EMS Leadership Part 2: Inspirational Motivational Transformational Leadership in EMS

This is the second 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.

Jake, executive director of Sunset County EMS, was recently hired to clean up the mess left by the previous executive director. Sunset County EMS currently has the worst reputation in the region. There are a number of issues including morale problems, high absenteeism, a 40% staff turnover, and numerous complaints from patients, as well as hospital ED staff, law enforcement and firefighting officials. Jake is responsible for making effective changes to improve all operational and relational aspects of the organization. His plan includes working with staff to change the organization's vision through leadership by example, as well as to create an inspirational motivational environment for all organizational staff.

The first thing on his agenda is a general meeting with all personnel. Jake opens his presentation by saying that the organization's new vision is to provide high-quality, responsive healthcare to the community while establishing supportive, effective and efficient relationships with others in the community, including law enforcement, firefighting and emergency room partners.

"You notice I use the word partners," says Jake. "The best way to establish an effective healthcare environment is through partnerships with other healthcare-related protective and supportive organizations. Do you all agree?"

There is a slow but responsive agreement from the staff.

Jake makes eye contact with everyone in the conference room and says, "We must also build partnerships within our organization. I am here to support and assure you success in all aspects of your individual careers, including creating a pleasant work environment that benefits not only you, but your patients, your family and our partners. You would not be in this challenging career field if you did not have the desire and drive to protect and care for the people in our community who need your effective and responsive skills to assist them. I assure you I am here to support you anyway possible that will lead to your success and the success of this organization.

"You are also empowered as individual leaders to identify and work with me to make improvements in our work environment at all organizational levels," Jake continues. "I cannot be with you in the field all the time, so you must take the lead to provide high-quality and responsive care. Your suggestions and recommendations are encouraged. You are now in a position to make a difference and improve not only this organization; but your relationships with everyone you come in contact with in your everyday work environment. You have my cell phone and email address--use them. When possible, I will be at your side to support you in all of our operational and organizational improvement initiatives. You must also be there for your ambulance partner and patients. Now, for the rest of this meeting, I want to hear organizational- related improvements, including not only our work environment, but our relationships with the community we support. I will take all suggestions and recommendations seriously, so let's get started."

This is an example of inspirational motivational leadership, which is part of the full-range or transformational/transactional leadership model espoused by Bass, Burns and Avolio beginning in 1978. The full-range leadership model includes eight factors. 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 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. All factors of the full-range model will be addressed in subsequent articles.

The viewpoint of leadership researchers is that indirect leadership is not confined to the realm of highly visible leaders. The belief is that leaders at all levels in organizations can influence the development and effectiveness of everyone within an organization even if they are not in formal leadership positions.

Inspirational leaders are able to develop an effective organizational vision and build team spirit, as well as a meaningful work environment. These ingredients are essential to ensure team and organizational success.

A fair amount of research has been conducted in support of transformational leadership regarding emergency medicine. For example, a research study in 1997 addressed two healthcare and two welfare organizations in the Netherlands. Results showed a positive correlation between transformational, especially inspirational motivational, leadership and the success of all four organizations.²

In 2005, researchers surveyed 60 head nurses in five general hospitals in central Israel. Results also showed that transformational leadership, including inspirational motivation, ensured organizational success and the well being of head nurses. The nurses saw themselves as transformational leaders, which they viewed as a positive work environment.³

Still another research initiative in 2002 regarding 2,617 nurses from 17 hospitals in Belgium showed that not only does transformational leadership lead to organizational success, there was 78% satisfaction in leaders who were transformational leaders, and an overwhelming number of nurses were satisfied with their work environment.⁴

An inspirational motivational leader is required to:

• Lead by inspirational example.
• Lead to the vision and mission of the organization.
• Provide positive buy-in motivation to followers.
• Empower followers to be inspirational motivational leaders.
• Emphasize positive teaming relationships through supportive success.
• Encourage team member participation.
• Build constructive and supportive relationships internal and external to the team.
• Provide followers unconditional support to ensure their success and that of the organization.

Transformational leadership with emphasis on inspirational motivation is a model of leadership that, when applied, will lead to successful healthcare teams and organizations. This will in turn lead to high quality and responsive healthcare being provided that benefits both patients and organization, 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. Den Hartog DN, Van Muijen JJ, Koopman PL Transactional versus transformational leadership: An analysis of the MLQ. Journal of Occupational and Organizational Psychology 70, pp. 19-34, 1997.

3. Hendel T, Fish M, Galon V. Leadership style and choice of strategy in conflict management among Israeli nurse managers in general hospitals. Journal of Nursing Management 13, pp. 137-146, 2005.

4. 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.

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 1: Master or Servant?