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EMS Dashboard Confessional, January 2019

January 4, 2019 by Matthew Streger

 

This month’s EMS Dashboard Confessional comes from a supervisor in a third-service EMS department.

I was the on-duty supervisor for our EMS agency with the headache of crew assignments and assuring the system was functioning. I was also given the “blessing” of sorts of having the dedicated supervisors vehicle at my disposal.

The shift was nothing special but what happened next will always stay with me – the Director came downstairs to the supervisors office and asked me for a ride to one of our local hospitals for a pre-planned meeting. As we pulled out of the building, he looked down, cursed and then said “ok, turn on the lights and sirens, I am running late.” I said no, knowing full well that this would anger him but also knowing that of anything occurred on the way to the meeting, he would rapidly disavow knowledge of asking me to turn on the emergency warning devices. He looked at me and said “fine, I will remember this”

This experience taught me a few things – not the least of which was that we, as leaders, need to assure our behavior is above reproach and always in line with our policies and procedures. How would if have looked to any of our crews had they seen this? Any time a leader takes a “do as I say, not as I do” attitude, it does not bode well for them.

Michelle Kobayashi, Administrative Director of EMS at Hackensack University Medical Center comments, “This is a challenging situation with a few issues to consider.  First, there is the power dynamic.  As a subordinate, there are risks to disobeying a higher ranking leader.  Second, there is a safety consideration.  Red lights and sirens increase risk for the responder and the community.  Third, there are the optics and message being sent to the staff.  Would the director tolerate this behavior for a staff member late picking up a non-emergent discharge?  The biggest fear in this situation, other than getting into an accident, is retaliation by the director at some future date.  ‘I will remember this.’  Does that mean no promotion? Denied days off?  That comment alone likely damaged the relationship with the director and undermined trust going forward.”
“Ultimately, I applaud you for making a good decision and standing up for your values,” Michelle continues. “Whether you knew it at the time or not, you were behavior modeling in a positive way for the staff by maintaining established policies and procedures.  Once leaders ‘bend’ the rules without valid cause, it sends a message to the staff that it’s ok for them to do it, too. This is also behavior modeling, but with a negative impact.  Overlooking these ‘bends’ promotes more bending until the preceptor tells the new employee, ‘I know the policy says this, but nobody does it that way.'”  
Think about your core values.  Know what they are.  See how well they align with your organization and know if there’s any dissonance so you can prepare for when your values conflict with your boss’ values, or the organization’s values.  Know where you’re willing to compromise and where you’re not.  

Filed Under: EMS Dashboard Confessional

EMS Dashboard Confessional, December 2018

December 3, 2018 by Matthew Streger

 

This month’s EMS Dashboard Confessional comes from a lead paramedic in an EMS-only system.

I was a lead paramedic in an organization but not actually a supervisor with supervisory authority. We were the eyes and ears of management, and could troubleshoot issues on-shift, but we could not “write someone up” when they did something wrong. Our job, when something reached that level, was to document the issue in our shift report.

I had someone on my shift who was constantly late for work. At one point, he was late several times in a row, so I confronted him and told him that I was going to “write him up” for his conduct. What I meant was that I was going to include this in my shift report, but he interpreted it as a threat to discipline on him.

He went to my boss and said that I had exceeded my authority, which I didn’t since I wasn’t giving him a written warning, but after talking to my boss I understood how I sent the wrong message. The thing was that I wanted to change his behavior, and at the time, the only thing I could think to do was threaten him with discipline. What I learned from this is that instead of going immediately to threats to change behavior, I should have looked at what might have been causing him to come in late and how we could find a good solution to the problem. This is especially important considering I didn’t have the actual authority to follow through on my threat!

As moderator of this blog, I think it’s important that we remember we have numerous tools in our leadership toolbox. Coercive power, or threatening, has a time and a place but probably should not be the first thing you reach for. Rather than using fear, we can start with problem-solving, shared vision, and inspiration.

However, it’s just as important to remember that even if you do have to resort to coercive power, consider if this is a hill you want to die on. If you were exceeding your authority for a life-safety issue, or some other mission-critical concern, then risking exceeding your authority has good justification. But it’s hard to go to your boss and explain that you simply HAD to do this because someone kept coming into work late.

Filed Under: EMS Dashboard Confessional

EMS Dashboard Confessional, November 2018

November 2, 2018 by Matthew Streger

 

This month’s EMS Dashboard Confessional comes from a hospital-based manager, and speaks to the human dynamic of leadership.

While in an operations leadership role in a hospital system that attempted to merge EMS services from several individual hospitals, I found myself faced with a dilemma when the system decided to stop the initiative of integration.

This decision left employees scrambling for positions because they were floating and working for hospitals where they were technically not employed. Many employees were upset about returning to their home hospital since they had found working in different geographical locations, and with different partners, made their job more enjoyable. Emotions were running high from both the staff and for the leadership.

The Director and I were called to the President of the hospital and were shown a letter from a local public safety leader that was submitted to encourage our hospital to find a way to keep a list of specific employees that were not employed by our hospital. The letter blindsided the Director and myself. as we had just completed a staff meeting directing all employees to return to their home hospital site and then we would sort out switches/swaps for requesting changes.

When we returned to our office, we immediately picked up the phone and called the staff members who we felt had orchestrated the letter. When the employees answer their cell phones, we immediately launched into our narrative about being blindsided. This caused even more emotional instability, as well as potential safety issues because we never asked if people were in a place to hear the news, or what they were doing, before we started talking about OUR point of you. Some employees were actively driving, and one was in the process of medical treatment with a loved one. Our emotions got the best of us and we led in a way that was not proactive.

The experience taught me the act of mindfulness and importance of checking in with whomever you are approaching to discuss a conflict. This could be a student, employee, subordinate or a boss. Having the wherewithal to take a deep breath, check in with the other person to see how they’re feeling before beginning my own narrative has changed my leadership style and definitely improved the respect I receive from people who work for me, with me, or beside me. Similar to holistic medicine, this is an example of holistic leadership, which promotes treating the employee from a physical, mental, and spiritual approach and thus allows for enhanced communication.

“This is a great example of progressive EMS leadership,” says Anthony W. Minge, Ed.D, Partner at Fitch and Associates. “This leader identified a starting point that was not centered around the staff, but rather was directed inward at his or her feelings. Recognizing that it may not be ‘about you’ and that other dynamics may be at play is critical for an effective servant leader.” Anthony leads the Ambulance Service Manager and Communications Center Manager programs for Fitch, and is co-chair of the Pinnacle EMS Leadership Forum.

SUBMIT YOUR ANONYMOUS EMS DASHBOARD CONFESSIONAL HERE

Filed Under: EMS Dashboard Confessional

EMS Dashboard Confessional, October 2018

October 2, 2018 by Matthew Streger

 

This month’s EMS Dashboard Confessional comes from an experienced executive working in a hospital-based agency. I am a big fan of getting stakeholder input before making critical decisions, but sometimes there is a downside:

“Some years back, we needed to replace our cardiac monitors and had secured capital to purchase about 50 of them – not a small purchase. Wanting to be inclusive, I stood up a committee to review products and asked the group of about 10 opinionated paramedics to make a recommendation.The group met multiple times and had spirited and thoughtful debate about what they thought would be the monitor best for our agency. After a time they made a unanimous recommendation that we should buy brand X. 

When I was ready to move forward with the purchase, I went to hospital management and ask them to place the order. To my dismay, I was told that our parent organization had an exclusive contract with the maker of brand Y, and I was not allowed to purchase outside that contract. With great regret I had to go back to the committee with my tail between my legs and explain that I never actually had the authority to authorize what I had asked the committee to do. It was painful, and it took me months (if not longer) to regain their trust. Moral of the story – understand your level of authority, and if you can’t accept someone’s opinion and/or recommendation, don’t ask for it.”

This is a great story that illustrates a common pitfall leaders can make! Ray Barishansky, a well-known thought leader in EMS, often speaks of critical pitfalls that can be fatal to the careers of organizational leaders. “One of the most common traps that we fall into is exceeding our level of authority. No matter what position you hold in an organization, you need to know the discretion that you have as well as your limits. Not knowing these can have significant repercussions up and down your chain of command if you try to go past that point, and actually succeeding in surpassing your authority could potentially be career-ending.”

Filed Under: EMS Dashboard Confessional

First EMS Dashboard Confessional

September 11, 2018 by Matthew Streger

 

For our first EMS Dashboard Confessional, let me tell you a story from my personal journey as an EMS leader:

In the past, I served as the Executive Director of a large hospital-based EMS system. We provided daytime BLS coverage for a local municipality as part of a legacy contract for free, and we were losing money on the agreement. At one point, the municipal EMS provider that covered the balance of the hours stopped functioning and the town asked us to pick up the balance of the hours. Of course, they still expected us to provide this additional service free of charge. Adding service hours with minimal call volume would have more than doubled the economic loss we were already incurring, so in communication with the town leaders we declined to do this and they entered into an agreement with a neighboring town for 24/7 ambulance coverage.

The final decision on this happened on a Tuesday night at a Council meeting. I didn’t think much of the issue, as we were putting that unit back into our general EMS system, without any layoffs, and actually improving our bottom line and response time compliance in the process. In fact, I didn’t even think that the Council’s decision would register with our staff, and I expected to notify everyone about the change on Friday in my regular news email update.

Unfortunately, this was three days too long. Our staff was watching this much more closely than I had anticipated, and by mid-day on Wednesday, it had blown up on social media. One of our employees was apparently gloating at what was perceived as a loss for the department by linking to “Another One Bites the Dust” and predicting the downfall of the department. The rumors about reduction in service, abandoning the town, layoffs, and cascading effects spun out of control. By the time I realized this, it was too late. Of course, I immediately sent out a bulletin to everyone with the information that I intended to send out on Friday explaining what transpired, but I was in damage control mode.

This wasn’t a fatal error, of course. A few of my employees got a black eye with management, but nothing long-term. The town got their ambulance service from a neighbor, and we went on with our business. But it taught me the value of being proactive in distributing information to our staff, much earlier than I would have expected, and in responding as quickly as possible to any rumors or issues that threaten or arise. I never would have expected to have to jump on an issue like this, not to mention how fast I needed to.

Lesson learned – I do my best to get out in front of ANY messaging like this now, now matter how much I think it might be a small issue.

Filed Under: EMS Dashboard Confessional

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