The director of a medium-sized service in the Northeast told me a few weeks ago that “I just want some control. It feels like I’m constantly crashing into the rocks instead of being the rock for my team.”

Reasons for chaos

We are living and leading in a chaotic world. In EMS, the pressure takes a heavy toll on the organization and its leaders. Four common sources of pressure include financial issues, mismatched caregiver expectations, increasing performance requirements and governance issues.

From a financial perspective, I’ve never met an EMS director who feels they have too much money. Revenue compression from payers, loss of subsidies, the confusion about Obamacare, and increasing federal scrutiny, audits and investigations all contribute to the current financial chaos.

Caregiver expectations that are unrealistic or not well aligned with the organization’s mission, vision and values are also problematic. So many EMS workers expect their needs to be met in the time it takes to complete a Google search. In contrast, many leaders have to deal with external factors that move as fast as cold peanut butter. When expectations are deeply mismatched, relationship issues between caregivers and leadership become more difficult, with both sides questioning the intent and integrity of the other side.

In EMS, the pressure takes a heavy toll on the organization and its leaders. Four common sources of pressure include financial issues, mismatched caregiver expectations, increasing performance requirements and governance issues.

Performance requirements have changed. EMS is being held to a higher clinical standard than in the past. Outcomes are being measured and benchmarked. It’s not just about timely responses, door-to-needle times and general process measures. Systems and their leaders are being held accountable to document achievement in the areas of quality, internal and external customer satisfaction, financial performance and growth.

Governance issues are also becoming more complex. When the city council or an external board has conflicting agendas (think about recent Congressional politics) it can make the EMS leader’s professional life miserable. If the governing authority’s perspective isn’t balanced, it can spell trouble for the leader. Making a difficult decision in such an emotionally charged environment requires special attention to the process of making the decision in a disciplined manner and then implementing the decision with positive action.

Each of these factors can cause an EMS leader to feel out of control. In trying to discern how to be “the rock” for your team, it’s helpful to remember that you chose to navigate the class 5 rapids of EMS leadership rather than sailing the sea of tranquility in some safe, non-demanding, non-fulfilling civilian position.

Becoming the rock

Here are seven suggestions to help steer your EMS boat so the team avoids crashing into the boulders in your path

1. Face forward: Plan well and execute better. Don’t dwell on the past. Know that there are rocks out there and create a step-by-step plan with timelines. Often EMS leaders get stuck playing “poor me.” Instead, engage your team so that they are truly invested in the plan and its success.

2. Over-communicate: It’s been said that EMS leaders have to listen loudly. To do that, we have to go where those with opinions are and ask for them. It’s also helpful to communicate using multiple media. For example, communicating verbally at caregiver meetings, in writing via email and social media posts and, most important, interacting with caregivers in settings other than at the office or while they are on-duty.

3. Develop clear expectations: When they were growing up, my children understood that a midnight curfew did not mean 12:15 a.m. The same is true with your supervisors. They need to know what you expect, when you expect it completed and how you will know if it’s done correctly before they embark on a task.

4. Transparent processes: Leadership, including human communications, clinical improvement, operations and deployment, technology and information systems, human resources and financial processes can be problematic if not transparent. When caregivers don’t understand why a process exists, why it’s important, or why it may not appear to be consistently applied, then that process becomes opaque.

EMS is being held to a higher clinical standard than in the past.

5. Cross-validate data: Having clarity on the facts is important. Whenever possible, cross-validate what you’ve been told using multiple sources. Look deeper for system issues rather than assuming that the problem is simple. There could be a system issue that created the problem. For example, when B shift complains about A shift not getting the unit in for preventive maintenance, be sure the metrics confirm individual perceptions. In this case, a quick review of the shift report may show that several other units were down and there were multiple out-of-town trips, so a reasonable decision was made to defer planned maintenance to the following shift.

6. Small corrections work best: When a problem is caught early, it enables a minor course correction rather than having to make a large scale or sudden turn. Being aware that a correction is needed is the first step. Leaders must be constantly looking downstream. Sudden turns make it more difficult to keep the boat afloat.

7. Accountability: Despite best efforts, there are times when EMS systems hit the rocks. When the same processes are used, the same outcomes can be expected. Leaders don’t like to hold people accountable and when we don’t do so, the system and its internal and external customers suffer. Remediation is appropriate for errors commensurate with a team member’s experience and training. However, for those who are unwilling or continually unable to perform, there must be consequences.

Summary

We live in chaotic times in EMS. One of the paradoxes of being the rock is that our leadership must be agile. We have to anticipate and act on those things we can control. To assess your organization’s agility, take the survey and compare your results at www.fitchassoc.com/agility

In a follow-up conversation up with the previously-mentioned director seeking “control,” he recognized that being the rock for his team didn’t mean that he would never get banged up. He indicated that using the seven strategies above “lets me lead from a position of stability and gives me a ballast when things get out of control. In that way I can be a rock instead of letting the team crash on the rocks.”

The post Seeking Stability appeared first on EMS Insider.

Under federal law as well as some state laws, there exist two types of illegal harassment: (1) quid pro quo harassment, and (2) hostile environment harassment. While quid pro quo harassment (for example, a job benefit conditioned on sexual favors) is rarely an issue in the modern workplace, hostile environment harassment claims abound. Hostile environment harassment is generally defined as conduct based on a protected category—such as an employee’s race, color, religion, gender (including pregnancy), national origin, age (40 or older), disability or genetic information—that is severe or pervasive enough to create a work environment that a reasonable person would consider intimidating, hostile or abusive.

Despite the fact that hostile environment harassment has a relatively narrow legal definition (because a viable claim exists only when the alleged harassment is based on a protected category), the term “hostile environment” has become a buzz word used by employees to complain about everything from a chatty co-worker to a malfunctioning computer. As a result, many managers and human resources professionals are inundated with employee complaints of such hostile environments.

Understanding the true definition of a hostile environment is important because employers have a duty to investigate complaints about illegal harassment. In addition, a legitimate complaint by an employee about perceived unlawful harassment may be protected activity, meaning that an employee who is subject to an adverse employment action such as a termination, decrease in pay, demotion, negative evaluation, etc. on the heels of such a complaint might have a basis for a retaliation claim. Given these risks, employers can find themselves in a web of never-ending investigations of hostile environment complaints and in constant fear of liability every time an employee uses the magic words “hostile environment.”

The fact that an employee uses the term “hostile environment” need not immediately sound alarms, however. Instead, it is important to determine and communicate early on whether an employee is complaining about a perceived hostile environment as that term is defined under the law, or is merely griping about a general workplace annoyance unrelated to any protected category. Involving the employee in this assessment can help clarify the issue for both the employer and the employee.

For example, if an employee complains that his co-worker plays music too loudly and that this is creating a hostile environment, the employer is well-advised to find out immediately whether the music is in some way offensive to the employee because of a protected classification. Does the employee find the music racially or sexually offensive? Does the employee believe the music is being played loudly to harass the employee because of a disability? Or is the complaint simply an issue of the high volume annoying the employee? If it’s the latter, then the complaint is not about a hostile environment as that term is legally defined.

Once the employer determines the exact nature of the complaint, it is important to explain to the employee that the company will respond to the complaint regardless, but the term “hostile environment” has a legal meaning and associated legal requirements and it is therefore important to determine the exact nature of the complaint. Once the employer and employee agree on the scope of the complaint, the employer can investigate accordingly. Including the employee in this determination and obtaining a common understanding of the nature of the complaint will often protect against future disputes over whether an employee complained about or was subjected to a hostile environment.

Another practice that helps ward off improper use of the term is to define it well in your anti-harassment policy. Make sure that the company’s definition of harassment mirrors the legal definition of the term, so that employees are aware of what the term really means.

A word about bullying: Hostile environment complaints often involve allegations that a co-worker is yelling, screaming, intimidating and humiliating other employees. While such bullying behavior may not involve a protected category (bullies are generally equal-opportunity harassers—happy to bully all co-workers regardless of gender, race or any other protected category), courts have recently become creative and devised ways to deem bullying illegal harassment. For instance, a California court held that a supervisor who bullied all employees regardless of sex could create liability for sexual harassment because the bullying impacted female employees more severely than male employees. This means that complaints of bullying should be taken seriously, investigated and resolved.

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