EMS Leadership: Part 9—Situational Leadership Support for EMS Environments

Robin Steward, Mountain Laurel County EMS Director, recently learned from the county commissioners that one of the major towns in the county has terminated its contract with a national EMS organization. Robin has now inherited responsibility for providing expanded EMS support for this township and has called a meeting with her support staff to address the situation.

She greets her staff and says, "As you have heard, we now must provide EMS support for Bluebonnet Township, and I am confident this team can make it happen with minimum impact to the patients and ambulance teams we are currently responsible for supporting. I recommend we approach this situation in multiple phases to achieve our goals. Do you agree that our goals include being responsive to EMS calls, providing outstanding patient care, and supporting our individual ambulance crews to ensure their success, as well as the overall welfare of our community?" Everyone in the room agreed with Robin's organizational goals.

Robin continued. "Now I will identify the phased approach we are going to take, and your feedback and suggestions are encouraged. Benjamin, as our hiring team lead, please use current job requirement standards to address the new response area and advertise for four additional crew members. We need these folks on board in 60 days.

"Rusty, as our ambulance vehicle lead, please meet with our local ambulance salesperson and obtain a quote for our standard ambulance components, and work with Janet to ensure we have supplies to retrofit one additional ambulance. I will take the quote to the next commissioners' meeting to obtain authorization to purchase a new ambulance. Let's make this happen within 120 days."

Ross, the training coordinator, was asked to train the new crews within two weeks after they were hired and schedule them to intern with current ambulance crews to affirm their training and make them familiar with the coverage areas. "Because it will be 120 days before we get the ambulances, let's use this time to educate our new crews and make them comfortable in our organization," Robin said. "Thanks, team, for your support. Tomorrow I will have an organizational meeting to identify our plan of action. I will also emphasize that until we get the new ambulance in and crews trained, the Medic-1 ambulance will cover the northern area and Medic-2 will cover the southern area, including Main Street, which is the dividing line of the new response area regarding Bluebonnet Township. Are you on board with these temporary response areas?" Everyone responded positively to the plan. "I have been working with the township fire department and they have an empty vehicle bay we can use to station the new ambulance," said Robin. "They also have no problem with the ambulance crew using their facilities while waiting for response calls.

"Again, thanks for your support, and please feel free to contact me at any time in the event you run into a problem. Because we are an effective and efficient team that works well together, I am confident this situation will be addressed in a smooth and comfortable manner. Take care and stay safe."

Hersey and Blanchard established what is known as the "Situational Leadership" approach,¹ which says that leaders should diagnose the competence and commitment of followers in diverse situations and change the leadership style to match. The approach stresses that leadership is composed of both directive and supportive behaviors, which are applied differently given a specific situation. For example, directive behaviors assist group members in goal accomplishment through giving directions, establishing goals and methods of evaluation, setting time lines, defining roles and showing how the goals are to be achieved. Northouse also specified that supportive behaviors help group members feel comfortable about themselves, their coworkers and the situation.² Daft says that this approach focuses on the characteristics of followers as the important element of the situation, and consequently of determining effective leader behavior.³

Strengths of situational leadership include:

• Widely used in training and development
• Easy to apply
• Rigid structure
• Unique in stressing leader flexibility

Weaknesses of situational leadership include:

• Not substantiated by research findings
• Unclear conceptualization of development levels in the SLII model
• Unclear conceptualization of commitment
• Prescriptions of model not fully substantiated
• Does not address issue of one-to-one and one-to-many.

Click here for a diagram by Hersey and Blanchard regarding the breakdown of the directive and supportive aspects of the situational leadership approach.¹

Situational Leadership Styles

S1: High Directive-Low Supportive (directing style): The leader focuses communication on goal achievement and spends a smaller amount of time using supportive behaviors.

S2: High Directive-High Supportive (coaching): The leader focuses communication on both goal achievement and maintenance of subordinates' socio-emotional needs.

S3: High Supportive-Low Directive (supporting): The leader does not focus exclusively on goals, but uses supportive behaviors to bring out the employees' skills around the task to be accomplished.

S4: Low Supportive-Low Directive (delegating): The leader offers less task input and social support, facilitating employees' confidence and motivation in reference to the task

Development Levels

This is the second major part of the situational leadership approach. Development level refers to the degree to which subordinates have the competence and commitment necessary to accomplish a given task or activity. Daft emphasizes that the essence of this leadership approach is to select a style that is appropriate for the readiness level of subordinates, such as their degree of education and skills, experience, self-confidence, and work attitudes.³ Development levels are broken down into the following areas:

• D1: Employees are low in competence and high in commitment.
• D2: Employees are described as having some competence but low commitment.
• D3: Employees who have moderate to high competence but may lack commitment.
• D4: Employees are the highest in development, having both a high degree of competence and a high degree of commitment to getting the job done.

Even though this leadership approach has limited research to validate it, EMS leaders can apply both supportive and directive behaviors to assist in the success of their individual teams and the organization as a whole. Taking the time to apply both supportive and directive behaviors is worth the effort and the benefits are self evident. EMS ambulance crews and organizations consistently find themselves in different and diverse situations. This approach is just one leadership style in an arsenal of many leadership styles that should be considered to assure team, organization, and patient care success.

References

1. Hersey P, Blanchard KH. Management of Organizational Behavior: Utilizing Human Resources. Upper Saddle River, NJ: Prentice Hall, 1969.

2. Northouse P G. Leadership Theory and Practice (3rd ed.). Thousand Oaks, CA: Sage Publications, 2004.

3. Daft RL. The Leadership Experience. Canada: South-Western as part of Thomson Corporation, 2005.

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.