Preparing for Supervision

     Chris stood at his station's bulletin board and studied the position opening for a shift supervisor. Chris had thought about getting off the road and moving up the career ladder. The patients were getting heavier, and he wasn't getting any younger. Chris' partner said it was a great move: "You could change all those things you don't like about this place." Chris interviewed for the job and received it. After all, his boss said, he was one of the best medics at Green County EMS.

     Ten months later, Chris called dispatch to say he would not be coming to work today. Most of the friends he'd made over the last five years didn't talk to him anymore. His suggestions for changes to help the crews had infuriated his boss, and he found himself outside the "loop." Yet the crews now referred to him as one of "them." Lately, there had been several heated meetings with his boss over his time management skills and priorities. He felt like he was in over his head and didn't know how to approach some of the assignments that landed on his desk. Chris found himself depressed on the evenings before his shifts, and he often became ill on the drive to work. Later that day, he stopped at his boss' office to tell him he was resigning to start a new job in Central City.

     Stories like Chris' are not uncommon in EMS. Often, promotions are based on a candidate's clinical competence. Little, if any, training is provided to help supervisors succeed. You may be like many EMS providers who look to move up the career ladder—but are you ready? There are several steps you can take to prepare for entry into EMS management. These start with a self-assessment, an assessment of the desired position and organization, and obtaining the job-specific knowledge, skills and attitudes required of a supervisor.

ASSESS YOUR SITUATION
     One of the first things you do on a call is assess the situation. Moving into EMS management is no different. Just as a careful assessment of the patient and his environment is vital for a successful call, a careful assessment of yourself and the organization is essential for a successful move into management.

     The decision-making skills developed over years in the field can be beneficial to a line supervisor. But in practice, your clinical skills will have little to do with your success on the business side of supervision. This isn't to say clinical skills aren't important; they are. Exceptional clinical skills set a good example for the organization's providers and give you credibility with subordinates. However, intubation and IV competence have little impact when trying to fill a schedule or mediate a customer's complaint. The aggressive approach that may be appropriate in a cardiac arrest or trauma resuscitation may alienate subordinates and the organization's customers, internal and external, when applied in day-to-day business operations.

Self-Assessment
     As an aspiring supervisor, you should try to become self-aware. How are you viewed by others? What is your attitude toward coworkers, coresponders, hospital staff and patients in general? If you don't get along well with partners, or find yourself in constant conflict with firefighters, nurses and medical control physicians, you may not do well in a supervisory capacity. If you don't have a liking and respect for the unique personalities of those in EMS, you won't be able to command the respect to perform in a management role.

     Ask yourself if you have the capability to learn planning behaviors. EMS people are good at being reactive--managing rapidly changing scenarios on a moment's notice is what we do. However, managing people in a reactive mode can create chaos. Just like a lawyer arguing a case in court, supervisors lose credibility with their bosses and subordinates when they react based on inaccurate information. When you spend your time reacting to and putting out fires, minor items (which are major issues to someone else) slip through the cracks. Egos can be trampled, feelings hurt, and subordinates can be left feeling ignored and frustrated. Having all of the facts before acting will build a positive reputation and make you a successful leader.

     If you lack organization and tend to not complete projects in a timely manner, your bosses will question your reliability. If you have a short temper or lack tolerance for the opinions of others, your subordinates will avoid communicating with you. Proactive managers pay attention to the details, get the facts and think through their options.

Organization Assessment
     The next step is to assess the organization. Supervisors often fail when their values, ethics, goals and objectives don't match those of the position, the organization or its leadership. People will sometimes move into supervisory positions expecting to change the culture, methods of operations or boss' attitudes or behaviors. Others may look to supervision as an escape from a job they don't like. If you take either of these approaches, you will be disappointed.

     Changing organizational culture can take a long time and is not easy. Procedures and policies have some potential for adjustment, but there's usually some history that led to them in the first place. As a line supervisor, you probably won't have the authority to alter them. Behaviors and attitudes are deeply ingrained in all of us. If you think you can easily change the behaviors, attitudes or work habits of bosses, think again. Their spouses probably can't change them, and you shouldn't expect to either.

     Ask yourself, "Is this an organization I can back 100%? Am I proud of this organization, its staff, operations and leaders?" If you find yourself ashamed of the agency's vehicles and/or equipment, the competence levels of its personnel or the ethics of its CEO, you will have difficulty representing the organization. Ask yourself if you can work with the managers of this organization every day. Do you respect them, and do they respect you? If you have issues with managers, you may find yourself having trouble communicating with future superiors. This can make it difficult to maintain consistency in the organization's message to its employees.

     Another question to ask is about the "party line." What is management's position toward the industry and issues you hold important? What are the administration's political views? Will the personal views of senior bosses be an issue? For example, if the operations manager consistently disparages volunteer firefighters and you volunteer at home, resentment could build to where the day-to-day work environment becomes untenable. You must ask yourself if you can isolate those views from your personal life. As a representative of management, you may be asked to support positions with which you disagree. Again, you must assess if you can separate your personal views from those of the company.

KNOWLEDGE

Your chances for success in supervision can be increased by laying an educational foundation and sharpening the skills that contribute to effective leadership. EMS education programs do a good job of preparing individuals for providing prehospital care. Unfortunately, most training programs do not include the skills necessary to be an effective manager. These include:

Formal Education
     College-level preparation teaches skills essential to success in the business side of EMS. A degree program will require you to master effective oral and written communication, critical thinking and project management. Attaining a degree develops attitudes toward lifelong learning. It shows you can persevere toward a goal.

Informal Education
     There are a variety of informal educational programs available. Locally, there are small-business, leadership and self-help seminars and mini-courses. State ambulance associations and the American Ambulance Association offer seminars and leadership-development classes, along with management tracks at EMS conferences. The National Fire Academy offers EMS leadership and management classes to develop the skills of emerging leaders.

     Do not discount the value of self-study. Seek out books and presentations that will develop your personal, supervisory and leadership skills. A trip to the business section of a bookstore or library will reveal a wealth of resources. Ken Blanchard's works, such as Leadership and the One Minute Manager, are a good starting point for reading about managing and leadership. In The Paradox of Power, Pat Williams explores the paradoxes of vision, weakness and failure among great leaders. Alan Brunacini's Essentials of Fire Department Customer Service and Zingerman's Guide to Giving Great Service by Ari Weinzweig describe approaches to creating excellence when dealing with customers. An audiotape series by Stephen Dean and Mike Taigman, Secrets of Successful EMS Leaders, pulls together aspects of management and leadership in the context of EMS.

SKILL SETS

Clinical Excellence
     High-performing EMS systems (and providers) put the interests of the patient first. As an aspiring EMS supervisor, you should take every opportunity to hone existing skills and develop new ones. Clinical excellence should be as important to you as a supervisor as it was as a professional. If you consistently demonstrate poor judgment or patient care skills in the field, you will lose credibility in patient care issues. As part of the self-assessment process, determine where your clinical weaknesses are and work to strengthen them. This not only augments your suitability for promotion, but will benefit patients you encounter in the meantime.

Management and Organizational Skills
     The development of management skills is the one area where many EMS supervisors are set up for failure. When you develop key skills in organization, delegation, priority-setting, communications and the basic functions of business, not only will your chances for promotion and future success be improved, but some of these skills will enhance your performance as a field provider and your personal life.

     Organizational skills include the development, management and execution of projects, time management and setting priorities. Managing the contacts you'll develop as a manager is critical to success. Returning messages and following through on issues is critical to developing and maintaining your trustworthiness. Practicing good business etiquette will help you excel. Books, audio programs and seminars can help you develop strategies for it.

Communications
     Good communications skills are vital for management, but often underemphasized. Developing them will help your practice both clinically and in management.

     The ability to practice empathetic listening is one of the most essential skills to master. It takes practice and patience to actively listen, see a different point of view and refrain from interjecting corrections, clarifications or solutions. The process of discussing issues with an employee will differ greatly from addressing a system issue with the boss, and both will be different from listening to a customer complaint.

     Written communication skills are an essential component of EMS leadership. Clear, concise and grammatically correct writing sends a message of proficiency and creates an impression of credibility. Like it or not, you will be judged on the quality of your written communication skills. Memos or e-mails that lack clarity, are rife with spelling errors and contain poor grammar will destroy your credibility.

     As an EMS supervisor, you will likely be called upon to conduct oral presentations. Implementing a new program or requesting equipment may require a presentation to your agency's board. You may be required to teach a class to recruits or present on protocols to members of the service. You could be called upon to speak to a county commission. In all of these cases, your oral presentation skills and a mastery of various styles of visual presentation will demonstrate your ability.

Finance, Legal and Planning
     A basic knowledge of business finance and legal issues is critical. You should be aware of how the organization receives its revenue. Is it tax-supported, contracted or totally fee-for-service? If the organization has any fee-for-service operations, a basic knowledge of EMS billing issues, such as those surrounding Medicare and Medicaid, is absolutely necessary. A supervisor may not be responsible for financial decisions, but familiarity with budgeting and accounting principles will provide an understanding of why organizational decisions are made.

     You must be aware of the laws, rules and regulations that affect EMS and business operations. Do you know where to find the state-mandated staffing and equipment lists for your ambulance? Do you know which licenses are required to conduct EMS in your state? Do you know what actions could constitute Medicare fraud or open your service up to a hostile-workplace claim? Many decisions made by a supervisor will involve interpretation of local, state and federal laws and rules.

     You will have a lot of great ideas as a supervisor, but your success in moving them forward will depend upon how they get to your boss. Your ability to plan a new program, write a proposal or create a business plan will serve you well. The U.S. Small Business Administration, small-business development centers and local chambers of commerce are good places to start. There are many courses, books and Internet-based resources available as well.

ATTITUDES
     Your attitude as an EMS leader can lead to a long career with great job satisfaction or to a short-lived experience filled with conflict and pain. You must assess your attitude toward the profession, the organization with which you plan to work, your coworkers and, most important, the system's patients and external customers.

     How do I feel about EMS? Your attitude toward EMS will impact your relationship and image with the players in the system. Do your actions, words and appearance reflect positively? Do you want to see the right things done and EMS grow as a profession? Do you behave ethically as a provider? These are the qualities of an industry leader and demonstrate respect and a positive attitude toward EMS as a profession.

     How do I feel about the organization? Once your attitude toward EMS as a profession is aligned, focus on the organization with which you plan to work. If you have a negative attitude toward it, its leadership or its goals, you'll have difficulty working with that leadership or supporting those goals. In a leadership role, displaying negativity toward the organization will breed a lack of confidence in management among field providers and undermine the organization's work. After reflecting, if you cannot form a positive, agreeable attitude toward the organization, you might be better off with an organization that more closely shares your goals.

     How do I feel about my coworkers? Your attitude toward your coworkers calls for critical reflection too. Just as with the organization and its leadership, an attitude toward your coworkers that fails to respect the diversity of their skills, opinions and lifestyles will eventually show in your management style. A positive attitude toward your coworkers, all of whom may become your subordinates, will prevent you from drawing premature conclusions or making hasty decisions based on personal bias. If you have a negative mind-set toward those you'll be supervising, entry into leadership is best avoided.

     How do I feel about customers? Finally, assess your approach toward patients and external customers. The EMS organization's purpose revolves around its customers: the constituency it protects and the patients it cares for. Other external customers, such as families and friends, first responders and hospital/care facility staff, are essential to the mission. You must understand that these customers are some of the most important people in the world!

     You cannot draw lines between interfacility patients and 9-1-1 callers, between "sick" patients and "not sick" patients, and between insured and self-pay customers. You must eliminate patient slurs and slang from your EMS vocabulary. If you see supervision as an escape from running interfacility transfers, think CPR is a job for Basics or feel your valuable skills are being wasted by holding the hand of a lonely Mrs. Smith at 0300, you will not excel in leadership (in fact, you should probably consider alternative career counseling). Be prepared to see all customers as having equal importance, and be willing to set an example to your coworkers and crews that nothing less is acceptable.

     How do I feel about me? Finally, you must be able to take care of yourself. Are you confident in yourself? Entry into supervision means you'll become a "them" to some of your former coworkers. Can you accept this change? Self-doubt and the desire to be everyone's friend will make you an inconsistent and ineffective manager. It will be impossible to please everyone, and conflicting viewpoints and agendas will develop. Strong leaders make decisions that create the best outcome for the organization's customers (patients) first. Your real friends will stick by you and help you separate work life from personal life.

     Can you accept the difference in hours? Management may mean a change in the scheduled days you work. There will be meetings and issues that require your attention in addition to regular shifts, and you may be required to take administrative calls from home. If your supervisory position is salaried, there may not be additional compensation for this extra work. The key to survival is being able to identify when you have personal time and when you have to work. Creating a balance in your life will make you more effective on the job.

     Chris has been working for Central City EMS for three years now. When he interviewed for his paramedic position, Gary, the operations manager, was impressed. Seeing leadership potential in Chris, Gary called Chris to his office about a year later and suggested he enter a mentoring program with one of the field supervisors. Chris worked with the supervisor to develop his management skills. With Gary's help, he attended several EMS leadership conferences, a small-business seminar and the Management of EMS class at the National Fire Academy. He also entered a degree completion program at a local university and found he'd already accumulated a large amount of credit toward a degree.

     He has also been filling in as a part-time supervisor for a few months now, giving the regular supervisors a break. He has earned the trust of his coworkers and is respected by management. Next week, Chris is returning to Green County EMS. After three years of staffing issues, financial problems and declining performance, Green County commissioners contracted with Central City EMS to operate the Green County system. Chris will be well prepared for his full-time role as a shift supervisor when he returns to his old service.

LOOKING AHEAD
     Once you've prepared yourself through self-assessment, self-improvement and perhaps even a degree, the next steps involve being a role model in your new job, managing positive change and dealing with people inside and outside your organization. Take your time, go slow and learn from those around you. Remember that effective leaders are "servant" leaders. There is no job beneath the status of a servant leader. They exist to serve the needs of others who do the work of the organization. This point of view toward management and your subordinates will create respect for you and your position within the organization.

     Your organization did not get where it is in one day, and you won't be able to create change that quickly either. Remember where you came from and include those people in developing your view of the world from the supervisor's desk. With careful preparation, communication and respect, and collaboration with your superiors and subordinates, you can live Chris' success story too.

Bibliography
Blanchard K. Leadership and the One Minute Manager. New York: William Morrow and Co., 1985.
Williams P. The Paradox of Power: A Transforming View of Leadership. Warner Faith, 2002.
Brunacini AV. Essentials of Fire Department Customer Service. Stillwater, OK: Fire Protection Publications, 1999.
Weinzweig A. Zingerman's Guide to Giving Great Service. Ann Arbor, MI: Zingermans, 2003.
Dean S, Taigman M. Secrets of Successful EMS Leaders. Midlothian, VA: Sempai-Do, 1999.

This article originally appeared in the April 2008 issue of EMS Magazine.

Paul E. Ganss, MS, EMT-P, has been involved in EMS for nearly 30 years as a paramedic in public and private systems, as well as hospital-based critical care transport. His career has also included the role of EMS educator and manager. He is now Operations Director for Life Safety Services, LLC, in Toledo, OH, and a paramedic with Harris-Elmore EMS.