EMS Leadership Part 7: Team Building

This is the seventh in a series of columns on EMS leadership. Dr. Breaux will cover leadership applications such as behavioral, managerial, situational, path-goal, leader-member exchange, full-range transformational and transactional leadership. Other areas like conflict management, effective communications and organization structure will also be addressed.

Medics 1 and 2 respond to a major 10-50 two-vehicle accident with multiple casualties at the intersection of Bluebonnet and Maple. Susan, Jefferson County's EMS director, calls dispatch to let them know she is responding and asks them to tone out the local fire department for scene assistance and place a medical helicopter on flying standby. She also tells them she will be scene commander. Susan arrives at the scene with law enforcement and asks the fire department to assist the ambulance teams in identifying and securing patients for on-scene rapid stabilization and emergency treatment. Before she can request it, two paramedics offer to conduct a quick triage on the patients in each of the two vehicles and provide the results of their findings so she can call in additional resources as needed and keep the hospitals and medical helicopter updated on the number of patients and seriousness of injuries. Susan commends the paramedics on their initiative.

The paramedics report that there are two critical and two ambulatory patients and advises Susan of their injuries. Susan requests dispatch to have the fire department establish a landing zone and bring in the medical helicopter. The ambulance crews, with assistance from the fire department, establish c-spine stabilization and place the two critical patients in an ambulance for transport to the helicopter landing zone; the two ambulatory patients are placed in the other ambulance for transport to the local trauma hospital. Susan advises both the medical helicopter and the emergency room of individual patient injuries. Based on previous team training, the ambulance crews update the medical helicopter crew and emergency room staff regarding patient vitals and other important medical information.

The good news is that all of the patients recovered from their injuries, thanks to responsive and effective team work of the ambulance crews, fire department, law enforcement, medical helicopter crew and emergency room staff. Everyone worked together to assure scene safety and provided appropriate and responsive emergency medical care for all the patients involved in the accident. Susan not only assured smooth on-scene command, but had previously conducted consistent training courses and collaborative team coordination exercises and strategy meeting involving all local response organizations. Susan immediately thanked all who participated in the incident for their outstanding support.

Team-building is important not only in emergency care, but also in other important organizational initiatives. Under the Leader-Member Exchange (LMX) model of leadership, the best leaders are those who build effective relationships within teams, which may involve giving credit to the team in a way that teammates feel they did it all themselves.¹ Members in high-quality exchange relationships with their team leaders are given more freedom, better job assignments and increased opportunities to work with their leader. Members with low-quality exchange relationships are directed toward unpopular jobs with few opportunities to interact with their team leader. ² Graen³ says that followers who share leadership grow into leaders within the team and share equitably in the team's success. Also, traditional managing or controlling leadership techniques work well in business-as-usual settings; however, more team-oriented, high LMX leadership is needed when dealing with less favorable situations. ¹

According to Graen, Hui and Taylor, effective team performance depends on three critical processes. ¹ First, teammates' working relationships and interdependent roles need to be developed in terms of LMX and member-member exchange (MMX) through a role-making process. ⁴ Second, relationships need to be successfully integrated into team effectiveness dynamics, which means flexible structure. Third, team leaders need to "step up" and perform their "backstop" roles and whatever is required to make their mission a success. ⁵ In a crisis situation, team dynamics can mean failure or success, depending on the effectiveness of the team and its leader.

Under the LMX leadership theory, the dyadic relationship and interactions between leader and followers is the focal point of the leadership process. According to researchers, high-quality LMX dyadic relationship-building produces less employee turnover, increases positive performance evaluations and promotions, facilitates better organization commitment, establishes more desirable work assignments and better job attitudes, increases attention and support from the leader, provides greater follower participation, and hastens career progression for everyone. ⁶ Additionally, prior studies have established that mastery goal orientation (focusing on acquiring competence) is positively related to LMX and that performance goal orientation (establishing superiority over others) is negatively related to LMX. ⁷ Team leadership level LMX is the most dominant predictor of affective and normative commitment, and the meaning, self-determination and impact dimensions of psychological empowerment. ⁸ Additionally, team relational dyads indicate low conflict, high ambiguity and high intrinsic satisfaction enhancing the link between LMX and performance. ⁹

Team members must go beyond business as usual. It is too late in worst-case scenarios to find out that team members are not accountable or responsible for the success of the team, or capable of supporting fellow team members. Innovative learning is a major part of team development that includes such principal components as anticipation, learning by listening to others and participation. ¹⁰ Bennis further relates that innovative learning obviously requires that you trust yourself and that you are self-directed rather than other-directed in both your life and your professional endeavors.

According to Daft, another way of reflecting team development can be specified in four stages of development, including forming, storming, norming and performing. ¹¹ Daft says that forming is the stage of development reflecting a period of orientation and getting acquainted. The storming stage deals with individual personalities emerging with clarity. Norming is the team development stage marked by conflict resolution and team harmonized unity. Performing is the final stage of team development, where the major emphasis is on accomplishment of team goals.

A final aspect of team development is how members respond under pressure in a crisis or crunch period scenario. A study by Graen, Hui and Taylor in 2004 found that the crunch period produced the fire that transforms and tempers potential teams into a real team, and real teams into high-performing teams. ¹ Conversely, the escalated pressure may cause "pseudo" teams to fail when integrating team leadership is lacking. A successful leadership team must be able to successfully operate and perform in any crisis situation they encounter.

The LMX model of leadership is just one way of building effective and responsive teams, including integrated team leadership. Other leadership models have been and will continue to be presented in this column. It is important that individual leaders identify the right leadership model appropriate for their team development to ensure the success of their organization, as well as provide the right care and the right time for patients they are responsible for treating.

References

1. Graen GB, Hui C, Taylor EA. A new approach to team leadership: Upward, downward and horizontal differentiation. New Frontiers of Leadership, LMS Leadership: The Series 2: 33-66, 2004.

2. Ashkanasy NM, O'Connor C. Value congruence in leader-member exchange. The Journal of Social Psychology 137(5):647-662, 1997.

3. Graen GB. To share or not to share leadership. In G. B. Graen (Ed.), Sharing Network Leadership: The Series 4, pp. 63-93. Greenwich: Information Age Publishing, 2006.

4. Graen GB. Interpersonal workplace theory at the crossroads: LMX and transformational theory as special cases of role making in work organizations. In G. B. Graen (Ed.), Dealing with Diversity, LMX Leadership: The Series 1, pp. 145-182. Greenwich: Information Age Publishing, 2003.

5. McGrath JE. Time, interaction, and performance (TIP): A theory of groups. Small Group Research 22, pp. 147-174, 1991.

6. Graen GB, Uhl-Bien M. Relationship-based approach to leadership: Development of leader-member exchange (LMX) theory of leadership over 25 years: Applying a multi-level, multi-domain perspective. Leadership Quarterly 6(2):219-247, 1995.

7. Chiaburu DS. The effects of instrumentality on the relationship between goal orientation and leader-member exchange. The Journal of Social Psychology 145(3):365-367, 2005.

8. Kent A. Multiple sources of leadership and employee reactions in a state park and recreation department. Journal of Park and Recreation Administration 21(1):38-60, 2003.

9. Dunegan KJ, Uhl-Bien M, Duchon D. LMX and subordinate performance: The moderating effects of task characteristics. Journal of Business and Psychology 17(2):275-285, 2002.

10. Bennis W. On Becoming a Leader. New York: Perseus Books Group, 2003.

11. 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.

Related

• EMS Leadership Part 6: Conflict Management Alternatives for EMS Leaders and Staff
• EMS Leadership Part 5: Idealized Influence Transformational Leadership in EMS
• EMS Leadership Part 4: Individualized Consideration Transformational Leadership in EMS
• EMS Leadership Part 3: Intellectual Stimulation Transformational Leadership in EMS
• EMS Leadership Part 2: Inspirational Motivational Transformational Leadership in EMS

• EMS Leadership Part 1: Master or Servant?