The EMS Supervisor’s 7 Keys for Success

The EMS Supervisor’s 7 Keys for Success

This article is the first in a series of three focusing on common pitfalls that may trip up EMS leaders. In keeping with the National EMS Management Association’s officer competencies, lessons will be divided into those for supervisors, managers and executives.

Michael Lipsky’s book Street-Level Bureaucracy: Dilemmas of the Individual in Public Services, first published in 1980, proposes that the actions front-line supervisors take, the decisions they make and the methods they use to deal with conflict effectively become the policies of their departments.

This vests an enormous amount of responsibility in supervisory personnel, often more than organizations realize or desire. Nonetheless, the ability to enforce or forgive policy infractions, steer individual behavior and regularly interact directly with providers is the kind of daily work activity that can make or break both the supervisor and the organization itself.

Here are some keys to success for EMS supervisors.

1. Take a Stand

The front-line EMS supervisor, regardless of what primary responsibilities he or she has, is constantly squeezed from both sides. They feel constant pressure from the personnel they supervise, who are looking to have problems fixed, grievances addressed and issues corrected. At the same time, supervisors are pressured from above to ensure certain actions take place and be the enforcement arm of the organization. This pressure is compounded by the fact that many, if not most, supervisors were promoted from within. Whenever supervisors bring issues to their manager, often the first reaction is that the supervisor has “forgotten they’re no longer a provider.” At the same time, providers often see these supervisors as having “sold out” with their promotion and become just another part of the organizational apparatus.

The key to survival for all front-line supervisors is to stake out your positions carefully. It is easy to become reactive to the line personnel you supervise, taking every issue they have up to management. Normal behavior is to desire acceptance, and by standing up for your people, it’s easy to think you’ll win their approval. Yet you will not win every battle, and if you continue to bring every issue up your chain of command, your manager(s) will quickly start to dismiss you as background noise. Similarly, a supervisor needs to exert his or her own autonomous authority, and by running to management with every issue, you will send a signal to your personnel that you can’t make any decisions yourself. Establish your own ground here and resist the urge to be reactive to every single impulse.

2. Follow Up

EMS supervisors are under enormous pressures, and much of that includes time. Each system is unique, and so are the specifics of each supervisor’s daily responsibilities. The only constant between systems is that supervisors are constantly pressed to do more with less. Besides supervising, individuals are asked to take on secondary projects, perform front-line tasks to reduce overtime or improve staffing, and take extra shifts.

In all of this it’s easy to make promises you fail to keep. This will very quickly result in front-line personnel losing respect for you. Much like raising a child, when you make a promise, you simply must keep it. When you aren’t on time getting back to someone, apologize and own up to it. This is even more problematic when your manager expects you to follow up and complete a task and you fail to do so. Both of these are critical failures and will quickly derail your career, as you will be seen as someone who cannot get the job done.
Keeping up with everything is of course easier said than done. Develop a system for logging tasks and reminders to follow up, such as a moleskin notebook or electronic task manager, so you don’t lose track of what’s on your plate.

3. Don’t Play Favorites

We are terrible about playing favorites in EMS. Part of it is the insular nature of our business. We often find our professional and personal lives are inexorably intertwined. Look at your Facebook friends list and see how many are from your department. Now see how many of them report directly to you.

This is a hard minefield to navigate, as we cannot simply dissolve our past friendships (or more) or wipe our memories about past actions. But we must try, at all costs, to remove any appearance of impropriety in our supervisory actions. First, try to prevent these types of issues in the first place. I strongly recommend that supervisors and subordinates not be friends on social media for a number of reasons, but one of them is that eventually you are going to decline a friend request. And by doing so, you will have immediately set up a claim of unfair treatment.

In addition, when you are faced with a conflict at work and think someone on the outside may question your objectivity, you should recuse yourself. It may seem overkill at the time, but if you and other supervisors cover for each other, your staff will quickly see that you are working together to ensure fairness and equal protection across the department. This has the added bonus of helping keep you out of legal trouble as well.

4. Remain Consistent

Again, much like with raising your kids, being inconsistent from day to day, person to person or issue to issue is an express pass to problems. Besides all the legal issues that inconsistencies can and will create, it instills a level of daily uncertainty in your staff that breeds both contempt and inefficiency. Staff will wonder if what they’re doing now is acceptable since, at various times, the same actions were both good and bad. As a result, they will become more conservative in their actions, clinically and behaviorally. Patient care will suffer, and you as a supervisor will begin addressing issues you think people should be handling themselves.

If you find yourself dealing with small issues where your staff should be autonomous, ask yourself whether they’ve been given good guidelines for decision-making or if perhaps you are giving them inconsistent guidance or signals.

5. Get Out and Listen

Supervisors are often tasked with a certain number of staff interactions or evaluations per shift. Frequently these interactions involve passing down information and policies and providing guidance—that is, talking. Instead try listening more than you talk.

A famous maxim says, “Only talk when it improves the silence.” Try to spend more time in your interactions with front-line staff listening rather than talking, and when you talk make sure your words involve active listening. You will be amazed what you will learn if you simply sit back and listen. Often the people who are talking have problems they want solved, and if you listen closely, you will hear them tell you the solution.
If you are not given a minimum number of interactions per shift, impose such a requirement on yourself. The worst thing a supervisor can do, bar none, is to hide in his or her office and not get out into the workplace.

6. Learn How to Calibrate

To be successful, one of the most difficult skills a supervisor must learn is how to calibrate their responses. Sometimes an employee needs a proverbial hand on the shoulder, and sometimes they need a proverbial smack in the head. Some actions require the supervisor to guide an employee, coach their behavior, help them make better risk-benefit decisions and learn from what may have happened. On the other hand, some actions require the supervisor take affirmative steps with an employee to ensure that something does not happen again. We live in the gray areas, as few activities fall squarely under one description or the other.

Just Culture is a good tool for guiding supervisory decision-making, although with all systems there remains the ability of a supervisor to short-circuit entry into the process. This is especially problematic given our propensity toward favoritism noted above.

Finally, always remember that employees should be able to come to you, off the record, with concerns and have a safe place to discuss them. Nothing is more valuable than the trust of your subordinates. However, also remember that some conversations can never be off the record, such as accusations of physical or sexual assault, workplace discrimination and criminal activity (to name a few). Do not be afraid to stand up for what is right and tell the employee that reports of this type of activity will always be acted upon.

7. Why, Not What

Finally, make sure you explain the reasoning behind actions or decisions and don’t simply demand obedience. The requirement to explain “why” and not just “what” is commonly attributed to millennials, but this is almost certainly an oversimplification of the issue. All employees in the workforce should be given the reasoning behind what’s happening, both at the daily task (tactical) level and the organizational (strategic) level. This will help guide their daily decision-making to accomplish the task at hand, while at the same time aligning these actions with larger-scale goals. A few minutes explaining the reasoning behind something is time extremely well spent. Just remember to listen as much as you talk.


In every organization, the strongest personality always imprints its patterns on the people. This is why, very often, each shift has its own style. Some shifts are “by the book” while others are misfits or rebels, and others are very lax. Often the individual with this strong personality is not the person in charge—in fact, in the absence of strong leadership, a grassroots leader may emerge who can take your shift, or your organization, in unwanted directions. Use these tools to be the strongest leader for your shift, unit and department.

Matthew R. Streger, Esq., is a member of the EMS World editorial advisory board and a member of the law firm Keavney & Streger in Princeton, NJ. He has over 30 years of experience in EMS in a wide variety of roles and locations.