We all strive to be the best we can be…but often it’s by accident. None of us hang banners in the day room reminding everyone
“Be the most mediocre you can be!” or “Try and do something decent today!” We encourage each other to be the best but rarely is that goal internalized as the mantra for the agency or transformed into an agency’s culture. The organizations out there that truly EXPECT Excellence are few and far between.

The starting point of excellence is our individual actions in the back of the ambulances, on the end of the 911 phone calls, handling a complaint from patient, facility or co-worker. As a leader, all eyes are on us. Effective leadership is NOT ‘do as I say…not as I do’.

As we speak about organizational excellence…do WE walk the walk? Do we treat others with respect, go the extra mile, are we the example of excellent that we want copied and internalized throughout the organization?

I was listening to an interview with an author who studied the Disney organization…arguably they EXPECT excellence every day, for every guest which is why they have a greater than 70% voluntary return rate of visitors.

They expect their cast members (employees) to make every interaction memorable, to insure that the place is spotless and they if anyone sees a guest with an issue that they step in to help. Does your team act that way…from the newest employee to the CEO…every day?

Every member of management will stop and pick up paper dropped on the ground…they walk the walk, in fact the parks are designed such that no guest will have to go further than 20 feet to find a trash can…they expect excellence and build the park to help accomplish the task. Now I know what you’re thinking, we’re a small ambulance service, not Disney, we can’t do that kind of stuff. Untrue!

You can make interacting with your office easier using technology to forward calls rather than answering machines that don’t get checked for days. You can make the new member intake and orientation process a supportive and welcoming one rather than a gauntlet designed to see who can survive it. If you’re in upper management, climb off the pedestal for a hour, order pizza for the crew and help wash a truck in the bay. Be careful, the first time you do it someone might actually have a syncopal episode from the shock.

As an example of this, when I was the director of a hospital based paramedic service, I was coming home very late one night. On eof the units was on a call about 2 blocks off my route of travel so I thought I’d swing in and do a spot check…it was 2:45am. As they carried the patient down the stairs on a stairchair I was holding the exterior door open at the bottom. My medic had his back to me and when I said…”Good morning John, do you need anything”…he was so shocked at the sound of my voice that he almost dropped the patient.

Nothing gets everybody paying attention faster than an unannounced visit at an odd hour…equipment, uniforms, procedures, etc. can be seen in a glance and the crews will pass the information that you’re ‘visiting’ around like wildfire. If you expect excellence, even at 2:45am, and you’re willing to check on it…the bar has been set for all. The 10 minutes spent on that call is good for 2-3 weeks of off-hour compliance…and the looks on their faces…priceless.

“You’ve got to be very careful if you don’t know where you’re going, because you might not get there.” – Yogi Berra.
Yes, I’m even willing to quote a member of the New York Yankees (being a Red Sox fan) to help get my point across.

“Would you tell me, please, which way I ought to go from here?”
“That depends a good deal on where you want to get to,” said the Cat.
“I don’t much care where–” said Alice. “Then it doesn’t matter which way you go,” said the Cat.
“–so long as I get SOMEWHERE,” Alice added as an explanation.
“Oh, you’re sure to do that,” said the Cat, “if you only walk long enough.” – from Alice in Wonderland

The only way to enjoy a successful career and to operate a high quality, state-of-the-art service is to set objectives, goals if you will, and to LEAD your team towards them. Achieving these objectives involves visualization, belief, action, commitment and communication on your part.

If you ask any professional athlete how they made the impossible shot, the multi-millionaire how he or she closed the big deal or how Academy Award winning directors created their masterpieces, the answers are all about the same…they visualized the successful ending format BEFORE they started.

The athlete saw the ball go in the basket, the cup or over the ballpark wall, the business person knew the deal was done, they just needed to do the formal close, the director saw the finished movie and the thrilled movie goers. Once the end was clear, visualization, all that remained was backing into the ending by orchestrating the steps necessary to motivate the people and the resources to bring it to life.

This of course is where belief in yourself, the dream or goal itself and your people comes into play. There are two differences between a dream and a goal…first is that a goal is written and the second is that deliberate, focused action is needed to make a dream real.

What also has to be addressed is the fact that belief without action is useless and action without the commitment and drive to see the project through, and to go over, around or through any obstacles that appear in your path will cause the process to fail.

The last ingredient is communication. You must communicate your vision in a way that others can see, endorse, adopt and join with you as your vision becomes THE vision. Everyone must know their role, must feel your belief and must see your action and resolve.

People love to follow leaders and they love being a part of something new, interesting and positive…if you can create that vision in your service and set the stage well…they will follow. If they see you acting in a way that supports your message and vision, they will join with you and together the team becomes unstoppable.

Leadership is an ongoing, never ending, continuous process of learning…if you want to do it right. The day you accept the position, you should add an entry onto your perpetual TO DO list to begin searching for your replacement. You should always be on the lookout for talent, encouraging and mentoring the next generation of leadership…you could get hit by a bus tomorrow.

The two biggest Achilles heels that I see in our industry are a lack of proper succession planning and a reluctance to engage in professional development. Many in the leadership ranks hang on to their ‘insider information’ like it was the kings gold thinking that if they are the only ones who know the information then only they have the power…making them indispensable. Actually this way of thinking breeds resentment in the short term, and usually leads to a overthrow coup in the long run. Dictators rule for a while but history proves over and over that they are all eventually assassinated or overthrown. If you suddenly see a flurry of activity, a huge upsurge in morale, and the delivery of a surprise load of lumber, you may want to look over your shoulder, the teambuilding exercise they’re planning might be the erection of a scaffold to hang you from.

You actually gain more power, prestige and respect by becoming the source of information, the go to person for mentoring and by having a mentality that by enhancing the capabilities of your team you can achieve more.

On the personal development front, how many books do you read each month? How many periodicals and journals do you read that are from OUTSIDE the emergency service industry…often the best ideas are adopted from other industries. Vehicle tracking didn’t originate in EMS, it came from air traffic control, railroad logistics and the trucking industry.

I urge you to learn something new every week, schedule time to read, join a coaching or mastermind group to share ideas with others and keep growing. I typically have 2-3 books going at one time, I read probably 8 books a month plus industry journals in healthcare, EMS, general business and marketing. Also invest in your education. Go to seminars and not just industry ones.

In September we’ll be launching the EMS Leadership Institute which will quickly become the place where both industry and non-industry topic experts will bring game-changing information to our members to help them not only think outside the box but to actually crush the box and step over the wreckage. If you’re interested, you can join the pre-launch email list @ www.WeLeadEMS.com.

Whether you join the Institute or not is a personal choice but please give yourself and your staff a huge advantage by plugging into a power source of information somewhere and growing as a professional a little bit every day.

This is not the way to build trust, show leadership or build a team of competent professionals. I’m going to go out on limb and assume that you have staff members trained, on your payroll, in your uniforms, on your phones, driving your vehicles, representing your agency to the public because they are best of the best. If not, and you’ve only been hiring people who can fog a mirror, then there are other issues to discuss.

Assuming that you have the best of the best working for you, you OWE them information. They are your mobile marketing force, your ambassadors in the community and they need to be able to interact with knowledge and authority when they encounter your clients/patients.

Several years ago I was working as interim General Manager for an ambulance service that was going through particularly hard times. The IRS actually wanted to padlock the doors and auction off the equipment. During the roughest 120 days of the engagement the rumors were flying, fed by competitors and the usual ‘back row crowd’ from within.

I needed to keep morale up, explain to the troops what was happening and we needed to stand strong as a company to keep our contracts, our dignity and to keep the staff from defecting thinking the ship was sinking. My response was to do two things, first I called a company wide meeting, off site with food…EMS people love to eat…they all came. I explained the truth of the situation including the possible outcomes which included losing the fight with the IRS in which case we’d all be looking for work.

I explained our strategy, the time frames we were working under and took the abuse from an angry crowd who felt let down by management…(in truth it was one member of management who had caused the issue but we were all guilty in their eyes).

The second thing I did was launch a one page, two sided weekly update sheet called ‘The Rumor Mill’. Every week we collected all of the stuff that was out on the street…listed each rumor and then provided management’s response (this was pre-Internet… if the same thing happened today we’d be doing a daily or weekly blog). If we had not done this…in writing…the message would have been twisted around by each story teller, especially our competitors, and we’d have had more problems to deal with.

This, in-your-face method of rumor control also allowed management to tell our story our way. We gave copies of ‘The Rumor Mill’ to our staff, our clients and had extras in the ambulances in case we ran across someone with the wrong information.

The employees now KNEW what we were thinking, what we were doing, they took up and active role in squashing the false statements, they were not being controlled by rumors and urban legends and had a way to feel empowered to fight back and stand up for their company. Everyone saw that they were positive therefore people were positive about the outcome. A lot of good comes from positive attitude in the face of adversity.

The outcome was that we won our negotiation with the IRS (with agents named Ransom & Savage…I kid you not), adopted a pay back plan, fired the member of management that caused the issue, structured a merger with a friendly competitor and the company is still in operation and thriving to this day. If you’d like to hear about the IRS negotiation and how we convinced them to see things our way…drop a comment in the blog, if enough people ask I’ll write a future post about it.

While this is an extreme situation that called for rapid, crisis intervention techniques, the key to success in this situation and in the day to day operation of your service is to communicate your message effectively so that the troops are informed and involved.
Being treated like a mushroom sucks!

Over the years, I’ve run companies/divisions ranging in size from 5 employees to 250 employees, in both union and non-union organizations. In every one of them I’ve found myself having to deal with staff issues ranging from fights in the ambulance bay, union complaints, sexual harassment claims, theft of equipment and even staff having to deal with life-threatening medical problems of their own.

On one particularly memorable day, over the course of a six hour period, our team dealt with a serious ambulance crash severely injuring two of our own, an employee that had to be terminated on the spot for aggressive behavior towards a patient and facility staff, a long time staff member who developed complications with her pregnancy and was worried about having to come off the road, losing her job and her benefits, and a younger employee who wanted career counseling about becoming a paramedic. Add in a couple of irate patients with billing issues, reporters looking for information about the crash and just the usual ebb and flow of a day in EMS and it would be very easy to mis-handle these interactions.

If you allow your staff and your day to control you, these issues will pile up, there will be a boiling point after which you will say or do something that will be hurtful, inappropriate and that will do a lot more harm than good…even though blowing up at someone may feel good at the time.

Here are six quick tips for putting space between events and for gearing up or calming down for the next appointment and for making sure that you are fully engaged:
– Closing your door
– Coming out from behind the desk
– Keeping the desk between you and the person
– Excusing yourself and using the bathroom
– Rescheduling for a later time
– Eliminate the distractions, phone, email, inturruptions, etc.

Closing your door. The door is a traffic control device. If you need to get a project done, need time to think, need time to cool down or simply need 5 minutes to collect your thoughts…close the door and train your staff to respect it’s closure unless the building is on fire or an employee is injured. If you’re agitated after just having gone through a disciplinary session with one employee, you’re not ready to sit down and career counsel the next one…you are not in a positive frame of mind until you stop, breathe, regroup, refocus and then start the next session.

Coming out from behind the desk. Body language says volumes and if you are tying to be sympathetic to the staff member afraid of losing her benefits due to a pregnancy (admitedly in the days before Family Medical Leave) but you follow my point, sitting behind the desk in an authority pose does not come across nearly as well as sitting on the same side of the desk for the conversation. Same holds true for the career counseling session.

Keeping the desk between you and the person. Again, body language sets the tone of the encounter. In a discipline situation, especially one in which the issue is aggressive behavior…a barrier is a good idea. Also the posture of authority in this situation is needed, valid and appropriate.

Excusing yourself and using the bathroom. If you find yourself with back, to back, to back, situations…whose fault is the poor scheduling by the way…you need to inject a break to give yourself time to focus and shift gears. I will invite the person into my office and then excuse myself to use the bathroom or grab a coffee (ask if they want one too…coffee that is). The three minute break lets me take a couple of deep breaths, refocus and be ready for the next topic in a fully engaged manner.

Rescheduling for a later time. If your day really has been shot to hell and you know that you can’t focus properly…explain to the person that the day has been so frustrating that you could be of more service to them if you could reschedule. Pick a time that works, thank them for being understanding and then keep the next appoinment come hell or high water. Which would you prefer…the reschedule of a meeting to a better time or to be in a meeting where you knew the other person wan’t really there?
I thought so…if that’s what you’d prefer, so will your troops.

Eliminate the distractions, phone, email, inturruptions, etc. Give the person you’re meeting with your undivided attention. Put the phones on do not disturb, ditch the smart phone (it is making you dumber by the way), do not look at email (another reason to be out from behind your desk), and do not allow other interruptions…make that person feel as though they are the most important person in the world right then…hint: they are!

If you can pull off these relatively simple things, even though your team will not always agree with you, they will know that you’re listening, that you care and that they are important…they will respect you as a leader for your efforts.

Sorry for that painful trip down bad memory lane, to a place you buried long ago, but that emotion is necessary for our discussion. The further up the leadership food chain we find ourselves, the more self-important some in our ranks feel…and the more license to dispense wounding criticism comes with that self-important attitude.

For the record, I make a lot of mistakes…really, I’m fun to watch just ask my team..and I DO NOT condone management’s right to criticize…ever. Critique, educate, teach, lead, correct, change behaviors…you bet…criticize, sorry not allowed. I also expect my team to critique me…how else will I get better?

Remember that painful place I took you two a couple of sentences ago…if that was painful for you, why should you have the right to create that moment and memory for anyone else? I work under a very simple rule…and I use it with my team and even with my kids: praise in public, critique in private. Oh yeah, there is no such thing as ‘constructive criticism’ either…criticism is DE-structive regardless of the fancy name you give it.

If you value your team, employees, staff, whatever you call them, and oh by the way I can tell in less than a minute the value you place on that group by the way you refer to them…you want them to be the best that they can be. Remember all of these people are your extended marketing department…if you don’t value them…why are you letting them take to the street wearing your uniform? So, assuming you truly do value them, why would you want to tear them down especially in public? Unless you are a drill sergeant you have no right…and even the military spends more time, money and effort building confidence and competence in their team, in boot camp and beyond, than they do during the first few weeks of boot camp which is used solely to get everyone to the same starting point. You have orientation for that.

Treat your team members the way you want to be treated…when they mess up, call them to the office, pull them aside in the apparatus bay and discuss the issue. THEY, as a person, are not the issue. Your critique should never be directed at them personally…you are discussing their action, inaction, attitude, speech or behavior…they are a person of value.

If you new at this or uncomfortable, in the beginning you can use the crutch of triangulating to the policies and procedure manual, other training or memorandums. After you’ve done this a few times you can simply start the discussion with “Hey (name), got a minute? I want to talk you about (issue).”

Here’s my discussion formula for the conversation once you’re in a private setting…

Say something positive to begin the conversation
Identify the issue and the behavior that required the meeting
Offer your comments and critique designed to help them correct and improve
Listen to their thoughts, comments and issues regarding the situation
[Agree to research, with a reply-by date] any items they bring up that need further review
Reinforce the way you want it handled in the future
Conclude the discussion, thank them for their time and shake hands making eye contact (not the creepy kind either)
Move on with your day and document the event just in case

You goal in the meeting is to call their attention to the behavior, reinforce the correct, expected behavior, listen to any concerns that they have…you can’t get them to listen and agree until they’ve been heard and conclude by reaching an agreement on expectations moving forward. I also always end the discussion standing next to them and concluding with a handshake…subliminally reinforcing the agreement we just made.

I’m sure that given the choice you’d prefer to have your mistakes discussed in private…you owe that your your team as well. Of course you should also look to publicly praise good behavior…for tips on that, search the back blog article…Becoming a 30-Second Hero…over time praising good behavior actually drastically changes the culture by organically cutting the amount of critiquing needed to run an awesome organization.

People prefer praise over being critiqued and looking for good is a whole lot more fun as the leader !!

Because most managers and supervisors in EMS and the Fire Service rise through the ranks, once promoted, people who were friends are now subordinates. Most of those we supervise know us, our habits, our past including all of the mistakes we made on the way up and they are likely to throw our own mistakes in our faces when we call them out on theirs. It’s a tough place to be, so the tendency to protect ourselves and to maintain friendships often leads to blaming others or shirking the responsibility for our actions and decisions.

Common cop outs include “it’s the Chief’s rule not mine”, “ sorry, it’s out of my hands”, “that’s what the Town Manager said”, “they left me no choice…”

Sorry…in my eyes those are ALL cop outs. Shifting the blame and the eyeballs off you in an effort to avoid assuming a leadership position or avoid working through unpopular policies, directives and other issues only serves to weaken your credibility.

When a policy is put in place that requires us to change, almost no one likes it, we are creatures of habit. In emergency services, we also have a lot of time between calls to look for reasons to complain.

If your organization has a solid leadership structure, you knew the policy was coming, in fact you probably sat in on the leadership team meeting(s) where implementation was discussed…99 times out of 100
you have not been surprised, don’t try to pretend otherwise.

Instead, take the time to explain the rationale behind the change, perhaps the options that were evaluated and the intended improvement that is expected…then stand up with the management team and support and enforce it.

If not, you will lose credibility and the trust of both staff and management. You will be seen by management as not being a strong member of the team and you’ll simultaneously be viewed as a wedge by the staff that they can exploit to undermine your fellow leadership team members…this will make for a very short career.

Another area that needs to be addressed here is the application of discipline. Leaders run the gamut from talking their staff to death and never taking disciplinary action to wielding the pen like a sword and cutting a swath through the ranks looking for any infraction. Neither choice a good one…everything in moderation…talk, teach, set boundaries, apply discipline as needed.

Those who talk their staff to death are looking for validation and being a leader that everybody likes. In fact, by not taking action and becoming known for fairness and consistency you will quickly be loved by those who want to challenge the rules and hated by those who recognize their importance…since you never make a decision…everyone will learn to just ignore and go around you rendering you useless and ultimately easily replaceable.

The flip side…the tyrant…newly promoted and out to prove who’s boss…hated universally by all, trusted by no one and unable to generate support, teamwork and if in the military, most likely to be killed by friendly fire.

After almost three decades in leadership positions in several types of organizations, I’m comfortable passing on some sage advice that was given to me…become known by your actions…make decisions, admit mistakes, be firm, fair and consistent and you’ll find support at all levels of the organization. You can’t be an effective leader if you are afraid to be out in front leading by example, make and admit your own mistakes and if you are always looking for the popular answer.

The biggest mistake that most freshly minted supervisors/managers make is believing that because they now have a title they immediately are entitled to respect…not so. First, you show respect to those that you lead…then you earn their respect in return. Once accomplished, you continue to earn it by your everyday actions, words and attitude.

In this series, I’m going to talk about Leadership and the seven principles that make up what we should all be striving for…the ability to ACHIEVE…together.

I’ve been very fortunate to have known and been mentored by people I consider leaders. I’ve noticed some common traits among them, leaders want to personally ACHIEVE more, leaders want their organizations to ACHIEVE more and, in my opinion, doing that requires the application of seven specific principles in order to ACHIEVE maximum success.

I’ll be exploring each of these principles in greater detail but for the record here’s the list:

The ACHIEVE Leadership Program
Seven Principles

• Accept responsibility for your actions and decisions.
• Critique never criticize.
• Handle each employee and problem individually.
• Inform and involve your staff.
• Encourage and develop yourself and your employees.
• Visualize your objectives.
• Expect excellence.

Most of us in EMS Leadership make the transition from EMT/Medic and cross the great divide to supervisor, then manager and beyond. Unless you are assigned as a working field supervisor, it is very difficult to run the system and ‘go out and play’ in it too.

If you want to develop as an effective leader, you can’t be one of the gang and the boss too…you need to pick one regardless of how hard it is. Throughout this series I’ll be discussing specific ways to make that transition easier and how to develop your skills throughout your career.

Embrace and encourage mistakes made by you and your staff. Then dissect what happened, what can be learned from it, share the good, the bad and the ugly components with your entire team and build a better business from the lessons.

Case in point, our award winning website www.AmbulanceBill.com was born because our customer service in 2005 wasn’t up to par. We had grown dramatically and we had a lot of people calling in to give their billing information during lunch time…when our staff wanted to eat too. You know, like most banks. Well, that was unacceptable so we build a 24/7/365 interactive portal that allowed the clients and patients to interact with us whenever they wanted to.

Every transaction remains behind a firewall so that we were HIPAA complaint before there was such a thing as HIPAA. The result was better data collection, increased claim resolution, improved collections, fewer inbound phone calls, happier patients and better communication with our clients. All stemming from admitting we had made a customer service mistake and learning from it.

Most service chiefs and administrators hate complaints…I encourage you to learn to love them. Every complaint is an opportunity to educate, inform and improve regardless of the source of complaint employee, patient or the public.

Celebrate your mistakes, strive to keep them small and relatively infrequent but don’t run from them…learn to listen for them and build a better organization from them.
Look around…there’s plenty to work on.

Three examples from just this week:

Client #1: A small community ambulance who is very fiscally responsible but is having great difficulty convincing their Town officials to accept the need to assist them financially in the provision of supplemental staffing.  Town sees it as the ambulance service’s issue.

Client #2: A municipal fire department who’s union leaders can’t accept that their members need to provide good quality run documentation so that billing can be done properly and revenue collected…a statement was actually made that it’s  ‘not our job…”  What?!  These same folks will be screaming it layoffs happen due to fiscal issues.

Prospective client: A very business oriented municipal fire department that analyzes everything and is in the process of proposing fully funded system enhancements based on solid historical evidence. I’d like to bottle their attitude and perspective.

I looked back over our client list from the last 24 years as well as the list of clients whose project we either turned down or former clients that we’ve chosen to no longer do business with and validated what I thought I knew about our best clients and longest relationships…the clients that we work best with are ones that understand that Emergency Medical Service and the Fire Service are in fact businesses, not strictly social clubs, entitlement organizations or municipal entities who feel that they that bear no responsibility for their operational efficiencies.

We are all in the business of emergency services, our products/services are providing outstanding care, safe transportation and aggressive fire/rescue services to clients(our community residents).  Regardless of service type, volunteer, for-profit, hospital based or municipal, we owe our clients our very best, ON EVERY CALL, which means timely service, high levels of equipment maintenance, continuous training and maximized revenue collection that requires tax payers to support as much as needed but no more.

Being in business means also effective leadership, marketing and public relations activity, timely reporting to the municipal leaders and the citizens we server about our responses (volume and times), issues we’re facing, our needs and our fiscal status…not hiding and hoping no one looks deeply into what we’re doing.

Throughout the year, my intention is to spotlight agencies, especially volunteer and municipal agencies, who have a progressive and efficient business model.  If you believe that your agency qualifies and you would like to be considered for a spotlight profile and are willing to share you best practices please contact me.