5 critical EMS leadership traits to achieve the IHI Triple Aim

By Roxanne Shanks

To know the skills EMS leaders need for the future, we need to understand where the rest of health care is headed. Many leaders are embracing the new era of health care by aligning their organizations with other health care providers in adopting the Triple Aim framework.

This framework was developed by the Institute for Healthcare Improvement and describes an approach to optimizing health system performance. The three dimensions are:

• Improving the patient experience of care (including quality and satisfaction);
• Improving the health of populations; and
• Reducing the per capita cost of health care.

EMS has definitely had some champions in creating innovative solutions for integrating themselves into the overall health care system and achieving the Triple Aim. This has been accomplished through services like mobile integrated health care, nurse triage lines, and community paramedicine.

As we continue to evolve and look to the future of health care and the role EMS professionals will play, there are five competencies we must focus on to achieve the Triple Aim. The five leadership competencies can be aligned with each dimension to continue to elevate the EMS profession as a vital part of the health care system.

Improving the patient experience of care (including quality and satisfaction)

1. Interpersonal skills leadership competency

• Builds relationships.
• Fosters teamwork.
• Develops others.
• Inspires other.

2. Getting results leadership competency

• Focuses on quality and safety.
• Sets stretch goals.
• Aligns and prioritizes.
• Improves performance outcomes.

Improving the health of populations

3. Character leadership competency

• Exhibits professional behaviors.
• Practices honesty and Integrity.
• Is self-aware and reflective.
• Accepts costs of leadership.

4. Leading change leadership competency

• Creates a vision.
• Builds strategy.
• Champions change.
• Maintains competitive awareness.
• Innovates.

Aim 3: Reducing the per capita cost of health care

5. Personal Capability leadership competency

• Exhibits knowledge and expertise.
• Solves problems.
• Has business acumen.
• Is a continuous learner.
• Demonstrates thought leadership.

Understanding the leadership competencies
Here is additional information on the five leadership competencies and their applicability to EMS leaders striving to achieve the Triple Aim.

1. Interpersonal skills
We all know that the ability to work within a team and show empathy for our patients makes us better EMS practitioners. But in some ways, these skills are even more important when we move up the ranks.

Being an EMS chief today doesn't mean writing policies in a silo or simply handing out orders. Collaboration with other health care and public safety organizations is critical, as is inspiring one's staff to perform at the highest level.

And with budgets tighter than ever, being able to engage the community, municipal leaders, hospitals and others and tell them the story of your organization — and how it helps people — might mean the difference between getting a budget increase or having to downsize.

2. Getting results
It is fairly common to set a goal and aim for that target, but this leadership competency is more encompassing in how you go about getting those results. Is it critical to focus efforts on key metrics, and only measure what adds value to your organization and the communities you serve.

Once you have the metrics identified, align activities to those goals, identify performance gaps along the way and effectively develop and prioritize solutions. This is a methodical approach you must do on a regular basis. It also is one that can be taught to and instilled in future leaders and refined as they progress through their careers.

3. Character
When you look at the character of the leaders in your organization it really starts with trust. Is the leader able to trust others and is she trustworthy" Trust is the foundation that allows the leader to exercise maturity and judgement in decisions: focusing on doing the right thing rather than the popular thing.

This competency is not so much about a skillset as it is about how one manages personal weaknesses, leverages personal strengths and takes ownership when mistakes are made.

4. Leading change
A large majority of successful leaders have an innate ability to lead change in an organization. For others, leading change is a learned ability.

In a constantly changing environment, it is essential that leaders have a vision and successfully communicate it, not only to those within their organizations, but externally as well. They must be aware of customer needs, understand the forces driving change and overcome resistance to the change.

Finally, focusing on the bigger picture by distinguishing between opportunities for transformational change and times better suited to an incremental move is key to their overall success.

5. Personal capability
If you have been in EMS for very long you have no doubt struggled to find qualified individuals who can step into key leadership roles and thrive. It is essential to have leaders who have the expertise required of the role.

At a time when managing budgets and understanding reimbursement and new payment models is essential, leaders must demonstrate strong financial and business acumen. Our industry is changing; being able to grasp issues relevant to not only your organization, but the entire industry, is critical.

The days of just promoting the most talented clinical staff member into a leadership role are gone. This is not to say you won't have clinical staff who have the capabilities to assume a leadership role and be successful, but they will be the minority. Look for employees who invest in their own learning and have an insatiable curiosity.

Progressing from emerging to seasoned leader
As you evaluate these competencies in yourself or in others, consider two things. In any action leaders take, there is what they actually do, and more importantly how they go about doing it.

Interpersonal skills and leading change are how leaders act, while personal capability and getting results are what they do. In the middle of all of this is the leaders' character.

You've heard the saying, "They get results, but leave dead bodies along the side of the road." This type of leadership has no place in the new world of integrated health care. Character and leading change are the hardest competencies to change; the other three are easier to teach and eventually improve.

As you move from the first characteristic to the last under each competency, you will see the natural evolution from an emerging leader to a more seasoned leader. This is a growth process. But with dedication and experience, leaders can develop these competencies as they progress through their careers.

About the Author
Roxanne Shanks, MBA, is a senior associate at Fitch & Associates. She serves as the CEO for LifeFlight Eagle Air Medical Program in Kansas City, Mo., and also as the executive director for the Association of Critical Care Transport in Platte City, Mo. She has an extensive background in health care leadership with more than 20 years of experience in progressively responsible clinical and leadership roles within an integrated delivery system. She can be reached at rshanks@lifeflighteagle.org.

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