibility, ease of change, volunteer spirit, political empowerment, and democratic principles.
The mixed style of management may seem to have taken the best of several models and incorporated sound business practices into the often chaotic world of EMS. But frequently, an attempt at combining management methods results in a "cookbook" or algorithm method of controlling the behavior of employees. The difficulties involved in this method are that various preconceived strategies must be applied to any number of dynamic problems. These prepackaged theories may not be tailored to specific concems. While Maslov's hierarchy of needs, analysis of personalities, and other management theories may be given credence in this system; they are all too frequently considered the be-all and end-all answer to complex leadership issues. The record suggests that this might not be the case. The strengths of this model include success if the proper "recipe" is chosen, adaptability, hiunanistic attitudes, and leadership understanding of employee problems.
The critical assessments presented so far in this article are intended not to criticize overtly any manager or EMS system but rather to point out weaknesses and faults that may result in ineffectiveness and confusion. It is said that we will never live long enough to make all the mistakes ourselves. As effective managers, we are responsible for leaming from the mistakes of others. In light of this attitude, I submit the following proposal for consideration.
Participative management is admittedly a synthesis of several management theories. Combining the best of several theories with a variety of state-of-the-art ideas may result in a leadership style that exceeds the capability of any single model or previously conceived combination. The basic principle in this leadership model is to involve all of the employees and managers actively in a common goal. This overall goal must be clearly defined and understood by everyone. It is best accomplished by direct face-to-face communication among all employees and all managers.
On discovery of the well-defined goal, employees and managers must then set about developing secondary goals and rational objectives to meet the group's responsibility. Each goal or objective is then given to a subgroup for study. These smaller groups are commonly made up of employees and managers with a particular expertise or interest in the issue at hand. Employees or managers who are especially vocal concerning a given issue might be included in the study group for that issue. Some typical examples of group topics include:
Each subgroup should elect a discussion leader and a recorder. The responsibility of the discussion leader is to focus group meetings, and the responsibility of the recorder is to present an accurate record of the group's activities. Subgroups should meet regulary for a limited amount of time. An agenda for each meeting is a necessity; agenda items may be referred by the group or by members of the management team. It is important for the subgroup to present a consensus within a set of previously established time constraints. In other words, with each topic comes a time frame for ultimate decision. If necessary, the group may issue a majority and a minority opinion, but only when a group cannot reach a consensus opinion regarding a single issue.
Participation in each subgroup should be limited to 15 members or fewer, to facilitate effective decision making. An odd number of members in each group will assist in establishing majority versus minority opinions. It is imperative to include medical control/medical advisory personnel in discussions involving patient treatment and medical management issues.
Members of the existing management team act as facilitators within the groups. Each group should include a minimum of one staff member (a middle or upper manager) with a particular interest or expertise in the group's topic. This management person should provide the group with pertinent information and resources necessary to accomplish the group's task.
The staff member is not necessarily the group leader unless elected by a majority of the group members. Frequently, the group is better served by electing a rank-and-file member as group leader, rather than a management team member. However, the assigned manager is responsible for assisting the discussion leader in maintaining decorum and maintaining a focus on the group's assigned activities. Additionally, the discussion leader, recorder, and management advisor are jointly responsible for preparing and presenting the group's decisions and opinions to the Chief Executive Officer (CEO) or Chief Administrator of the organization.
Upon presentation of oral and written reports by individual topic groups, the CEO may do any of the following:
Creative managers will undoubtedly discover other options that correlate to situations in their particular systems, but it is important to ensure that the groups are aware of anticipated management responses to their recommendations and that every report receives a prompt answer.
For participative management to assist effectively in the management of an EMS system, it must foster communication among all workers and managers in the system. It is equally important for the study groups to address issues of concern to management as well as the welfare of the employees.
Prudent managers will refer appropriate items to each study group for consideration on an ongoing basis. Managers should assign time guidelines to each project to allow for an effective planning process and should constantly direct their efforts to finding the most cost-effective method of implementing study group recommendations. In fact, one of the study group's charges should be to prepare an economic impact statement for each suggestion that is presented.
Nothing recommended in this proposal should be construed as a degradation or diminishment of the responsibility or authority of an emergency manager for the effective operation of his or her system. This participative management style may, however, allow for maximum communication and shared responsibility within an EMS system. Often, worker participation in decision making adds an additional dimension to employee/employer relationships, due largely to employees' perception they have a vested interest in the decisions that have been made and that they can have direct input into the environment and working conditions surrounding employment in the EMS system.
The employer's chief advantage is an ability to share responsibility for difficult decisions and to obtain continued cooperation and input into the system's operation. This proposal will undoubtedly be refined further, and EMS managers are encouraged to adapt the ideas in this article and modify them to fit individual systems.
Electronic (c) Emergency Response & Research Institute, 1994-95
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