Serving by Leading, Leading by Serving

Broad evidence suggests today’s EMS workers are struggling to keep doing what they do despite loving the work.^1–5 Comments from hundreds of medics posted in some of those resources and others validate what we know: Not everybody who can make it through paramedic school has the necessary talent, desire or sense of balance to do the work of a good medic. Those three things are necessary components of any field caregiver, regardless of who’s leading them.

The resources validate something else too: the importance of able, dedicated leadership. Good medics don’t just throw up their hands and walk away from EMS because they hate their work. They leave because of the stuff that gets in the way of their work. They quit because they’re selected for their intelligence but routinely expected to do things that are impossible, unsafe, unethical or just plain stupid. And they quit because, in the course of taking care of sick people, they don’t receive the respect and support of their leaders.

Servant leadership is a simple, ancient strategy for leading people based on the notion that if your job isn’t taking care of customers, then it’s taking care of the people who do.

Historic leaders who were known to employ servant leadership include Jesus, Gandhi, Abraham Lincoln, Eleanor Roosevelt, Martin Luther King, Jr., Nelson Mandela and Mother Teresa. Strangely, four of those were assassinated, and one of them (Mandela) spent 27 years in prison. So either the strategy isn’t perfect, it scares people or it gets misapplied. Or people are simply tough to lead. Possibly every one of those propositions is valid.

There is much information available about servant leadership^6–8 and its essential ingredient, emotional intelligence.^9,10 This article will concentrate not on its nature but on how to apply it daily.

Narrative

If you’re not familiar with it, servant leadership may seem to you upside down, backward or even goofy. Bosses working for subordinates? Huh?

But think about it: The people you’re responsible for are caregivers. For them servant leadership makes perfect sense: Before you can expect people to go out there and take good care of others, you need to show them, daily and consistently, what good care feels like. You need to keep them—and yourself—focused on your organization’s mission. And you need to clear their path of anything that frustrates their ability to fulfill that mission. Your function is to provide them with direction, then make their work as sensible, safe and reasonable as possible.

That’s it—that’s servant leadership. The following are some concrete ways you can use it to effectively lead an EMS workforce.

Humility

The first, most critical must-do step to take as a servant leader is to humble yourself. Why? Because like the crews, dispatchers, clerical workers, mechanics and supply staff you lead, you and every other leader in your organization must orient yourself to serve others before you serve yourself.

That’s so much easier if you honestly like them. I think you especially need to like crews—the way they think, the work they do and the things they laugh about. You need to care about the things they care about and worry about the things they worry about. And remember, these are people readers. Don’t bother trying to fool them.

What does that mean, humbling yourself?

It means instead of choosing the parking space closest to your office, you choose the one that’s farthest away—so crews and customers who need to come and go much more often than you can do so as easily as possible. It means when people are busy and you find dirty coffee pots and bathrooms, you quietly pitch in and clean them, just like everybody else does. It means when you see a lone crew member washing a rig before going home late, you help them until they’re done. Or, if you have other resources, you enlist their help as well.

When you discover the newest, least comfortable, most anonymous member of your team reporting on their first day and wandering the hallways of your station, you drop what you’re doing. You welcome them, make them feel valuable, show them around, personally take them wherever they need to go, and introduce them to whomever they’re looking for. Make a little fuss about them. And leave them with a couple of cell phone numbers in case they have questions later (including yours).

When one of your crews has a really busy night, you make sure they have a quiet place to sleep before they attempt to drive home. You call their family and explain their delayed return. If they need to get home right away, you drive them—and arrange for them to access their vehicles later.

And finally you make yourself accessible. Orient your office so instead of hiding behind a desk, you situate yourself sideways or with your back toward the door. Be sure there’s a table with at least three chairs, so when a crew wants to confer with you, you can get away from that desk and sit with them. Make it known that if your door is closed, you’re busy or in conference, but if the door’s open, people are welcome to walk in and address you anytime. Obviously some of the information you process is confidential. To protect it, choose a laptop computer rather than a desktop, so you can quietly close it when you need to be discreet.

Safety

It turns out that notion about making people feel valuable is really important.

The key to keeping people safe has nothing to do with slick salesmanship, color posters or signs, or free donuts at mandatory “safety meetings” hastily arranged in the wake of awful mistakes. Safety happens when committed leaders are fussy enough to select good people in the first place, then teach them well and make them feel unmistakably valued and appreciated. Why is that so important?

Because what enables EMS providers to get out of bed, make their way through a blizzard, sense the fear of somebody’s grandma and treat her like the most important person in the world is talent. Not everybody has it, and the ones who do are a mite sensitive. They don’t do what they do for money. (You couldn’t pay most people enough to do some of the things EMTs do every day.) But part of the price you pay for any good caregiver is that they can be needy. That, and they generate a little drama sometimes.

For years EMS has told its young practitioners they aren’t valuable. The industry has based itself on cursory initial training programs, memorized treatment protocols, make-believe medical direction, pathetic pay scales (most rural ones have traditionally been volunteers) and, in many areas, subordinate relationships with fire boards that see EMS as a revenue source. And heaven help the crew that generates a customer complaint, however unwarranted. Remember, most of a typical EMT’s customers are either having awful days, are ethically challenged or are themselves burned-out medical providers looking for low-profile targets to blame for their own mistakes.

Use that word, valuable. Use it every day, in your routine communications with and about people. Use it so often you think about it in your sleep. People who know they’re irreplaceable tend to protect themselves and others.

Fifty Little Things

It’s not the big things you do once in a while that inspire people to follow you, and it’s certainly not platitudes or anything else you say. It’s the 50 little things you discipline yourself to do, day after day and year after year, that tell people over and over again how valuable they are to you, your organization and the public’s well-being.

Crews are not just operational units; they’re people, and so are the workers who support their mission. How much trouble would it be to make sure they all receive some kind of recognition on their birthdays? That belongs in every budget, way ahead of fancy office furniture. It’ll cost you peanuts. But it matters enough to warrant your commitment.

Crews are experts on their daily work, much more so than those who sign their paychecks. Involving them in the selection of their own equipment (and potential colleagues) does more than convey respect. It makes good sense. But don’t just pretend. Be clear from the start about how much influence they will actually have. Be prepared to say no sometimes, but honor their influence faithfully and consistently.

Never attend a meeting that doesn’t matter to anybody, and don’t expect others to. If a meeting is necessary, invite those who really need to attend it. Give them some notice. Prepare an agenda and adhere to it.  Don’t talk without listening, and for gosh sakes, show up on time. Anything short of that is disrespectful.

People have families, and their families are important to them. For years Carl Craigle, the chief paramedic at Platte Valley Ambulance Service in Brighton, CO, sent notes to his crews’ families on the hiring anniversary of their family member, briefly telling them their loved ones were valued. Craigle still invites the families to annual awards banquets. He also explains to families how he has allocated capital each year and why. So, for instance, he tells them why he sought matching funds for power-assisted patient loading systems but couldn’t raise salaries that year.

Smart guy. If you earn the families’ support, you’ve got the workforce.

Be sensitive to the other things that are important to people (all people.) Weddings, funerals, kids’ school issues and hockey games, college schedules, deaths of pets and even mental health days all affect people’s lives. You can pretend those things aren’t as important as duty rosters, but that mistake would be yours. Is it hard work, serving subordinates like this? Yes. But if leadership were easy, anybody could do it.

When somebody leaves, make a fuss. Gather photos of their time with you, have them professionally mounted and invite their coworkers to sign it before it’s framed. It makes a statement to everybody, every single time, that they matter.

Finally, make it as practical as possible for supervisors to take care of crews stuck on runs involving long scene times. Crews are people. They need hydration, nutrition and protection from weather. They get tired, they need access to bathrooms, and sometimes they get sick. Address that stuff, even if it means the big boss gets asked to deliver food and drinks.

Again, it’s not the big things you do once in a while, but the 50 little things you do every day that define you (and others) as a leader.

As an industry, we need to be fussier about the people we hire. There’s been a striking lack of information in the past 40 years to indicate that anybody in EMS—anybody—does psychometric testing to determine if somebody who says they want to be a medic has any aptitude or desire to actually do the work. As far as we can tell, no psychometric test has ever been validated with regard to the needs of EMS (other than perhaps the one for emotional intelligence).¹¹

Fire and police departments have done that for years, using tests like the Minnesota Multiphasic Personality Inventory (MMPI and MMPI-2.) In fact, this author personally knows of people who applied with and were hired by EMS agencies after they were first rejected by those kinds of agencies based on the findings of a “psych test.”

Nor does any of the research cited in the introduction to this article mention mental health screening. So medics are dying by suicide and suffering from something we call PTSD. (Is it PTSD?) We’re sure that’s the fault of EMS. (Is it?) We’re all upset about the loss of those people, and we should be. But we don’t know how many of them join us already suffering from diagnosable mental disorders,¹² and we don’t know anything about other critical variables in their lives. This work we do is not always easy, and it’s not always easy on us. But it’s not horrible, and it’s certainly not horrible every single day. Maybe it’s time we assigned it a little more respect.

We gossip way too much, and gossip is anything but benign. If we know that a Brand X ambulance chassis is likely to destroy people’s lives, marriages and careers, we would certainly exclude Brand X from our fleets. We know that gossip does all of those things. So why do we tolerate it? Gossip should be considered a safety hazard by every single member of every single EMS organization, and it should be eliminated as vigorously and consistently as every other safety hazard that concerns us.

Wanting to Do the Work

There’s a very good reason why we call this work. It’s certainly a lot of other things, but first of all it’s work.

Is taking care of sick people burdensome? Why would you want to do it? Why would anyone?

Why would you want to risk your life in an emergency vehicle every single day, negotiating your way through hordes of selfish or incompetent drivers who flip you off or won’t yield? Why would you repeatedly enter other people’s homes, knowing they might be deceitful, chemically altered, scared, belligerent, armed, just plain stupid or otherwise impaired enough to do something that ends your career or life? Why would you risk your back, your knees, your shoulders, your hearing and your future disentangling bloody, dirty, stinky people from some of the crazy situations they get themselves into? And why would you risk your personal life, your emotional balance and perhaps your marriage to mitigate the emergencies of people you don’t know, most of whom will never appreciate your efforts?

Why? Because something deep inside of you makes you want to serve them. Call it talent, a gift or a calling; it’s part of you. Among other things, it makes you especially and uniquely who you are. It doesn’t exempt you from the responsibilities of any good person, as a parent, lover or citizen. Instead it’s something extra and necessary that you will always be challenged to balance against the rest of your life.

Now, why would you want the burden of leading such a complicated, high-risk, often difficult and unpredictable class of workers? Perhaps because, like them, you were born with the same desire to serve as they were.

And that, as it happens, is the basis of servant leadership. 

Is Talent Essential?

Is talent essential, even if one has good leaders and good teachers? Certainly it is.

The Italian Renaissance master Sandro Botticelli completed a painting in 1484 called the Birth of Venus. There’s little argument that it’s one of history’s greatest artworks. That image has been so widely distributed in so many ways, it’s recognized everywhere. In fact, part of it served for years as an Adobe software logo. Most people on earth can’t learn to draw a human face at all. But anyone who has ever tried would agree, Botticelli’s rendering of Venus’ face is a masterpiece in itself.

Botticelli was trained by masters, but he was also born with something no master can create in any student: talent. Consider the images you’ve seen on boxcars and buildings. There’s a clear difference between the ominous, territorial drivel you see on some of those surfaces and the artistic evidence on others. Any of us could identify the delineating variable there as talent.

Many kinds of work presuppose talent. Consider the work of a NASCAR mechanic, a trauma surgeon, a writer, an opera singer, a farmer, a championship NFL quarterback or a fine guitarist. Or—as any paramedic preceptor can tell you—a paramedic. Schools are expected to produce certified bodies, but preceptors know the truth: Some people get it. Others never will.

In my opinion that’s an important realization. I think the reason why EMS providers throughout the world do what they do for unrealistically low salaries—or for free—is that decision-makers don’t understand it. (Until they have their “big one,” anyway.)

We’re all different, with various blends of ability. If you’re born with the gifts of a caregiver, an emergency decision-maker, an observer, an adapter, a negotiator, a mechanic, a choreographer, a writer, an emergency vehicle operator and perhaps an athlete, a medic’s work can seem like the most natural, comfortable, reasonable thing you’d ever want to do with your life. People who have it consistently create a flow of energy, common sense and compassion on their calls, the beauty of which is unmistakable.

People who don’t have it consistently struggle.

References

1. Newland C, Barber E, Rose M, Young A. Survey Reveals Alarming Rates of EMS Provider Stress and Thoughts of Suicide. J Emerg Med Serv, 2015 Oct; 40(10).

2. Reviving Responders, www.revivingresponders.com.

3. Code Green Campaign, www.codegreencampaign.org.

4. 911 Peer Support Group, www.facebook.com/groups/828274287220637/.

5. Erich J. Earlier Than Too Late: Stopping Stress and Suicide Among Emergency Personnel. EMS World, www.emsworld.com/article/12009260.

6. Greenleaf RK. The Servant As Leader. Westfield, IN: Greenleaf Center for Servant Leadership, 1970, rev. 2008.

7. Trastek VF, Hamilton NW, Niles EE. Leadership models in health care—a case for servant leadership. Mayo Clin Proc, 2014 Mar; 89(3): 374–81.

8. Schwartz RW, Tumblin TF. The power of servant leadership to transform health care organizations for the 21st-century economy. Arch Surg, 2002 Dec; 137(12): 1,419–27.

9. Big Think. Daniel Goleman Introduces Emotional Intelligence. YouTube, www.youtube.com/watch?v=Y7m9eN0B3NU.

10. Queendom. Emotional Intelligence Test, www.queendom.com/tests/access_page/index.htm?idRegTest=3037.

11. Ibid.

12. Cf, Queendom.

Thom Dick has been a passionate advocate of sick people and the safety of their field caregivers since 1970. He has written hundreds of articles and three books on those subjects, including the People Care books, which you can order here. You can reach Thom via Facebook or at boxcar414@comcast.net. Thom is also a member of the EMS World editorial advisory board.