Pack Mentality

      In my household it's tempting to measure the passage of time in dog years. Maybe that's because my wife and I are outnumbered by four-legged companions: two dogs and a cat who thinks he's a cocker spaniel. For those of you not certified in ACAS (Approximate Canine Age, Supposedly), one dog year averages seven human years of existence. That's a lot of living crammed into 12 months; hence the expression "party animal."

   I'm only eight canine years old, which is why I'm such a big fan of ACAS. I didn't get started in EMS until I was, let's see, 5½--a lot later than most. While you old dogs were rotating tourniquets and transmitting telemetry from small suitcases, I was into my second decade (my first "dog-cade") as a corporate carnivore. This was in the '80s, when a whole genre of business books tried to distill profitability into a few buzzwords and homilies. Most of those works were of less consequence than the average music video, but one book that still engenders almost biblical reverence is In Search of Excellence by Tom Peters and Bob Waterman. Although my copy is looking a little jaundiced, its content is as relevant and thought-provoking as it was when Rex--I mean Reagan--was in the White House.

   I retreated to my bookshelf this morning because I've been preoccupied with the future of our industry. I blame my colleague Skip Kirkwood, who has a knack for raising and clarifying significant issues such as enhanced education, quality of care, and compensation. Recently Skip tackled EMS inertia, our tendency to resist change even when there's evidence some of our practices are ineffective and obsolete. Part of the problem is parochialism--regional chauvinism that subordinates global imperatives to local customs. I agree with Skip that "courageous leadership" is needed to infuse EMS with something more than personal preferences and anecdotes. In Search of Excellence is a robust resource worth examining.

   The essence of the book is the authors' claim that they discovered eight characteristics common to well-managed companies. Seven are relevant to EMS:

   A bias for action. As emergent care providers we're trained to take action. Do something rivals Do no harm as a prehospital imperative. Some of us lose that proactive predisposition when we acquire supervisory responsibilities. Are we too worried about political correctness and executive backlash to try new solutions for old problems? Who among us will dare to be different?

   Close to the customer. Most EMS providers know not to let long hours and low pay interfere with good medicine. Are we equally uncompromising about patient advocacy? When we allow some citizens' system abuses to foster an us-against-them attitude, we tarnish not only our own reputations, but also the public's perception of our profession.

   Autonomy and entrepreneurship. Street medicine offers more autonomy than most occupations. Providers who require lots of hand-holding probably should consider other careers. Entrepreneurship, uncommon at EMS's administrative levels, is much more prevalent among the rank and file, many of whom rely on multiple revenue-producing activities to pay bills. Smart managers nurture new ideas and encourage innovation, regardless of the source.

   Productivity through people. Leadership isn't about organizing gripe sessions and group hugs; it means giving workers the tools to succeed, then expecting them to do so. Delegating responsibility is part of the process, but employees also need feedback about corporate objectives and control over their areas of accountability. The headline from management should be "I trust you," not "I like you."

   Hands-on, value-driven. Talking about values is easy; instilling them is hard work. Good examples must be set from the top down. If your boss preaches safety, then assigns you and your partner to a rig with paroxysmal electronics, the message is "Everyone for themselves."

   Simple form, lean staff. This tenet is about decoupling complexity from growth. As companies expand, practical limitations to each administrator's scope of responsibility dictate new reporting relationships. Decentralization and flexible, user-friendly systems can minimize layers of management and facilitate bidirectional flow of timely information. However, we must guard against unrealistic corporate expectations that often accompany indiscriminate paring of staff.

   Simultaneous loose-tight properties. Even a decentralized organization with lots of low-level empowerment needs ongoing reinforcement of core values from above. It's like reminding your kids of their curfews before they borrow your cars.

   The authors' message requires no slide show, advanced degree or high-priced consultant to interpret: Simple practices based on devotion to customers (i.e., patients) and respect for employees lead to successful ventures. That sounds easy to execute. It's not. There's a shortage of experienced EMS supervisors with the requisite traits--selflessness, passion for quality and big-picture awareness--to promote organizational excellence. We can look to our nonexempt ranks for tomorrow's champions, but the stars we seek are not necessarily high-profile clinicians. And management courses are not yet part of mainstream paramedic curricula.

   Must we import our next generation of leaders from other industries? I don't think so. If you alpha males and females who have already implemented excellence at regional levels share a few of your best of breed with the rest of us, they'll find plenty of opportunities to apply your teachings in new and challenging environments. Meanwhile, you'll backfill with other young pups who want to be pack leaders someday.

   Enough already with the dog metaphor. It's time for my walk.

   Mike Rubin, BS, NREMT-P, is a paramedic at Opryland in Nashville, TN, and a member of EMS Magazine's editorial advisory board. Contact him at mgr22@prodigy.net.