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EMS Leadership: Part 11—Transactional Leadership Factors in EMS
Ben was hired as director of the Rain Tree EMS organization six months ago and is doing his best to improve EMS operations and patient care for the county. Things are still not improving, so he has called a meeting of all staff to establish a plan of action to improve this organization.
Ben greets the staff and tells them he wants to briefly cover some recommended oversight initiatives to assist them and their team in improving the operational and patient care environment. He encourages them to offer feedback and suggestions during the discussion and lays out his plan of action:
• "We need to improve our response time," he tells them. "It is still taking too long to respond to county EMS calls. By the end of this week I would like you to let me know how we can improve. I will reward teams that improve their response time by 5 minutes in the next 30 days with a monthly barbeque supported by me and the county commissioners. However, these responses must be safe and non-reckless. The last thing we want is injured providers and patients.
• "I will not only closely monitor your response times, I will also accompany ambulance teams periodically to evaluate and provide instant feedback," Ben continued. "I believe you will agree we need to be safe, responsive and supportive, and we also need to be courteous to patients' families, other ambulance teams, and hospital and flight support personnel. The objective of my instant feedback is to provide continuous recommendations for how to improve all aspects of our important operational environment.
• "For the next 12-months, I will implement twice-yearly performance reviews from ambulance team leaders and myself. Many of you are doing good patient care; however, constructive feedback is important for all of us to ensure we are doing our best. These performance reviews will be documented and reviewed with each individual team member in private. I believe you will agree that private discussions will allow and support open communications and encourage productive discussions on how we can improve and be a successful EMS organization."
Ben concluded the meeting by announcing there would be more meetings to ensure they were all communicating and doing their best for patients and the organization. He reminded them he is always available to answer questions and receive feedback on how to improve their important organization.
Full-Range Leadership
Burns and Bass established what is known as "Full-Range Leadership" theories that include transformational, transactional and laissez-faire leadership styles. Burns and Avolio espouse that transformational leadership is an expansion of transactional leadership.1 Transformational leaders are called transformational because, when applied, leaders and followers are transformed. According to Northouse, the transformational leadership approach is concerned with emotions, values, ethics, standards and long-term goals, and includes assessing followers' motives, satisfying their needs and treating them as full human beings. 2 The laissez-faire full-range leadership factor is defined as the absence or lack of leadership.
Transactional leadership emphasizes the transaction or exchange that takes place among leaders, colleagues and followers. The transactional leader recognizes followers' needs and desires and then clarifies how those needs and desires will be satisfied in exchange for meeting specified objectives or performing curtain duties. 3
The opening scenario is an example of transitional leadership, which supports three factors: contingency reward (#1 above), management-by-exception active (#2 above) and management-by-exception passive (#3 above) leadership. Contingency reward is considered an exchange process between leaders and followers where the followers' efforts are exchanged for specified rewards. Normally, an agreement is established between leader and follower before work is performed to specify what needs to be accomplished in order to receive a pre-determined reward or payoff. For example, an EMT training instructor might be expected to train 35 individuals a month to receive a paycheck.
Management-by-exception active transactional leadership is where the leader actively monitors followers to ensure they routinely meet established standards and procedures. For example, at a specific time when an EMT violates a standard or procedure, he is corrected immediately by the leader.
Management-by-exception passive is where a leader does not actively watch a follower, but evaluates the follower's performance later over a specific period of time. For example, an EMT may receive a performance report annually based on the leader's evaluation of his performance over the past 12 months.
Research has shown that both the active and passive management-by-exception leadership process can be either a non-supportive or negative reinforcement approach to EMS or other organizational leadership initiatives. Research has also identified that the majority of organizations, including EMS, follow more of the transactional than transformational leadership style. It should be highly encouraged to have transformational take priority over transactional, because it is better to transform followers than to just reward or monitor their efforts.
In 2006, McGuire and Kennerly administered a survey to 63 nurse managers and 500 staff nurses from 21 not-for-profit hospitals in the Midwest. 4 The goal was to compare how nurse managers and staff nurses rated nurse managers on their application of transformational and transactional leadership.
Staff nurses overall rated nurse managers higher on transactional leadership than the nurse managers rated themselves. For example, staff nurses rated nurse managers higher on both management-by-exception passive and management-by-exception active than did nurse managers. However, nurse managers rated themselves higher on contingency reward than did staff nurses.
Results of a survey administered to 125 critical care nurse managers in Minnesota suggested that nurses with previous leadership experience rated themselves higher in transformational leadership than did nurses with no previous leadership experience. 5 While there was no significant difference with regard to overall transactional leadership, nurses with previous leadership experience rated themselves higher in contingency reward leadership than did nurses with no previous leadership experience.
From a survey administered to 2,617 nurses from 17 hospitals in Belgium, results indicated that the more leadership applies management-by-exception passive, the less nurses made an extra effort, were satisfied with the leader, satisfied with their job, satisfied with goal attainment and supported staff retention. 6
While transactional leadership style can provide a possible foundation of effective leadership, it is better to be more transformational than transactional to ensure the EMS organization is successful. Transactional leadership can be seen as a preliminary transition to transformational leadership. As specified in this article, while transactional leadership is prominent in many EMS organizations, transformational leadership should be the main focus to ensure followers perform as required. This will ultimately benefit patients, their families, hospital and flight support groups, and the whole EMS organization to ensure sustained effective leadership and proactive and responsive patient care support.
References
1. Bass BM, Avolio BJ. Improving Organizational Effectiveness Through Transformation Leadership. Thousands Oaks, CA: Sage Publications, 1994.
2. Northouse PG. Leadership Theory and Practice, 3rd ed. Thousand Oaks, CA: Sage Publications, 2004.
3. Daft RL. The Leadership Experience. Canada: Thomson Southwestern, 2005.
4. McGuire E, Kennerly SM. Nurse managers as transformational and transactional leaders. Nursing Economics 24(4):179-185, 2006.
5. Ohman KA. Critical care managers change views, change lives. Nursing Management 31(9):32B-32E, 2000.
6. Vandenberghe C, Stordeur S, D'hoore W. Transactional and transformation leadership in nursing: Structural validity and substantive relationships. Euro J Psycholog Assess 18(1):16-29, 2002.
Paul Breaux, PhD, LP, has a doctorate in leadership studies and conducts research in EMS, firefighting, law enforcement and military leadership environments. He is in his 11th year as a volunteer licensed paramedic (LP) for Bandera County Texas EMS and is an adjunct professor at Our Lady of the Lake University. His full-time leadership job is in applied electromagnetic research and development with Southwest Research Institute.
