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Consultant Editors Lynda Sibson, Ian Peate, Pete Gregory Editor Aysha Mendes Commercial Manager Frankie Bramble Group Classified Manager Daniel Doherty Production Manager Kyri Apostolou Production Assistant Jamie Hodgskin Content Development Director Tom Pollard Editorial Director Sophie Gardner Managing Director Anthony Kerr Associate Publisher Mike Shallcross Publisher Anthony Kerr Chief Executive Officer Ben Allen

Editorial Board Guillaume Alinier Director of Research, Hamad Medical Corporation Ambulance Service, Doha, Qatar; Professor, Simulation in Healthcare Education, University of Hertfordshire, UK Ayesha Bal Paramedic, West Midlands Ambulance Service Trust, UK Aidan Baron Paramedic Researcher, Sydney, Australia; Visiting Researcher in Emergency, Cardiovascular and Critical Care, Kingston University and St George’s, University of London Tony Bleetman Consultant in Emergency Medicine; Honorary Associate Professor, University of Warwick Medical School, Coventry, UK Malcolm Boyle Associate Professor and Academic Lead in Paramedic Education, Program Director Paramedicine Programs Griffith University, Australia Dr Mike Brooke Doctor and Advanced Paramedic, Tameside Hospital NHS Trust/North West Ambulance Service NHS Trust UK Tanoh Asamoah-Danso Paramedic, East of England Ambulance Service Trust, UK David Davis Clinical Lead, Integrated Urgent Care Workforce Development Programme, NHS England; Fellow and Mental Health Spokesperson, College of Paramedics; Founding Fellow, Faculty of Clinical Informatics, UK John Donaghy Senior Lecturer, Paramedic Science, Anglia Ruskin University, UK Georgette Eaton Clinical Practice Development Manager, Advanced Paramedic Practitioners (Urgent Care), London Ambulance Service NHS Trust, UK Kerry Gaskin Principle Lecturer, Advancing Clinical Practice; Academic Lead, CPD and Paramedic Science, Allied Health and Social Sciences Academic Unit, University of Worcester, UK Pete Gregory Head of Allied Health Professions, University of Wolverhampton, Wolverhampton, UK Sigurd Haveland Paramedic and Divisional Clinical Lead, Primary Care and Emergency Services, Gibraltar Health Athority Andrew Kirk Assistant Director for Education and Organisational Development, East Midlands Ambulance Trust, UK

Joanne Mildenhall Paramedic Team Leader, South Central Ambulance Service NHS Trust, UK Dr Tom Mallinson Prehospital Doctor, BASICS Scotland, UK Ian Mursell Consultant Paramedic, East Midlands Ambulance Service NHS Trust, UK Ian Peate Viiting Profesor, Northmbria University, UK John Renshaw Senior Lecturer in Paramedic Science, Wolverhampton University, UK Alan Rice Associate Professor, Paramedic Practice, Department of Paramedic Science, Kingston University and St George’s, University of London, UK Lynda Sibson Telemedicine Manager, East of England Stroke Telemedicine Service, Addenbrookes Hospital, Cambridge, UK Ceri Sudron Senior Lecturer and Paramedic Science Course Lead, University of Wolverhampton, UK Kacper Sumera Deputy Head of Education, East Midlands Ambulance Service NHS Trust, Nottingham, UK Sammer Tang Public Health Registrar, Gloucestershire Hospital NHS Foundation Trust, UK James Taylor Locality Manager, Yorkshire Ambulance Service NHS Trust, UK Carl Webster Senior Lecturer and Paramedic Science Course Lead, University of Wolverhampton, UK Mark Woolcock Consultant Paramedic; Lead Clinician, Cornwall Health Out-of-Hours Aimee Yarrington FCPara, Clinical Team Mentor and Midwife, West Midlands Ambulance Service NHS University Foundation Trust, Shropshire, UK

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Healing the ‘cultural chasm’

The dramatic lurch to ‘command and control’ leadership during the COVID-19 pandemic and its aftermath has seen commentators asking whether ‘heroic leadership styles’ might linger, affecting the long-term culture of the workplace (Hulks, 2020). Those who work in ambulance services generally favour a hierarchical and broadly directive style of operating (Wankhade et al, 2015). Therefore, a step-change away from direction and advice might present a more significant psychological challenge to the ‘hard-wiring’ of many senior ambulance staff. This ‘cultural chasm’ is surely a significant matter if one of the single most important things leaders do is to create and manage culture.

A leadership style that is overly directive and centred on advice-giving works well in emergency situations or when the environment or task is unfamiliar. However, if this becomes a dominant and pervading culture, it is unlikely to sustain good relationships and is likely to contribute toward a ‘dependency culture’. The natural desire to innovate and strive for improvement will be impeded, as professionals learn to await repeated instruction before acting. A symptom will be more frequent ‘escalation’ of routine tasks that should comfortably be within the scope of the role.

This thinking appears to be in keeping with national policy on NHS workforce development, as NHS England’s plan is to recruit but more staff than is needed to ensure that the NHS is the ‘best place to work with positive cultures and leaders who develop, support and engage their workforce to improve’. But what do senior staff need to be conscious of when attempting to deliver this?

A classic piece of work explaining the difference between ‘management’ and ‘leadership’ might provide a clue. Handy (1993) argued that management was about direction, mentoring and managing risk through clear process and procedural design. This sounds like an essential role in ambulance services. A totally different prescription is offered when it comes to leadership, as this is about enabling people to calculate and take risks, engaging and encouraging them to think creatively and to challenge the existing way of doing things. Leadership, unlike management, is said to be about coaching and delegating (Handy, 1993). A fundamental lack of understanding about these differences is commonly found in the NHS, causing confusion or even conflict. A number of NHS organisations continue to pour petrol on this confusion by treating the word ‘management’ as a toxic term, often eliminating it from the organisational lexicon and instead, promoting ‘leadership programmes’ that, ironically, broadly consist of and promote a management-based ethos.

So, the challenge for leaders in the ambulance sector is to recognise that they contribute to the pervading culture through their own behaviours and approach. To heal the ‘cultural chasm’ exacerbated by the pandemic, senior staff will need to learn to ‘let go’ of the safety blanket of heroic leadership and embrace the skills required to coach or delegate to what is, after all, a technically competent and professional workforce. The further challenge for those providing regulatory oversight of course, is whether they are prepared to provide the support and air-cover required for what is now a seismic change of culture. JPP

Handy C. Understanding organisations. Oxford: Oxford University Press; 1993 Hulks S. Heroic Leadership: the order of the day?’ London: Kings Fund; 2020 Wankhade P, Radcliffe J, Heath G. Organisational and professional cultures: an ambulance perspective. In:

Wankhade P, Mackway-Jones K, eds. Ambulance Services, Springer; 2015:65–80

Darren Leech, Director and Head of Coaching, NHS Elect, London, UK.

Journal of Paramedic Practice • Vol 16 No 1


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