Leader's Digest: Diversity and Understanding

Leader’s Digest is a bimonthly column produced in partnership with Cambridge Consulting Group (CCG), a group of subject matter experts with expertise in paramedicine, ambulance operations of every organizational structure, and medical transportation services. Visit www.CambridgeCG.net.

My favorite definition of diversity comes from expert Salwa Rahim-Dillard, PhD, who defines it as a “quantifiable measurement of all the ways we differ. It refers to characteristics that make us unique, like ethnic background, color, race, religion, gender, sexual orientation, age, educational background, and mental and physical abilities.”

By this measure and most others, there is not a lot of diversity within American EMS. In its early years (just two-plus generations ago), frontline EMS providers were almost exclusively white men. Many of us can still recall when a woman working on an ambulance was met with ridicule and inappropriate comments that would never be tolerated today.

It has only been in the past decade or so that diversity in EMS has become a topic of conversation at all. To date, and understandably, most initiatives have focused on people of color. But diversity encompasses many groups of people, and many leaders in EMS are inadequately prepared to coach, inspire, and mentor a broad range of staff—particularly those who are LGBTQIA+ (lesbian, gay, bisexual, transgender, queer/questioning, intersex, asexual, and other sexual minorities).

Even socially conscious leaders who embrace diversity and inclusion can find themselves uncomfortable in this space. I humbly include myself among them.

A Few Numbers

Happily, over the past three decades, women have entered the EMS profession in steadily increasing numbers and now make up approximately 35% of the workforce. That’s better, if not yet equal. But other groups have fared less well: According to a 2019 study, newly certified Hispanic EMS professionals accounted for 13% of EMTs and 10% of paramedics. Black, indigenous, and people of color (BIPOC) represent just 3%–6% of EMS providers.

No specific accounting has taken place to better understand the number of LGBTQIA+ staff working as EMS providers in America. But we do have an idea of the growing number of Americans who are members of these groups. Specifically, according to a recent Gallup poll, 5.6% of U.S. adults self-identify as lesbian, gay, bisexual, or transgender. That’s 18 million people. 

While diversity among frontline staff is sorely lacking, diversity among the ranks of EMS leaders is abysmal. Data is scarce, but ask yourself how many EMS chiefs, managers, and supervisors you know who are gay, lesbian, transgender, disabled, Black, indigenous, or people of color. Perhaps a few—but not many. There can be no inclusion without diversity at the top.

Expectations of a Leader

This lack of diversity can allow narrow perceptions to persist. Recently a board member left a national EMS advocacy organization after expressing hurtful and misinformed opinions about transgender people on social media. Most would agree this is no way to advance the field of paramedicine.

Not knowing or understanding something should never, in and of itself, be viewed as a fatal flaw. Not even the most extraordinary people know and understand all things. However, when leaders are presented with new information, facts, and sensibilities, we have an obligation to dig into them, to try to learn about them and grow our practice of leadership. We should allow room for contrary thinking and respectful disagreement, but clear boundaries must be set for behavior that is needlessly harmful to individuals or damages a population. Leaders are not entitled to a free pass simply because of their position, particularly when they refuse to see and acknowledge the damage left in their wake. 

How to Improve

Doing better at such issues requires learning from others not like ourselves. It’s not uncommon for leaders to seek input and new knowledge from others who may have better information on a topic. I recently spoke with Ann Marie Farina about these issues. She is a paramedic, educator, and past president and cofounder of The Code Green Campaign, a mental health advocacy organization for first responders. Most important, Ann Marie is a passionate champion of doing the right thing.

One nugget I heard from her was about clarity in what you want to accomplish. Is the goal of diversity training to help providers take better care of LGBTQIA+ patients, or are you trying to build a more inclusive culture for LGBTQIA+ staff? If you begin by working with staff, a Hawthorne effect might result in positive change in the behavior of crews on the streets when interacting with LBGTQIA+ people.

Farina also sees value in seeking outside expertise about diversity and inclusion rather than engaging solely on the inside. While LGBTQIA+ staff members have their own lived experiences, they may feel singled out if asked to educate their peers about their existence. Additionally, they themselves may benefit from the validation an outside resource can offer. 

Sometimes even knowing what language to use can be difficult. Farina shared some language guides (see the resources) that can be consulted for proper terminology when speaking with and about LGBTQIA+ people. Words matter, and the simple act of trying to use inclusive language demonstrates respect for differences and an appreciation of diversity.

Conclusion

Effective leaders grow by exploring new ideas and seeking the wisdom to understand how those ideas might inform and influence their work. Learning is often enhanced when coming from a place of appreciative inquiry and recognizing that our own particular upbringings and social, economic, and career experiences deeply impact how we perceive things. The theme here is about being open to exploration and new thinking—even (and especially) if you do not agree.

One of the best ways to learn is to listen. John Becknell, PhD, longtime leadership teacher, encourages leaders to listen deeply “in such a way that you might actually learn something—or even change your mind.” Now more than ever, listening deeply is a skill worthy of refining.   

Sidebar: Self-Assessment

Earlier this year the Harvard Business Review ran an article by Salwa Rahim-Dillard titled “How Inclusive Is Your Leadership?” I found this to be a helpful piece worthy of sharing (find a link in the resources). 

Rahim-Dillard discussed use of a self-assessment tool developed following years of research in the area. It is a thorough yet simple instrument whereby participants review a set of desired behaviors and give themselves scores of low, average, or high. Each ranking comes with a narrative describing that behavior. 

For example, one desirable behavior is, “To model authenticity, vulnerability, and openness.” Someone with low ability in this area might acknowledge they try hard to maintain the status quo, while someone with high ability in this area is accepting of others and listens intently. The point of the exercise is to create a snapshot in time of your personal strengths and weaknesses. From there the leader can build their own unique road map where strengths (areas of high ability) can be developed and gaps (areas of low ability) targeted for improvement. The result is a more inclusive leadership style.

Taking a long, honest look in the mirror to determine where you land on the inclusion continuum is not easy and can be uncomfortable. But those who do the work stand a much better chance of building a leadership practice strong in inclusion.

Resources

GLAAD. GLAAD Media Reference Guide—Transgender, www.glaad.org/reference/transgender. 

Oregon Health and Sciences University, Transgender Health Program. Transgender Health Program: Terms and Tips, www.ohsu.edu/transgender-health/transgender-health-program-terms-and-tips. 

Rahim-Dillard S. How Inclusive Is Your Leadership? Harvard Business Review, 2021 Apr 19; https://hbr.org/2021/04/how-inclusive-is-your-leadership. 

Trans Language Primer. The Transgender Language Primer, www.translanguageprimer.org/primer. 

Zweigenhaft RL. Diversity Among Fortune 500 CEOs from 2000 to 2020: White Women, Hi-Tech South Asians, and Economically Privileged Multilingual Immigrants from Around the World. Who Rules America?, 2021 Jan; http://whorulesamerica.net/power/diversity_update_2020.html. 

Brian LaCroix, FACPE, NRP (ret.), is an executive advisor and cofounder of the Cambridge Consulting Group (CCG). He serves as EMS coordinator at the Center for Patient Safety and is a retired EMS chief at Allina Health EMS in Minnesota.