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EMS Leadership Part 4: Individualized Consideration Transformational Leadership in EMS
This is the fourth 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.
Mike was team leader of a military EMS response team in Afghanistan. Two medics, Ben and Johnny, who were new to Afghanistan and the challenging combat environment, had just been assigned to his team and were displaying "deer-in-the-headlights" operational body-language. They had never been in combat, and they were new to EMS.
When Mike met with them prior to their being assigned to an operational combat team, he told them, "Pull up a chair and let's talk about what you need to know when operating in the field."
Both sat down and stared at Mike, fully concentrating on what he was about to tell them: "Before I begin, I want to encourage you to ask questions and provide feedback on what I say to you. It is very important that we establish two-way communications and that you fully understand the lessons I am about to share. I want you to consider me a mentor who is always available to assist you in this challenging and dangerous operational environment."
Both Ben and Johnny agreed to ask questions and listen closely.
"I know you are both new to EMS," Mike said. "Let me assure you that you have received the medical training you'll need to be successful, and your skills will continue to improve with experience."
Mike slowly walked Ben and Johnny through what to expect in the field and how to maintain their safety and the safety of their patients, and provided step-by-step procedures on individual injuries they might encounter in the field. Both asked questions and provided appropriate feedback to Mike. Mike told them it's normal to be nervous or fearful, and to experience an adrenaline rush in a combat situation. He assured them their training would kick in at the right time and enable them to provide the care and protection they needed to stabilize their patients and get them to sustainable care they needed for survival.
"Understand that even with your training you may not be able to save everyone, and that is not your fault," he said. "Remember that I am here for you anytime you need to talk about what you experience in the field. This will be a continuous learning environment on both medical procedures and team leadership. Good luck, and stay safe."
Over the next 12 months, Ben and Johnny performed well in the field and saved many lives. They both moved into team leadership positions and applied the same successful individualized consideration leadership practices they had learned from Mike. They were not only transformed into responsive medics, but also established as effective medical team leaders.
This is what is known as "individualized consideration" leadership, which is part of the full-range or transformational/transactional leadership model espoused by Bass and Avolio beginning in 1978. Transformational leaders, regardless of their organizational position, can use individualized consideration, intellectual stimulation, inspirational motivation and idealized influence to influence others from a distance.1
According to Bass and Avolio, transformational leadership is seen when leaders:
- Stimulate interest among colleagues and followers to view their work from new perspectives
- Generate awareness of the mission or vision of the team and organization
- Develop colleagues and followers to higher levels of ability and potential
- Motivate colleagues and followers to look beyond their own interests toward those that will benefit the group.
The transactional leadership aspect of the full-range model includes contingent reward, management-by-exception (active), management-by exception (passive) and laissez-faire, which relates to an individual who is not a leader in any way.
Individualized consideration is when a leader coaches, facilitates, teaches and mentors, and encourages two-way communications and feedback. Transformational leaders pay special attention to each individual's needs for achievement and growth by acting as a coach or mentor and the followers or colleagues are developed to successful high levels of potential.1 According to Bass and Avolio, the individually considerate leader listens effectively and delegates tasks as a means of developing followers. These delegated tasks are monitored to see if the followers need additional direction or support and to assess progress. Ideally, followers do not feel they are being checked on.1
A fair amount of research has been conducted in support of transformational leadership in medicine, including individualized consideration. The following examples emphasize its use.
In 2006, a research study conducted by McGuire and Kennerly surveyed nurse managers and staff nurses from 21 not-for-profit hospitals in the Midwest. Results show that nurse managers rated themselves higher than staff nurses regarding their application of individualized consideration and identified a positive outcome and job satisfaction from this transformational leadership factor.2
In 2002, Vandenberghe, Stordeur and D’hoore surveyed 2,617 nurses from 17 hospitals in Belgium. The authors relate that individualized consideration is conceived of as the individual support and attention provided to followers in pursuit of challenging goals. Results reported that transformational leadership that included application of individualized consideration ensured followers put in extra effort, were satisfied with their leader and had overall job satisfaction, emphasized goal attainment, and supported positive staff retention.3
A research initiative conducted by Hetland and Sandal in 2003 regarding 177 subordinates and superiors of mid-level Norwegian managers in five different healthcare organizations showed a positive correlation in their application of the individualized consideration factor, which was defined as where a leader communicates personal respect to followers by giving them specialized attention and recognizing each one’s unique needs.4
A study conducted by Ohman in 2000 of 125 nurses who were critical care managers in Minnesota showed a positive correlation regarding the application of individualized consideration, which was defined as having a leader who mentors, coaches and teaches staff while working toward the organizational vision.5
Corrigan, Lickey, Campion and Rashid related in their study of 27 leaders of rehabilitation teams that used individualized consideration, defined as followers treated by their leaders differently but equitably, showed significant improvement in their leadership factors based on effective training and organizational support environment.6
Transformational leadership with emphasis on individualized consideration is a model of leadership that, when applied, leads to successful healthcare teams and organizations. This in turn will lead to provision of high-quality and responsive healthcare that benefits both patients and organizations, as well as other supportive and protective organizations and the community.
References
1. Bass BM, Avolio BJ. Improving Organizational Effectiveness Through Transformation Leadership. Thousand Oaks, CA: Sage Publications, 1994.
2. McGuire E, Kennerly SM. Nurse managers as transformational and transactional leaders. Nursing Economics 24(4):179-185, 2006.
3. Vandenberghe C, Stordeur S, D’hoore W. Transactional and transformation leadership in nursing: Structural validity and substantive relationships. European Journal of Psychological Assessment 18(1):16-29, 2002.
4. Hetland J, Sandal GM. Transformational leadership in Norway: Outcomes and personality correlates. European Journal of Work and Organizational Psychology 12(2):147-170, 2003.
5. Ohman KA. Critical care managers change views, change lives. Nursing Management 31(9):32B-32E, 2000.
6. Corrigan PW, Lickey SE, Campion J, Rashid F. A short course in leadership skills for the rehabilitation team. Journal of Rehabilitation 66(2):56-58, 2000.
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.
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