To Follow the Leader, Lead the Follower

Ambulance 5 responds to a major vehicle accident. Its crew is Ben, a paramedic; Randy, who is driving; and Cindy, an Intermediate EMT assisting Ben in the back. On their way to the scene, Ben asks his team how they will prepare for this incident.

Randy says he will position the ambulance close to the scene, but not close enough to inhibit responders’ activities. Cindy says she will obtain the trauma bag and oxygen tanks to assist Ben on the scene. She recommends Randy get the backboards, neck braces and stretcher out of the ambulance when they arrive. Randy agrees. Cindy then recommends Ben go immediately to the patients to start their evaluations so they can prioritize and begin addressing their injuries.

Ben thanks both members of his team for their recommendations. He acknowledges that he enjoys working with them, and the support they provide helps establish a positive and effective environment for the successful treatment of patients.

Treatment of the accident victims is smooth. Both are transported to the nearest emergency department and treated effectively in route. On the way back from the hospital, Ben provides positive feedback to both his teammates. He also encourages Randy to remember to respond immediately to the dispatcher when they arrive at scenes in order to establish their time on scene. Randy relates that he forgot to do that, but says it won’t happen again and that he appreciates Ben’s feedback. Cindy also responds positively to Ben’s support and says she’s proud to be on the Ambulance 5 team.

Leadership and Followership

Good followership can greatly assist leadership in any organization, but they are particularly intertwined in EMS. There are several reasons why followership is important to leadership. First, individuals shift into and out of the dual states of followership and leadership. Second, building and sustaining a friendly and proactive relationship between the leader and follower is very important. Third, both leaders and followers exhibit many of the same qualities that are desirable in establishing a good organizational team.

According to leadership expert Richard Daft, there are five styles of followership.

1) The first is the alienated follower. These are often effective followers who have experienced setbacks and obstacles, perhaps promises broken by their leaders. They think independently but are often cynical and do not participate in developing solutions to problems they encounter. They allow hostility and cynicism to permeate their work environment. The leader needs to work with these individuals to turn them around into active and effective parts of the EMS team.

2) The second style is the conformist. Conformists participate actively in EMS organizations but do not utilize critical thinking skills in task behavior and accomplishment. Normally, conformists simply follow the orders of leaders without providing feedback. They work with the team, but do not provide critical thinking to support improving the operational environment or patient care.

3) The third style is the pragmatic survivor. Pragmatic survivors, according to Daft, emerge when organizations go through desperate times, and followers find themselves doing whatever is needed to get through. According to Daft, 25%–35% of the followers in an organization are pragmatic survivors.

4) Passive followers are the fourth style. Basically they exhibit neither critical nor independent thinking and are not active participants in the organization. Passive followers leave the thinking to the leader. Their leader may be the type that overcontrols or gets carried away with punishment, which leads to their followers being passive just to survive. This is poor leadership and must be changed to establish a constructive and participative EMS team.

5) The fifth style is the effective follower. These followers behave the same toward everyone in the organization regardless of their position. They do not try to avoid risk or conflict. They provide critical thinking to support the organization and leaders at all levels. They get involved and enjoy being part of the team. Good leadership establishes and sustains these types of followers. Achieving this style of follower should be the goal of any organization to ensure its activities are accomplished effectively.

Developing Good Followers

Development by leaders is important in establishing and sustaining effective followers. According to expert Peter Northouse, PhD, development levels refer to the degree to which followers have the competence and commitment necessary to accomplish a task. The leader must establish a positive environment that breeds positive attitudes and support from the followers. This includes communicating positively with followers and encouraging them to provide the critical thinking important to the success of the organization. Leaders need to stay in contact with followers and help make them integrated members of the organization and operational teams.

According to leadership pioneer James MacGregor Burns, effective and active followers are generally more diverse than their activators (leaders), and followers normally view themselves as a member of the organizational family. These types of followers want to participate in social and psychological activities important to the organization; this makes them feel like they are a family member who is taken seriously and helps keep the organization successful.

According to Daft, leaders should provide the following support to develop effective followers:

First, make regular feedback a habit. The leader should share goals and objectives with their followers continuously, not just at some annual meeting. This keeps the followers informed and participative. The leader should use elements of storytelling to obtain effective feedback and to establish equal footing with their followers. Followers are encouraged to analyze and respond effectively regarding their examination of information being presented by the leader.

As noted by Daft, leaders should be generous with positive feedback to their followers. This helps followers to improve their behavior and limit their shortcomings. It is also important to weak followers because positive feedback encourages them to do their best and participate positively toward the organization’s goals and objectives.

The leader should also train followers to view feedback as an opportunity for development. Help them see it as a chance to improve their skills and become more active participants in the organization and their EMS teams.

We should agree that establishing and sustaining collaborative relationships between leaders and followers is important. Effective followership is not always easy, and leaders need to take the initiative to establish relationships that are productive and cooperative. Effective followers assume responsibility, serve actively, meet challenges they encounter, and provide support for the organization and the EMS team that helps establish an environment for success. It is not unusual for effective followers to eventually become effective leaders. They learn from their leaders and apply.

As a leader, continue to provide positive feedback and encourage participation from your followers. This is important to the relationships you establish and the success of the organization you serve.

References

Daft RL. The Leadership Experience. Mason, OH: Thomson Southwestern, 2008.

Northouse PG. Leadership: Theory and Practice, 3rd ed. Thousand Oaks, CA: Sage Publications, 2004.

Burns JM. Leadership. New York, NY: Harper & Row, 1978.

Paul J. Breaux, PhD, LP, has a doctorate in leadership studies and conducts research in EMS, firefighting, law enforcement and military leadership environments. He is a volunteer licensed paramedic for Bandera County (TX) EMS and an adjunct professor at Our Lady of the Lake University in San Antonio.