First Arriving Network
Powered by the First Arriving Network,Reaching 1M+ First Responders Worldwide

Philosophical EMS Observation #3,477

On leadership versus managing:

A leader treats the policy and procedure manual as a guide, and uses his best judgment in deciding whether strict adherence to policy is in the best interests of the agency, the crews, and the patients.

A manager treats the policy and procedure manual as the Bible, and uses it to bludgeon into submission any underling who dares to question the dogma.

There are far more managers than leaders in EMS.

Discuss amongst yourselves…


Comments - Add Yours

  • Scott Brown

    1 entire career…worked for precisely 1 leader.

  • Robert Martin

    I would agree.

  • Skip Kirkwood

    In most organizations, those few not working the street must be both managers and leaders. Very few have the luxury of adopting one or the other persona. Dealing with Medicare compliance – gotta be a manager, or go to jail – no flexibility allowed. What color to paint the truck? More room to maneuver there – leadership possible.

    Neither are easy. Walk a mile in my shoes…..

    • Ambulance_Driver

      That’s my point, Skip:

      A leader knows when strict adherence to the rules is necessary – like Medicare compliance – and when a more people-centered approach is better.
      A manager only knows one way.

      • Skip Kirkwood

        I think that there is a reason that we get more “strict rule compliance” type behavior than we would like – a climate of fear.

        Medics are always afraid that they are going to “get in trouble” for stuff. The only group more afraid are people in administrative and executive positions, who “serve at the pleasure” and are often accountable to “non-EMS” people. Those folks don’t know anything about the “reasonable limits” in EMS, but they can tell surely if the rules were followed. So a sure way to not get fired, for a middle manager, is to protect yourself by following the rules strictly.

        If we had more of a whole “climate of trust” and “just culture,” people would be less included to act out of fear. One of the hallmarks of a leader is “courageous behavior,” and it is hard to be courageous when you have to worry about feeding your family.

        We also fail to teach people as they move up some things that they recite daily at places like West Point – the first and most important duty of an officer is the well-being of their troops. It is reinforced regularly, by the simple concept then when they are in the field together, “Officers eat last.” EMS supervisors often believe (and often correctly) that they are accountable to the schedule, the deployment plan, and the narcotics inventory, and not accountable for the well-being (physical and mental) of their medics.


        • Ambulance_Driver

          That’s one big bravo I’ll give The Borg. They’re implementing Just Culture here.

          • Lone Medic

            Their Offshore Division was great when I worked there. I always knew my boss had my back. If I was wrong it was dealt with in a professional manner, and if I was right I was backed 100%

    • Guest

      It may not be easy, Skip; but in my experience, most of the ones in the headquarters office don’t even make the attempt. Besides, if it was
      easy, then anyone could do it and management wouldn’t need to make so much more money than the field crews.

      Sorry if that sounds bitter; but I’ve been on both sides of the fence. When upper management is shown a picture of a dent in a rig, and they’re more concerned that the rig wasn’t washed than the dent caused by a fatigued crew bumping an overhang, it tends to make you a bit jaded towards management in general.

    • Skip Kirkwood

      We’ve got crossing thoughts – see my post below the next post.

      The part that makes me laugh is the “make so much more money than the field crews.” I sure wish that were true. At the end of the year, I regularly see 10-20% of the field work force taking home more money than senior officers, by the simple expedient that the officers are FLSA exempt and field personnel are not. Everybody works lots of hours, but no time-and-a-half for the bosses!

      • Ambulance_Driver

        Last place I was a supervisor, the extra money did not come close to making up for the extra hours and headaches.

  • IAWU

    In my limited experience, promotions happen more often because the employee in question must taken off the road because they are a liability due to lack of appropriate social skills, rather than someone looking at them and sating, “Hey I think this person would make an exemplary supervisor!”

  • Old_NFO

    Not just EMS, trust me… sigh

  • Bill

    “You manage things, you lead people. We went overboard on management and forgot about leadership. It might help if we ran the MBAs out of Washington.”

    — Adm. Grace Hopper USNR

  • Windy City Medic

    In my opinion, a significant portion of this issue is based on the for-profit EMS model. I’m not at all excluding municipal, county, etc. EMS systems from falling victim to this sort of mentality. But in a lot of situations, at least in my experience, we get an emphasis on management from the desire or need to maximize profitability, and we get an emphasis on leadership from a desire to do the job well and ensure the ready availability of the tools the team needs in order to achieve that goal.

  • Bob Sullivan

    Nice work Kelly, spot on as usual. Unfortunately I have an example that illustrates this:

  • WebFoot Logger

    It’s not just in EMS.