UNIT II STUDY GUIDE
Leadership and Governance
Course Learning Outcomes for Unit II
Upon completion of this unit, students should be able to:
1. Differentiate between management and leadership.
1.1 Describe how leadership and governance in EMS work together.
7. Explain how leadership styles can impact morale in the EMS workplace.
7.1 Determine the importance of sound leadership in EMS systems.
7.2 Consider leadership styles for managers.
Unit II Essay
Unit II Essay
Unit II Essay
Chapter 2: Leadership
Leadership: Theories, Models, and Styles
What is a leader? What is leadership? When those questions are asked, one often considers an answer that
is on a global scale such as the President of the United States, the leader of the free world, or on the opposite
end of the scale, the leader of North Korea, Kim Jong-un. However, leaders are not just found in the realm of
politics and national governance, in fact they are found in every aspect of life and business from the largest
group of corporate organizations to the smallest group of kids on a playground.
Many also believe that management and leadership are one in the same, and although one may be both
leader and manager, they are two separate functions. A manager, as we have seen in the last unit, is
someone who is in charge of a variety of tasks that must be accomplished for the smooth functioning of an
organization. These tasks may include anything from billing and supplies, to discipline and hiring and firing,
and anything in between. A leader, on the other hand, is an individual who can exercise a high degree of
control or influence over others, for good or evil. Leaders can come in all shapes, sizes, and moral standards,
but the one thing they all share is the ability to influence. Clearly, this is a more emotional connection rather
than the task-oriented one of management.
The academic study of leadership theory has as long a history as that of management theory. Our textbook
looks at theories beginning in1920s and 1930s with the great man theory that supposed you were born to
greatness as a result of genetic traits and specific behaviors (Buchbinder & Shanks, 2017). The textbook
continues the timeline and shows the progression to today’s theories of adaptive leadership and global
EMS 4302, Leadership in EMS Systems
leadership. It is hard to look back at some of these and imagine that they wereUNIT
of as cutting
especially in today’s era of teamwork and flexibility in EMS and healthcare leadership.
Adaptive leadership, developed in the early 2000s, recognizes that an organization faces constant
challenges. From growth and development in technology to the types of generational issues seen from
Generation X to today’s Millennials and Generation Z, adaptive leadership recognizes the need for change as
needed to accomplish the required tasks. Global leadership is the recognition that the world, not just the local
area, has an impact on the growth and/or survival of industry. The flexibility of adaptive leadership and the
worldwide reach of global leadership theory are required in today’s leaders.
Now that we have a reasonable idea of how the theories of leadership have changed over the last 100 years,
we should have a greater understanding of the emotion of leadership. Those who are leaders will have both a
leadership model/philosophy and a leadership style that will allow them to adapt and lead in every situation
they find themselves.
Leadership models or philosophies include the concepts below.
Emotional intelligence (EI): Interpersonal and intrapersonal skills are required to be well adjusted.
This includes a deep understanding of self.
Authentic leadership: These leaders display traits such as optimism, hope, and positive morals and
values that attract others to them and result in positive outcomes.
Diversity leadership: This is particularly important in today’s global environment. In order to create
success for an organization, it is important to be aware of, and function with, a variety of cultures and
religions, whether in patient care or in dealing with directors and boards.
Servant leadership: This is collaborative and includes the desire to help others succeed. Those who
follow this philosophy persuade rather than tell and use personal trust to motivate cooperation.
Spirituality leadership: This is one of ethics, values, and balance in the workplace
Resilient leadership: This style is one of inner strength and self-care in an organization with high
stress such as found in all healthcare groups but particularly in EMS (Buchbinder & Shanks, 2017).
Keep in mind that these philosophies may be found in combination with each other, and the use of one does
not cancel out the use of others.
In the 1930s, psychologist Kurt Lewin identified three of the four leadership styles that are still referenced
today. The first one, we have all experienced in our working lives, is the autocratic style leader. These leaders
do not collaborate with their teams or employee groups. They are the boss; they make the decisions and do
not care if there is agreement with the choice. Although there may be times when this is an appropriate
stance to take such as a pilot’s choice to land or not land, when used excessively, it can produce unhappy
workers. Disgruntled employees may try to find ways to avoid working with or for the leader by absenteeism,
excessive sick days, and rapid turnovers. Imagine in EMS this might be the old school chief who uses the “my
way or the highway” control over his shift personnel, the shift supervision, or adopts a “like it or leave it”
attitude. However, when a quick decision must be made, these are the leaders who do not hesitate to make it.
The democratic style leader includes input from his or her team members, but they make the final decision.
Teams that work under these types of leaders are often happy and satisfied in their jobs and are productive
and creative in the workplace. An EMS leader of this type might be the shift captain who takes input from his
crew on new equipment requests or training needs and opportunities. He takes it all into account, but the final
decision rests with him.
The laissez-faire leaders leave it all up to their team to decide when and how to get things done. A deadline
may be given, but the way they get to that deadline is not a concern. These leaders give a lot of support and
advice but little involvement. When the team is not self-motivated, this style can lead to limited work being
done and poor time management. Can you imagine a shift captain who says, “Change the oxygen tank,” then
does not follow up? Would there be oxygen available for the next call if the providers on the shift did not
bother to change it?
Lastly, we can look at the transformational leader. These are great communicators and hold themselves
accountable for their actions and leadership. They have a vision and want to share it with everyone who
EMS 4302, Leadership in EMS Systems
works for them. They have high integrity and are often humble. They just wantUNIT
These are the types of leaders you often encounter when a department is in trouble,
Title and a new inspirational
leader arrives to save the day.
(Food for thought: Can you see where different styles might be useful in EMS? Would a transformational
leader be great on the scene of a mass casualty incident? Would an autocratic leader be great in a situation
where his or her medical certification was lower than the people the leader was supervising? Just another
bite: What kind of leadership style would you want to have?)
The “wild west” days of volunteer EMS agencies doing whatever they please are long gone. We truly can no
longer view emergency medicine as a new field or career path. EMS has been around in some form or the
other since the Roman times, but as a modern entity, it has reached its half-century mark from the white
paper of 1965. It may be even older if you credit the mobile army surgical hospital (MASH) units of the Korean
War in the 1950s.
The Bureau of Labor Statistics (2015) compiled data showing the number of Paramedics at almost 250,000
as of 2014, with an estimated job growth of 24% through 2024. As EMS systems have grown in the number of
paramedics and emergency medical technicians (EMTs) employed, all 50 states have developed statewide
EMS systems that are overseen by boards that monitor licensing, certifications, and discipline. Governance
for health care, and in particular EMS, takes many forms and is found in many layers. EMS differs from many
organizations in that the structure is hierarchical in nature with administration being separate from staff and
overseen by a governing body that could be a board, council, or commission. These bodies have legal
authority over the governance of EMS, and it is not just the state level of governance that EMS is held to but
also the local board of directors, local governments, and local medical authorities may all have a say in how
EMS is practiced and paid for. In some states, the allowable skills differ from county to county while other
states adhere to a national standard such as the National Registry of Emergency Medical Technicians
Regardless of who, or how many, boards an agency must answer to, the one thing that is clear is that today’s
EMS leaders/managers have a lot on their plate. Having a clear concept of a management style and
leadership philosophy is more critical than ever in the success and long-term well-being of emergency
Buchbinder, S. B., & Shanks, N. H. (Eds.). (2017). Introduction to health care management (3rd ed.).
Burlington, MA: Jones & Bartlett Learning.
Bureau of Labor Statistics. (2015). Occupational outlook handbook: EMTs and paramedics. Retrieved from
EMS 4302, Leadership in EMS Systems
Assignment: There is an assignment where you will write an Essay about what you feel will help you
establish yourself as a manager/leader. This report is specific to you and not just a generic report on
management or leadership.
As you progress through Unit Two, consider the leaders you have in your career. What did they do best
and what areas could they improve on? If you have questions, please be sure to email those to me or
post them in the "Ask The Professor" discussion so that everyone has the opportunity to learn from my
Due: Tuesday, 12/18/2018 11:59 PM (CST)
Course Project Essay
Now that you have begun to settle into your new job as general manager and have an idea of the
problems you might encounter, you should be deciding on a management and leadership style and
approach to use. Using the models of leadership and the styles of leadership discussed in the unit, write
an essay describing what you think might work to establish yourself as both a manager and a leader.
Your textbook lists several organizations on page 42 that you might partner with. Discuss the
importance of sound leadership in EMS systems that include the community you are serving ”Hinsdale
County, Colorado and I answer to the County Manager and the State Bureau of EMS” as well as the
governing agencies that you answer to. Include a discussion of your external as well as internal domains
in your plan.
Your essay should be at least two pages in length. You are required to use at least two references, one
of which may be the textbook and the other from peer-reviewed, academic, or government
publications. You are expected to use correct APA style formatting for references and citations. The title
and reference pages do not count toward the minimum page length requirement.
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