Reflections. How Leadership Affects The Streets

Poor morale and the degradation of paramedical services are a double edged sword that every individual should pay special attention to. It is a fact that paramedics and EMT's are good at adapting and overcoming a lot of adversity to ensure that patients receive excellent care. There comes, in time though, a negative feedback loop if the leadership of an industry becomes complacent and appears unsupportive of its staff. This is true in any industry but today we will focus on paramedicine. When leaders become disconnected from the street they can sometimes start to make decisions that in their eyes appear beneficial. This is not always the case, and if there is poor communication from the leadership it leaves the people on the street confused, and angry. This then causes a decrease in the general morale of the people on the floor. The people on the floor are the reason an EMS system works and degrading morale can directly affect their ability to do their job. It's the street staff that are going into people's homes to help them. The leadership team has a part to play in taking care of the business side of things, but if there is no back and forth communication and no acceptance of input from the people on the street the problems become worse.


The problem though is that the leadership are not the only people at fault. Sometimes street level staff are not the best at finding ways to communicate ideas to the upper management teams. I spoke the other day about how it is important to let ideas surface and find practical ways to implement them. That being said, it is evident sometimes that there is a complete disconnect from upper leadership and the street. When a leadership team has issues with implementing good ideas, and spend a lot of time arguing about things, and on occasion fail to get along themselves it will reflect directly to the street. The street level is a direct reflection of their leadership. We have all heard the phrase lead by example, and if the example being portrayed is disconnected, confrontational, and apathetic these attributes will show up at the street level as well. This is a known and studied fact. There is good news though!

There is room for improvement and fortunately it only takes one or two good leaders to at least affect positive change for morale. When a leader steps up and listens to the street level staff there can be a drastic increase in morale. When that happens there is a good chance that the staff will be able to let their good ideas surface. The people at the street level are the people that are going to give you the best ideas for improvement. Necessity is the mother of invention, and when someone sees something that can improve patient outcomes, or safety or any number of other things that person should be able to send that idea up the chain of command. When leadership teams can't even accept ideas from one another though, the staff becomes complacent, and reflects the actions of their leaders.

This double edged sword can freeze an industry in apathy, and complacency. When this happens, morale crumbles, leadership fails, and the industry can fall apart. Good communication is one of the biggest factors that can drive change within an industry. It is known that not all ideas can be implemented, but if ideas are at least heard, and discussed openly, that alone can boost morale. It can show that ideas are being considered. This will make a huge impact at the street level. Leadership is important, there is a vast difference between running an organization and leading one. At the street level it is important to remain positive and let good ideas surface and find the right channels of communication to implement or at least have good ideas looked at!

Positivism, Professionalism, Pride, Progress

How do we make change? The world of EMS can be a fast and progressive system as is being demonstrated in countries like Australia, and the UK. These advancements have provided for fewer ER visits, as well as progressive and improved patient care at home. Patient's are given different options, and care plans are made that can improve patient quality of life as well.

These advancements don't just happen. They happen because someone or a group of someones made a choice to advocate for patient's and advocate for improvements in the system. I'm not saying that a revolution is needed, but a resolution does need to be sought. The health care system needs help. We have overloaded ER's, full patient units, increasing EMS call volumes, and no money to increase resources at any level. So how do we make change?

The first thing that needs to change is our attitude. That's a hard thing to hear, but being negative about everything is not the way to change anything. A positive attitude goes a long way to at least improve your day to day mental health, and helps to keep your mind open to seeing ideas for improvement. When you start to see the ideas that could improve patient experience, or lower hospital overload it's important to write them down. New ideas don't get implemented if they never get suggested. That being said you can't just throw ideas at people and see change. Proper presentation is also vital. So how do we make change? In the picture above it's said in fairly plain English. A long time ago I recall hearing a phrase that said, be the change you want to see in others.

Taking pride in our profession and being positive at work and letting the ideas that could make real change come to the surface is a good first step. The next step is to find ways to show that these ideas will work. One of the best ways I have found to do that is to use On Line Medical Control. When you want to step out of the box, involving a doctor is a great way to do it. They will usually agree with a good idea and help you make it happen. These ideas are then documented, recorded and can be studied to ensure the outcomes are positive and beneficial, both to the patient, and to the system.

It is a fact that our system is going to continue to get busier, it is also a fact that we are not going to get a bigger budget. The other fact that some people might not agree with is that we don't need a bigger budget. What we need is YOU, your ideas, your thoughts, presented in a positive fashion. Thinking outside the box is OK, it just has to be done in the right way. We are the front line, we are the ones that have the opportunity to see potential changes that could be positive and beneficial. Let's think outside the box and involve our OLMC doctors and direct supervisors. Be diligent, be professional, and let's work together to bring progress to the paramedic profession.

The Importance Of Putting Ego Aside

It was a shift like any other shift. We were steady, calls were kind of run of the mill, the hospitals were backed up, and healthcare plodded on in it's broken state. I had brought a patient into the ED who was moderately injured and would need some diagnostic imaging to confirm or deny a possible head injury and other injuries. The patient was uncooperative and didn't want anything to do with EMS but agreed to accept a ride. The details are of less importance than what transpired in the emergency department. Upon giving my bed side report I was ostracized because I hadn't started an IV. This is something that occurs in our world far too often.

The constant ego battle between paramedics and nurses has been an ongoing concern and problem for years. It is something that has baffled me, and angered me for just as long as I have been in this industry. I have the utmost respect for every one of my healthcare colleagues and when I am ostracized for not getting one thing done, or criticized for varying reasons it affects me deeply. I know by far that I am not perfect at this career, as none of us are, but that is why we have a health care system that PRACTICES medicine. Medicine has never been perfect and we learn new things every day, and make advancements and change things based on evidence and common practice. This battle of ego's between nurses and medics is something that is archaic, out dated, and the evidence shows that it only causes tension, complaints and general bad feelings between the two groups. This is a detriment to patient care.

If we look at both professions and match up our similarities and our differences, together we are a mighty awesome team that can provide excellent care to any patient. Don't misread what I am saying, this is a small problem and definitely not the majority of the time. Although it happens enough to my self and many colleagues, both nurses and medics, as medics are guilty of doing it to nurses as well, that I felt it was something worth mentioning. Health care has to be a team approach, utilizing the skills of every person involved from the nursing aid to the neurosurgeon. Nurses, ED physicians, respiratory techs, Paramedics, lab techs, cardio techs, and every other discipline that works together to provide every patient with excellent care. Imagine if you will an ideal world where the medics have done everything they can in the short time, limited space and chaotic conditions. They arrive at the emergency department, and hand off care to the ED team and instead of focusing on the one or two things the medics didn't get a chance to finish before they got there the team acknowledges the work they completed, and continues the care from that point, all the way to the end of the patient's time in the hospital. This is how health care should be. Patient focused, let me say that again, patient focused.... Your ego is irrelevant, your skills, and your knowledge and your patient advocacy are vital, and are important. Communication about what is done and what isn't done is vital, and transferring care calmly, and efficiently is what is important.

Egos are dangerous friends, and it's time that nurses, and medics recognize that when we argue, or focus on the little imperfections of each other and act better than the other we are only hurting ourselves. As a team we are amazing together, we are a force to be reckoned with that make a huge impact on any situation. How do I know this? I know this because I have seen it, and the evidence shows that when we focus on the patient, the out come is always better.

As I said earlier, this is not the norm, but I believe that relationships between medics and nurses can and should be improved. Gentle ribbing of course is acceptable, but at the end of the day we have to recognize that our strength lies in the fact that our similarities give us synergy to enhance patient care, and our differences broaden the scope of care that we can provide. How is this ever a bad thing? It looks like a win win to me. The next time you are faced with a medic or a nurse that hasn't done everything that YOU deem is necessary think of this. You weren't with that patient five minutes ago, and their condition could be changing, also you have no idea what the situation was like before you arrived or before they arrived. Sometimes if things aren't done there is a reason, it may not seem like a good reason to you at the time, but instead of ostracizing them, focus on the patient and work together to enhance the patient's care. Put your ego aside, it only gets in the way. Ego gets in the way of intelligence and professionalism, and those are the two things the patient needs from you, be a team, work together, be part of the solution.

Public Relations, The Importance Of Shameless Self Promotion

Today I had the privilege of being involved in a public relations event for the Police department and for EMS. This was such an amazing event and every time I get to do one of these I remember the importance of shameless self promotion. When it comes to emergency services many people do not understand who we are or what we do. This is OK for the most part, but if we don't promote who we are, no one else will. We as Paramedics, and EMT's need to plug in to public relation events. I find these events also remind me why I got into this career in the first place.

Today I got to partner up with our City Police department as well as with the city public library. My self and one of my best friends and co workers went to a school today to meet with several grade 3 classes. This is not a new program and has been going on for several years. I have only participated a couple of times now, but it is becoming a regular thing when our schedules allow. Kids truly are our future. If we don't demonstrate and talk about what we do we won't have as many people in the future wanting to pursue this career. This would be tragic because, to me, this is one of the best careers that a person can do. Especially a person that has a burning desire to help people. Yes, as I have said in past posts, this job can take a toll on you emotionally and even physically, but it is still a noble and important profession. Public relation events are actually very good for the emotional aspect of what we do. I never laugh more than when I am with a group of kids, answering their questions, and hearing their stories of when they have had dealings with Paramedics and Police.

OK, so a little more about what we did today, because the day was a great time. We were involved in a program today called "It's A Crime, Not To Read." This program promotes reading, and at the same time promotes emergency services. It originally started with Police only but over the last several years EMS has been getting more involved. The fun starts the moment we arrive! The kids are always so excited to meet us, and talk to us, and ask us questions. We are in a stream of endless high fives, fist bumps, and smiling faces.

As we took our seats, and the Public Library representative introduced us the kids sat and were attentive and welcomed us to their classroom. We then listened as the two police officers read a story to the kids. The story was hilarious, and brought to life by these two amazing officers who had a great time reading it. Once their story was done, it was our turn. We were a little nervous following up such a great performance, but we gave it our all. The story we had was also very funny, and the kids received our antics just as warmly as they had received the police officers. Once everything was all said and done the kids were encouraged to ask us a few questions, and then they were allowed to come and speak to us. We spent several minutes at the end of it all signing autographs for the kids, and more high fives, fist bumps and genuine thank yous for coming to read to them! We laughed a lot with the kids, and had an overall amazing day! I encourage my fellow emergency services workers to embrace a few public relation events a year. They are usually easy to find, and help to rekindle that excitement that brought you into this industry in the first place. Who knows, one day, you might be the inspiration for someone to join us in this awesome career!

Unplugging In Our Digital Age, A Necessary Break

Unplugging  can be hard in this world where everything seems to be connected to everything else. I see a lot of posts on line that ask about unplugging. The only problem is that to be unplugged means you are disconnected from everything. Wait though, isn't that the point? In emergency services we are surrounded by media, radios, MDT's, cell phones and we are constantly being bombarded. We spend four days glued to these devices and then when we are on days off we are surrounded by tablets, TV's, super phones, GPS and more! This is not healthy. Unplugging is one of the most freeing and necessary things you should do. Unplugging is easy, though many people are too afraid to try it.

I think that some people in emergency services have recently started to learn that getting away from everything is healthy. It is exciting to be in this time in EMS, although there is a lot of darkness and storms still to weather. As the story goes though it is always darkest before the dawn. The media attention and public admissions of people under duress in our industry is ushering in changes that have been necessary for decades. This change will still take a long time as old ways of thinking take a long time to die, but the most unwise thoughts we can have is "we have always done it this way." In the meantime I encourage people every where to unplug.

Before my last post, I needed some time to reflect on my problem, and on the solution. The steps I will take to ensure I break this habit. The two days before I wrote my last post I decided it was time to unplug. I literally shut my phone off, and took time for me. I spent time with a good friend and went on a long hike. I also spent some time cooking and avoided television, especially the news. This time was for me and was important. It is also something I plan to embrace often. When we are surrounded by digital media and constantly bombarded our psyche takes a beating. We may not notice it as it is now just what we are used to. We are surrounded by it in every aspect of our lives.

I encourage you to take the time to shut off your computer, shut off your phone, and even shut off your television. Take time to be outside, enjoy nature, look at wildlife. It is one of the most therapeutic things you can do for yourself. When your mind is full of stressful situations, and some of the awful things we see in our career, clean air, blue skies, trees and nature are an almost certified treatment. Of course it is not always just that easy, but when things are getting you down it is a good stop gap that can cleanse your mind and help you regain perspective.

Perspective of our place in the world is vital to ensuring we continue to provide our best work in our career. We are not machines, and we are far from perfect. We strive to be, but at times we are not going to get there. It's important to take that pride in what we do, as our career can literally be life and death, but we can not let it define us. Those decisions that we make, right or wrong, will carry with us always. It's how it works. Gaining perspective will help us to realize that we don't have to be perfect. We strive to always be as perfect as we can, but dwelling on things that may or may not have made a difference will take a much deeper toll on your psyche than you think. It is time to unplug, and refocus your perspective on things. This allows for recovery, and for healing, which in turn makes us better practitioners.

Reining In Demons

It is no secret that this job will take a toll on you personally. There will be demons that you will carry, in the form of bad calls, disappointment in yourself and expecting more of your self than is realistic. These demons sometimes can and often do take the form of addictions of some sort. Facing these demons is something that we should do, and need to do. Take it from someone who has tried going this road alone, it doesn't work. I never wanted to admit I had an addiction to something, until I realized that by not facing it I was at risk of far worse consequences. Fortunately my addiction is not any form of drug, but it can be just as damaging. I recently realized this and reached out to a friend for help. Reining in ones demons can and will be a difficult task, but with help demons can be beaten.

When you expect much of yourself you sometimes find it difficult to reach out and show that you need help with something. You forget that just like you are there for your friends, that they will also be there for you, and if people won't be then they are not friends worth having. Recently Emergency services has been in the spotlight for occupational stress injury which manifests itself in many ways. Over the last 10 weeks 13 first responders have committed suicide due to PTSD and other occupational stress injuries. This is a big deal, and I am deeply saddened by this unnecessary loss of life. When my demons surfaced recently and I looked them in the eye and realized I had a problem I was in disbelief. I couldn't believe that I had a problem, I couldn't comprehend that I was carrying so much. I have been in this industry a long time and I didn't want to believe that the reason I was addicted to gambling was possibly career related. I have been lucky, as I have realized it before things got too desperate for me.

Making a decision to face, and defeat our demons comes at a price. There is fear, there is apprehension, even as I write this I don't know if I will publish it, as this puts it out there for everyone to see. That might be a good thing though, being transparent, and accountable for my own actions. Actions that could have cost me everything. Biggest lesson I learned this week is to never try and go it alone. We have an awesome support system and though times are tough with work being busier and lives also remaining busy it's important to stay connected to your peers. Our camaraderie is what helps us, and keeps us whole. For anyone suffering alone or going through things that they think people won't understand, reach out to someone you trust. You will be surprised at their understanding and their support.

Reining in our personal demons takes effort, it takes time, and it takes honesty. Honesty with your loved ones, and honesty with yourself. Admitting there is a problem is sometimes the hardest part. Once you have passed that step, the road ahead is long, but the road is passable. Taking things one day at a time and finding your joy on the journey is the best part. I share this for two reasons. One I don't want to go it alone anymore, and two, I want anyone that may be keeping things in to know that it's ok to reach out. Reaching out doesn't make you weak, reaching out shows that you have the strength to face what your going through. Strength takes many forms and sometimes when we feel at our weakest it's the next step that demonstrates how strong we are.