The Privilege of Pressure

It was a random Wednesday, and with it came the double edge of an open-door policy. One of our team members finished answering my question, and it was obvious he was out of sorts. A short time later, he segued into a perennial litany of complaints. 

Every manager knows this comes with the territory. You will always have the critics, the bell ringers, the doomsayers, and the easily panic-stricken. The important thing is to be able to listen to them with a critical ear so that you can tease out any addressable issues. Sometimes though, it can make you feel like a punching bag. This is especially true if you're tired or not at your best. 

Growth and change are hard, full stop. Even when they bring good outcomes for the agency and community, they result in periods of enormous stress. Leading people through change, regardless of your level, is equal parts enthusiasm and fear of the unknown. Keeping that positive momentum and believing in the long-term plan is a delicate balance you must actively work at daily, sometimes hourly.

He left the office, but his words remained. Finally, the scale in my head tipped to the negative. My own internal narrative shuffled over to the cabinet and pulled out the file marked “Imposter.”

Most people have heard some version of it for themselves. It’s the one that questions every professional choice you’ve ever made and says your critics are right; you have no idea what you’re doing, and your vision isn’t working.

Recognizing the signs that I was sliding full tilt into the Pit of Despair™, it was time to engage countermeasures. (If you want a list of those tactics, that’s another article.) One of these is some version of a binge-able show you can hitch your brain to for a couple of hours. This time I chose the documentary on Netflix, “America’s Sweethearts,” about the Dallas Cowboys Cheerleaders. I curled up with my blanket and settled in for a good sulk about how much I wished I was back on the ambulance again.

There isn’t an EMS manager out there who doesn’t know exactly what I am talking about.

Episode one passed by amidst a swirl of leggy angst and generational trauma exacerbated by the excessive use of hot rollers. Still, I became increasingly fascinated by the depth of drive these young women had in pursuing their goals. Episode two brought the full realization that they audition like this every season, regardless of status. 

Every member of the squad must earn their position each year. What a brutal thought. 

I watched as veterans—experienced, beautiful, talented women, were dismissed as just not good enough this year. They all knew it was a possibility coming in, even likely—yet they did it anyway, putting
themselves at risk of that level of professional rejection just for the slim chance to be a part of the team. 

Watching the cuts and departures not just then but throughout the season, I saw remarkable demonstrations of resilience and dignity. As the final few were culled, the survivors banded together, and you could see the radial bonds of a team begin to form as they headed to Training Camp. I was invested.

By episode three, I was taking notes.

This is an excellent place to mention the focus of this article: Fundamental issues, such as mental health or exploitation, are found throughout elite athletic and entertainment organizations. There are a lot of problems here, but there is also value. This sliver of the internet shows how this structure was built to reach the top of its niche. 

What does any of this have to do with EMS? After almost four decades in the industry and having been exposed to almost every model out there, there's only one thing that remains consistent no matter where one goes—the cries about retention. While it's true that staffing everywhere hit appreciable crisis levels during COVID, there is one true constant, and that’s the fact that few people stay.

For many providers, it’s not a lifetime career—not in the 1980s, 90s, 00s, or today. We're still an ad hoc service, with too many variations to offer a uniform structure and career path from start to finish. We lack the appreciable structure of fire or the pure lateral capacity of application that nursing has. 

Some systems have done a decent job building a stable structure to work within, of one type or another, but even they vary from type to type. Consider the “biggest names” out there: Boston, Medic One, or FDNY, for example. I am not arguing good or bad; I am just pointing out how different each delivery model is for essentially the same work. They represent just a tiny fraction of the systems nationwide. 

We can’t agree on a system. There’s limited room for advancement and lateral application, and the pay scales vary so widely that in some areas of the country, it doesn’t qualify as a living wage. There's only so much a “sign-on bonus” can mitigate.

Now add the generational factor. Gen Z: They. Do Not. Stay. It’s not you; it’s them. With an average of three careers by age 30, you will likely not have them for more than five years. Generation Alpha does not look to be much better. We are left with an unstable job landscape filled with digital nomads in an industry that doesn't look evenly stratified. 

While there have been advances in different areas, things are not likely to improve or even change for at least another decade or two. So, what's a manager to do? How do you make your agency the best place to go to?

Maybe the answer is that you don’t. 

Perhaps it is best to fully own the short-term employee and build a structure that builds the strongest teams in the least amount of time. Maybe the answer is that you work on making it the best place to be from. 

Watching "Sweethearts," it becomes clear very quickly that, regardless of anything else, becoming a part of that organization is the goal that drives these young women. For those who do make it, even if  only for one season, they become a part of something larger than themselves—for the rest of their lives. 

I wanted to know what was so fundamental about DCC that drove this culture and this global brand? Here are some of my takeaways and some quotes I pulled as I went through the series and took notes:

Know what you want. What is the vision? This applies to the people, the things, and the principles. Have a clear idea of the type of people you want to hire and what kind of energy you want them to bring. “Your vision determines your decisions.”

Audition. Care about who comes through your door. In interviews, we ask people if they are good enough to work with us. If they audition, then they must show us. 

Don’t be afraid to cut. This is so difficult, especially when staffing is a challenge. Yet employee engagement routinely mentions not addressing poor performance. “Be as honest as you can, as fast as you can.” They are constantly rebuilding; they can't afford to hold onto to poor performers.

Appearances matter. “Aesthetics are part of the role.” The same is true in our world. Professional appearance, courtesy, behavior, and compassionate interactions all contribute to exceptional levels of care. It’s not just the appearance; it’s all the details. It’s consistency, compliance, following the standards, and attention to detail, whether that is during an assessment or with documentation. Mind the details; that’s where you can continuously improve.

Innovate, but respect tradition. It’s possible to evolve along the lines of a vision while remaining true to the original principles.
Traditions give people common ground and can unite them across generations. If you don’t have any, create your own.

You are not alone. Whether the meeting was positive or negative, there were senior staff members prepared to be with the team afterward. Mentorship is vital.

Give back. The ability to give time and energy back into the local community in some way is a self-perpetuating gift. As one of the girls said, “Every time you interact with someone, it may be the ONLY time you get to interact with that person.” So, make each one count.

None of these are new concepts, but for the DCC brand they are ingrained in the foundation and are nonnegotiable parts of their identity. Now, I don't know if God really loves Dallas, and there are downsides to some of their methodology. But I can say that I came away with a renewed sense of purpose and new ideas. 

Perhaps we've been looking at our agency issues in the wrong light, and it's time to change some tactics. Instead of worrying about people moving on to their next job, what about focusing more on building up the structure that people will walk into? Solidifying our identity and values and bolstering those that were already here.

Over the next couple of weeks, I assigned the series as homework for the officers and asked them to watch at least the first two episodes. 

There was some pushback at first, along with at least one request for an e-mail explaining the assignment to a spouse, and it scored well among households with male children aged 11-16. 

We recognized some things we were already doing or were trying to do and things we could implement. It made for an excellent conversation that left the entire group fully engaged. Ideas from this are being rolled in to a long-term strategic plan that we will implement over the coming months. We talked about culture and vision and what we could look like going forward if we raised the bar together. And that, my friends, is how the Dallas Cowboys Cheerleaders pulled me out of the Pit of Despair™.

The moral of the story is to take your inspiration where you can get it. The next time Netflix asks you if you’re still watching, say yes—it’s for homework. Full send.