Point of View: Closing the Gap Between Medics and Managers

Recently I was talking with a close friend of mine who is a street paramedic and the subject of the current state of EMS management came up. My friend bemoaned the ongoing disconnect she saw between field EMS providers and the majority of the administrative types (aka "white shirts").

Later that evening, I continued to mull over our discussion and her comments. I wondered how many other field providers have similar opinions of and experiences with their management staff. Does a lack of communication between the two groups prevent great ideas or important insights regarding existing operations from rising to those who can do something about it?

To take the temperature among a wide variety of people functioning in both provider and management positions, as well as those who work in fields tangential to EMS (i.e., nursing, public health, consulting, etc.) I turned to a trusted collection of individuals willing to give me an honest perspective when asked--my Facebook friends! That night I posted the following question to my Facebook page: "What's the one thing you would tell your EMS agency management team to help get your system moved forward?"

The answers that emerged were enlightening and could be grouped along several universal themes, including:

• Stay current: Managers must make it a priority to stay in touch with advances in the field. Whether that is accomplished by reading various trade magazines, such as EMS World Magazine, or attending relevant industry conferences, get out there and read/see/hear what is being done by other EMS agencies. Who is doing the advancing and how are they doing it? Also, stay open to organizational lessons from non-traditional teachers. Great ideas can come from entities that seem far removed from the delivery of emergency medical care.
• Be a role model: Professionalism starts at the top. Field providers take their cues from how managers and senior staff comport themselves, both in appearance and behavior. Know the department's mission statement and seek to invest it in day-to-day operational decisions. Get the rank and file invested in the mission statement by making it a living, breathing part of the organization.
• Be open to change: Fear of failure can prevent a good company from being great. When the system is broken, be courageous enough to step up and address the problems as well as the necessary corrections.
• Demonstrate real leadership: There is an art to leading and doing the "right thing for the right reason." The relationship between management and staff works best when leaders can say, "follow me" and not just, "DO THIS." A very simple way to obtain this is to listen -- listen and you will understand what your employees need to do their jobs versus the "nice to haves" that are seen as perks. By first filling the needs of your employees so they can fulfill the mission of the organization, it will be easier to find the time/money/energy to address the things they want. This can only benefit your company and ultimately the patients you serve.
• Encourage goal-oriented behavior: While a good deal of work in our profession is often strictly guided by specific medical protocols, government regulations and agency policies, there comes times in our profession where what actually makes the greatest difference is the art and not the science. To quote one of the posts I received, "the soft skills, the intangible things, are often the difference between a good system and a great system." If field providers are empowered to do what is right, even when the official guidelines don't cover a specific situation, it is then that your EMS agency really shines. Getting to that level of trust with your rank and file can take a lot of time and effort through a combination of ongoing education and active positive feedback, but the results are worth it.
• Think about the big picture: Just as everyone is doing more with less in this bleak economic climate, EMS will not escape the pressure to maintain services while having to cut resources. Having to think more economically and efficiently about operations, one way to deal with reduced supply is to affect demand. Repurposing some of our resources to help address the ongoing issues of chronically ill patients seeking emergent rather than primary care or residents in need of social services abusing the health care system, can help decompress not only the hospital EDs, but also requests through 9-1-1. Street crews see these same issues play out day after day without anyone paying attention to possible solutions. Partnering with other community resources can help to shift our mission to include prevention actions to stop these cycles. Instead of continuing to taxi chronically ill and repetitive patients to overcrowded EDs, efforts can be made to direct them to better and more appropriate pathways. While there is no quick or simple answer for implementing prevention, and current public funding is structured around transports, the future of EMS may hinge upon how well managers and leaders can think outside the old paradigm of emergency medical response.

Close the Gap

Most of the comments elicited made it clear there is a gap between what EMS field providers face each day on the street and the way management seems to view these same events.

Perhaps this Facebook post, and the resultant answers, can act as a wake-up call of sorts for management to try non-traditional methods to reach out with greater frequency to the crews delivering frontline care in their systems. If nothing else, it should show the benefit of having something as simple as an old-fashioned suggestion box.

Raphael M. Barishansky, MPH, is chief of public health emergency preparedness for Prince George's County (MD) Health Department. A frequent contributor to and editorial advisory board member of EMS World Magazine, he can be reached at rbarishansky@gmail.com.

The author would like to thank the following people for their perspective: Katherine O'Connor, Timothy Perkins, Drew Posner, Tracey Loscar, Dave Williams, Yael Nelson, Tim Phelan, Kelly Grayson and Skip Kirkwood. He also begs the forgiveness of those whose names he has left out.