09/03/18, Peter Russian

The Power of the Paramedic

Intent-Based Leadership, leadership, empowerment, control

My father had a fall this week and so I found myself in the back of an ambulance en route to the Edinburgh Royal Infirmary.  My dad was okay; whilst he didn’t need the blue light treatment, he needed attention and during the journey, David the lead paramedic was telling me about his career.

He had trained to become a chartered surveyor but quickly realised that this wasn’t for him: “I hated working in an office and I hated just being told what to do”.   He swapped the office and the building site for an ambulance and 12 hour shifts so I asked him what was better?

“I love this job” he replied. “I get to work with great colleagues, I make a real difference to people’s lives and I don’t have anyone telling me what to do.”  I asked whether he made all the decisions and he said that they generally discussed things as team and if they needed expert advice they would phone it in.

The paramedics who turn up at your house or at an accident or a major incident are at the front line. They carry an awesome responsibility - being the first people on the scene who can make a difference between life and death.

There’s few more important jobs – saving lives is pretty darn important and David loves his job because he’s able to make all the decisions that count – so why aren’t we learning more from these extraordinary folk?

In the hugely popular “Greatness” YouTube video, David Marquet describes how he created an environment on a nuclear submarine in which no one was ordered to do anything.  Instead he built two pillars through which he could give control:

Thinking about David the paramedic, he clearly had the technical competence to do the job – quickly analysing the situation, asking questions to check his understanding and then recommending a course of action. He also had the clarity on what the right thing to do was – he engaged with everyone in an open and friendly way, he reassured the patient and he worked with his team in a professional and supportive manner. 

Paramedics are entrusted to make the right decisions so why do organisations find it so hard empower their people and trust their people to make the right decisions?

The first problem is historical and deeply embedded in our psyche.  It’s the assumption that in order to work effectively people need someone to manage them, to tell them what to do, to motivate them to work harder and to make the important decisions when they come along.

The second is that even when organisations think that they actually need to empower, rather than control, their people they struggle to make it work effectively enough to convince the sceptics that it is the right thing to do.

When I first read Turn the Ship Around I was captivated by the story and the simplicity of the proposition of the Three Cs – Control through Clarity and Competence.  But when I first started to implement this approach with my own team, I made the mistake of not focussing enough on helping people to make right and safe decisions.   I empowered people but I didn’t do enough to ensure that they could make the best decision and so I got frustrated that we were doing things which didn’t seem to make a difference – they weren’t the right thing – or were executed poorly and therefore were not safe decisions.

A world in which everyone works with the equivalent of David, the paramedic’s total autonomy is unlikely but how many high skilled and competent people are working in jobs where they feel the opposite of autonomous? 

The recently published Chartered Management Institute report “21st Century Leaders” reported that one of the most important skills or behaviours that employers wanted in future leaders was to take responsibility.

But people can’t take responsibility unless their leaders take the time to ensure that people have the capability to make the right – and safe – decisions. 

There’s an age old maxim that people are promoted on the basis of their technical competence rather than their capability to lead or manage. To that list we must add their capability to make and delegate decisions.


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