Leadership: Determining the Best Approach

 The true value of leadership is empowerment, or the ability to promote those traits through the chain of command for subordinates to use to effectively make decisions that are in the spirit of the vision of the leader (Buchbinder, Shanks, & McConnell, 2012; Kirkpatrick & Locke, 1991; Wieck, Prydun, & Walsh, 2002). When leaders make decisions, the focus is not on the myopic view of the here and now but reflects the nature of ethics and vision promoting the endeavor (Kirkpatrick & Locke, 1991).

Buchbinder, Shanks, and McConnell (2012), discuss various strategies and attitudes employed to both lead and manage the health care workforce. Though each of the styles presented are effectively used in certain scenarios, many managers and ineffective leaders misuse these styles due to misplaced attitudes, trust, and motives. These styles are authoritarian, bureaucratic, participative, theory Z, laissez-faire, and situational. The authoritarian and bureaucratic styles are closely related as dictatorial and at risk for involving micromanagement; however, authoritarians tend to be motivated by their responsibilities, whereas bureaucrats tend to disregard their responsibilities. The participative and theory Z styles are more democratic and egalitarian describing the usefulness of a majority opinion or consensus before moving forward. Though these styles could result in indecision, they are best implemented when a leader has ultimate decision-making capabilities and relies on his or her subordinates for input. Laissez-faire leadership is typically characterized as the hands off approach. Laissez-faire leadership, when used correctly, relies on the specialized training or focused scope of the work of the subordinates and lends guidance only when necessary. Laissez-faire leadership, however, can provide refuge for a lazy manager. Situational leadership is the use of all or some of the styles described above depending on the specific circumstances of a given situation. For instance, providing guidance to a new employee might benefit from an authoritarian approach; however, deciding on the best approach to implementing a new process might benefit from a participative style of leadership.

In the emergency medical services, a move has been made over the last decade to separate from the authoritarian leadership of the fire service. In my opinion (due to the gross lack of research within both the fire and emergency medical services), the attitudes of the fire service leadership do not correspond well with the manner in which paramedics wish to be led. As paramedics are formally educated and expected to perform as skilled clinicians in the field, they tend to operate independently and view their supervisors more as a resource tool than as tactical or clinical decision-makers. Combination departments, or those that operate both fire and emergency medical services, would do well with developing situational leadership skills to guide both operations (Mujtaba & Sungkhawan, 2009). Though paramedics may utilize an authoritarian style of leadership during an emergency call (and, do well to follow such styles in these environments), during normal day-to-day operations, paramedics respond much better towards a laissez-faire, or indirect, style of leadership that allows for independent critical thinking (Buchbinder, Shanks, & McConnell, 2012; Freshman & Rubino, 2002). For example, during a call, I expect that when I direct my crew to perform a certain task that it is completed immediately; however, between calls when I might say that in a particular scenario a certain intervention is necessary, I expect some discussion to aid in the learning of my crews and to help develop and hone their critical thinking skills.

True leadership has its own rewards, primarily, empowering those who follow to synthesize the traits of their leaders and evolve into leaders, themselves. This, in addition to watching your own visions take root and flourish.


Buchbinder, S. B., Shanks, N. H., & McConnell, C. R. (2012). Introduction to healthcare management (Laureate Education, Inc., Custom ed.). Sudbury, MA: Jones and Bartlett.

Freshman, B. & Rubino, L. (2002). Emotional intelligence: a core competency for health care administrators. Health Care Manager, 20(4), 1-9. Retrieved from http://ezp.waldenulibrary.org/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=mnh&AN=12083173&site=ehost-live&scope=site

Kirkpatrick, S. A. & Locke, E. A. (1991). Leadership: Do traits matter? Academy of Management Executive, 5(2), 48-60. doi:10.5465/AME.1991.4274679

Mujtaba, B. G. & Sungkhawan, J. (2009). Situational leadership and diversity management coaching skills. Journal of Diversity Management, 4(1), 1-55. Retrieved from http://journals.cluteonline.com/

Wieck, K. L., Prydun, M., & Walsh, T. (2002). What the emerging workforce wants in its leaders. Journal of Nursing Scholarship, 34(3), 283-288. doi:10.1111/j.1547-5069.2002.00283.x