Leadership Styles amongst the Emergency Services

Ashley Loughman, Katherine Bowron and Cindy Kalai

Correspondence
Ashley Loughman, Katherine Bowron and Cindy Kalai
UWA School of Medicine and Dentistry
Queen Elizabeth II Medical Centre
Perth
Australia
E-mail:
Lougha01@students.uwa.edu.au
Bowrok01@students.uwa.edu.au
Kalaic01@students.uwa.edu.au

Leadership styles amongst the emergency services

Aim The aim of this study was to understand the similarities and differences
between leaders in the fields of health, business and emergency.
Background Leadership amongst emergency services leaders is an area that has
been poorly researched to date. This is important as traditional models of
leadership based on business or health research may not translate to
emergency services.
Methods Staff (n=136) across the three fields of emergency, health and
business were asked to complete a survey detailing the traits present in the
best and worst leader in their field. Their responses were stratified into three
leadership foci; Production, Change and Employee orientation.
Results Effective leaders in all fields scored significantly higher across all
leadership foci than ineffective leaders. Additionally, there were significant
differences between leaders in health and emergency services in both Change
and Employee focus. In comparison, business leaders were not significantly
different from emergency leaders.
Conclusions Effective leaders in the field of emergency services have more in
common with leaders in the field of business than they do to leaders in the
field of health.
Keywords: Leadership Styles, Emergency, Health, Business

Introduction
Effective Leadership
Effective leadership and its defining features is a
topic that has invoked much scientific interest
over the last 50 years. This is because leadership
is known to have the potential to improve overall
performance and the attainment of goals(1) and
also because it is a complex area of social
dynamics. Good leadership involves a complex
and delicate balance of multiple aspects in order
to be effective, including teaching, planning,
listening, judgement and decision-making(2, 3). In
addition to this, the occupational environment is
believed to be extremely important in
determining which leadership strategies are most
effective(4). This is believed to be because the
pressures, goals and potential crises that arise in
various lines of work favour very different

leadership approaches. For this reason, an

analysis of which leadership attributes are most
effective in certain occupations could be very
helpful in future training of leaders in these areas.
Leadership Attributes
The attributes that comprise an effective leader
are a useful way of breaking down what factors
contribute to make a good leader. For this reason,
the behaviour and traits of effective leaders have
been an area of much interest. Over the last 50
years, many theories have been proposed and of
these, many still contribute to the overall
accepted doctrine(5).
Prior to the 1940s, emphasis was placed on a
persons inherent qualities which were thought to
characterise good leaders(6). Since then, the
emphasis shifted more to the behaviours and
attitudes demonstrated by effective leaders. Early
1

theories of leadership behaviour focused around a

two dimensional model of leadership in which
leaders were either personnel or goal orientated
(6-8)
. One example of this was Douglas McGregors
theory of X and Y leaders(6) in which he set up a
dualistic view of teams as requiring either heavy
handed
external
direction
maximising
achievement of goals(Theory X) or positive
encouragement to pursue goals in a self directed
way, maximising employee satisfaction(Theory
Y)(6). Similarly, under Halls 1982 model(2), leaders
are either the task orientated authoritarian,
separated from the team by a defined hierarchy
of command, or the supportive style of the
democratic leader, who leads from within the
team, focusing more on the needs of team
members(2). This was termed Transactional
Leadership as it was believed to be based on an
agreement between the leader and subordinates
for rewards in return for the accomplishment of
goals(9). Goal orientated leaders demand more of
their subordinates in return for the reward, where
as employee orientated leaders offered more
rewards to their employees in to encourage them
to achieve the goals(9). While each of these
extremes was held to be ideal under certain
circumstances, it quickly became apparent that
the best leaders often combined attributes of
both of these extremes(10).
Following a major shift in corporate focus in the
1980s which required leaders to be much more
adaptive(3, 11, 12), the term Transformational
Leadership was coined as an alternative to
transactional. This is based around the idea that
the exchange between leaders and subordinates
goes both ways and leaders may be required to
adapt their style based on the attributes of their
employees (13). Subsequently, the Change
dimension of leadership was added by Ekvall and
Arvonen and this three dimension model remains
the generally accepted leadership model in health
research(3, 5, 11, 12, 14).

(14)

3-Dimensional Leadership Model

Production (task)-oriented
Plans carefully
Gives clear instructions
Is very exact about plans being followed
Defines and explains the work requirements
Employee (relation)-oriented
Shows regards for the subordinates as
individuals
Is considerate
Is just in treating subordinates
Relies on subordinates
Allows subordinates to decide
Change-oriented
Offers ideas about new ways of doing things
Pushes for growth
Initiates new projects
Gives thoughts about the future
Likes to discuss new ideas
Source: Ekvall, G., Arvonen, J. (1991), "Change Centred
Leadership. An Extension of the Two Dimensional
Model", Scandinavian Journal of Management, Vol. 7
No.1, pp.17-26.

Emergency Leadership Research

Since 1970, over 7000 journal articles have been
written on the area of leadership and leadership
attributes(15). Of those written between 1970 and
1999, as few as 4.4%(15) were data based studies,
the majority preferring to theorise over leadership
issues. Of these studies, almost all have focused
on the areas of either health care or business and
other fields have been comparatively neglected.
One such area is amongst emergency services
staff. To date, there have been few papers with
emergency services staff as the subjects. As such,
there is currently contention as to whether
emergency services staff conform to the models
used for health and business, or whether the
vastly different role of emergency services means
that there is a significant departure.

Leadership in an emergency is complicated by the

intriguing dichotomy between the need for
careful response planning and the unavoidable
spontaneity of events(16, 17). Whether these unique
pressures have a bearing on the extent to which
2

emergency services identify with current

understandings of effective leadership in health
and business is significant, particularly as effective
leadership is crucial in crisis response(17). For this
reason, the attributes of effective emergency
services leaders are an area of interest with a
direct link to potentially improving emergency
responses. Given the large body of evidence on
leadership characteristics amongst health and
business professionals, if parallels can be drawn to
similar attributes in emergency services, then
leadership and education strategies currently
employed in these other fields can be employed in
the emergency services.
It has been suggested that in settings such as
emergency services, leadership dynamics will be
greatly altered by the presence of smaller teams,
multiple leaders and multiple disciplines requiring
integration(17). As yet, there is little research as to
how this alteration in hierarchy impacts upon the
team leaders(17). In particular, the fields of
medicine and emergency services commonly
overlap, especially in the wake of major disasters.
This also means that personnel will come under
an over-arching leadership structure designed to
coordinate the actions of both of these
services(16). A greater understanding of the
similarities and differences from traditional
leadership models of both these areas could
facilitate a better system of coordination.
Alternatively, it could highlight the barriers to
establishing over-arching leadership teams to
manage both these services roles at such times.
Either way, an increased understanding of the
attributes of effective leadership in these two
professions would ensure a higher standard of
care and response during disaster situations.
The aim of this project is therefore to determine
the extent of similarities or differences between
the fields of Business and Health compared to
Emergency. Furthermore, it aims to analyse the
differences so as to gain an overall picture of a
successful leader in each field.

Methods
In order to compare leadership styles, data were
collected from employees in the three fields of
business, health and emergency. A previous study
by Sellgren, Ekvall and Tomson(2006)(5) which
looked at assessing preferred leadership
behaviour, was conducted in the form of a
questionnaire. Similarly, data for this study were
gathered by a survey which questioned workers
on what, in their opinion, were the qualities,
behaviours and beliefs of the best leaders in their
field. These questions were then repeated for the
worst leaders in their field. The survey contained
a series of open, closed and scaled questions(18).
The inclusion criteria for participation included
being over 18 years old, employed in health,
emergency services or corporate businesses south
of the Swan River and competent in written
English. Participants were asked for demographic
information in order to determine any statistically
significant differences in responses from those of
different age, gender, employment organisation
and level of education.
In each field, 130 surveys were distributed with
the aim of an ideal yield rate of 100 surveys each.
The health surveys were distributed amongst
medical, surgical and nursing staff at several
major teaching hospitals, business amongst
several large businesses south of the river and
emergency amongst volunteer SES officers and
law enforcement agents. Surveys were distributed
and collected either by a collection box placed at
their workplace or in a group setting with a
research team member present. What was
consistent, however, was that participants were
asked to complete the survey to the best of their
understanding and no direction was given by the
research team. Final returns for these completed
surveys totalled at 50 emergency surveys, 42
business surveys and 44 health surveys. This was
less than expected however a response rate of

40% is generally considered adequate for research

conducted with surveys(18).
In order to analyse the qualitative data gained
from these surveys, the questions were stratified
using the three dimension leadership model
outlined in Ekvall and Arvonen(1991)(14) and
successfully used in their subsequent research(5,
12)
. Individual questions were distributed to one of
the three variables, Production-orientation (P),
Change-orientation (C) and Employee-orientation
(E), depending on the focus of the question. As
the survey contained scaled responses, these
were then scored numerically on a scale of one
(for Never) to five (for always). Each of the three
variables was given an overall numerical score
which represented the leaders overall propensity
for each of the three leadership orientations.
Demographic data on the leaders was also
collected allowing analysis of the leaders age,
gender, highest level of education as well as which
sector he/she was employed within. The data
were represented in our analysis as numerical, in
the case of age, or as nominal variables in the case
of the remainder.
Significance testing was used to determine the
difference in means for the three leadership
variables between effective and ineffective
leaders in emergency as compared to the fields of
health and business. A multiple linear regression
model was also used to determine the influence
of other variables contributing to the results and
also the strength of association explained by our
model. Where required, the analysis was done
using SPSS.
This study was conducted to ensure
confidentiality for all participants. Given the
sensitive nature of the data collected, namely
subordinates opinions on their leaders
effectiveness, this was a priority at all times.

Informed consent was assumed by the completion

of the survey after information on the study was
provided to participants via the cover sheet. Some
demographic data was collected; however no one
was able to access the completed surveys other
than the research team. This study received
ethical clearance from the Human Research Ethics
Committee at the University of Western Australia
(R08/16120).

Results
Respondents
The total number of survey responses received
was 136, each of which contained responses
pertaining to two leaders. Of the information on
271 leaders, the responses were incomplete for
15 of them resulting in their exclusion. There were
256 leaders with complete data sets. The
distribution of these leaders based on the
demographic information provided is shown in
Table 1. The included data consisted of 128
effective leaders and 128 ineffective leaders.
These were distributed between the three fields
with more overall responses in emergency (95) as
compared to business (82) and health (79). There
was an even distribution of effective and
ineffective leaders across all fields.

Table 1: Leadership Demographics

Number
Effective(%)
Sex (%Male)
Age (Yrs)
Education level (%)
None
Bachelors
MBBS
Masters
PHD
Sector (%)
Govt
Private
NGO
Number Led

Total
257
.50
.81
44.75

Business
82
.49
.88
47.5

Health
79
.51
.71
46.25

Emergency
95
.50
.84
41.5

.64
.32
.15
.09
.08

.17
.66
0
.16
.01

0
.23
.49
.05
.23

.85
.09
0
.05
.01

.5
.22
.28
40

.73
.26
.01
63

.49
.45
.06
30

.31
.00
.69
29

Table 2: Leadership Attributes

Production Focus Mean Score (P-value)

Change Focus Mean Score (P-value)

Employee Focus Mean Score (P-value)

Emergency

Health

Effective

42.19

41.8

(.3)

41.53

(.23)

Ineffective

27.38

29.44

(<.05)

25.07

(<.05)

Effective

41.19

34.48

(<.001)

39.98

(.05)

Ineffective

28.13

25.36

(<.05)

28

(.45)

Effective

34.58

42.48

(<.001)

33.18

(<.05)

Ineffective

25.27

26.64

(.13)

25.55

(.35)

Leadership Demographics
There was a gender bias across all three fields,
with an overall percentage of 81% male leaders
ranging from 71% in health to 88% in business.
The mean age of leaders was 44.75 years with
business and health marginally above this (47.5
and 46.25 respectively) and emergency having a
younger mean at age 41.5. The highest level of
education of the reported leaders varied between
the fields, as did employment sector. Number led
varied with 63 per business leader as compared to
health and emergency with 30 and 29
respectively.
Leadership Attributes
A comparison, of effective and ineffective
leadership attributes in the three fields is
presented in Table 2. Effective leaders had higher
scores in Production(P), Change(C) and
Employee(E) focus than ineffective leaders in all
fields. This comparison of mean E, P and C scores
between the fields of emergency, health and
business is also presented in Figure 1. This shows
that there was often a similar pattern across all
fields.
When compared to Emergency, effective health
leaders had a significantly higher employee focus
(34.58 to 42.48, p<0.001) and a significantly lower
change focus (41.19 to 34.48, p<0.001). This was
replicated in the ineffective health and emergency
workers, however only the difference in Change

Business

Figure 1: Leadership Attributes

focus achieved significance (28.13 to 25.36,

p<.05). In contrast, the difference in Production
focus between emergency and health failed to
achieve significance for effective leaders, but was
significant for ineffective leaders (27.38 to 29.44,
p<.05). In the comparison between effective
emergency and business leaders, both change
(41.19 to 39.98, p.05) and employee focus (34.58
to 33.18, p<.05) achieved significance, however
the differences were small. Alternately, for
ineffective leaders there was a significant
difference between emergency and business
leaders for production focus only. Overall the
means for emergency and business leaders are
highly similar with only small differences
achieving significance. This is in contrast with
health leaders who have large and significant
differences from emergency leaders.

Table 3: Adjusted regression coefficients for Production Focus, Change Focus and Employee Focus as related to
overall effectiveness and field of employment
P
Effectiveness
Emergency
Health
Business

.719*

C
<.001

0 (Ref.)

.679*

E
<.001

0 (Ref.)

.667*

<.001

0 (Ref.)

.083*

.076

-.216*

0.081

**

**

**

**

.365*
**

<.001
**

* The analysis was adjusted for Age(numerical), Gender (male or not), Sector (Government, private or NGO), Highest level of education
(None, Bachelors, MBBS, Masters, PHD) and number of employees led(numerical).
** Business statistics failed to achieve significance for analysis on any of our independent variables

Effect of demographics upon leadership

attributes
As seen in Table1, the distribution of each of the
demographic variables varied across the three
fields of business, health and emergency. For this
reason, a multiple linear regression model was
used to examine the associations between these
variables and each Production focus, Change
focus and Employee focus. It was also used to
isolate the effects of the field of employment on
the three leadership foci and remove the effects
of possible confounders. Our model was assumed
to comply with assumptions underlying the
general linear model, namely that error term was
normally distributed and had equal variance
around the mean. It was also assessed and
deemed to have minimal multicollinearity.
The following variables were included in the
multiple linear regression analysis: The field of
employment, Age, Gender, Sector (Government,
private or NGO), Highest level of education (None,
Bachelors, MBBS, Masters and PhD) and number
of employees led. The variables gender, sector
and highest level of education were specified by
binomial dummy variables. The hypothesised
models were estimated using the multiple
regression facility of SPSS. Not all these variables
were included in the final model for each focus.

For Production focus, the preferred model (R2

Adj.= 0.554) included the variables of private and
NGO sectors, health field, number of employees
led and gender. For Change focus, the preferred
model (R2 Adj.= 0.529) the statistically significant
variables are NGO sector, health field and number
led. For employment focus, the model included
health field, highest level of education being
MBBS or PhD and Age. The Adjusted R2 for this
equation was 0.544.
Table 3 demonstrates the adjusted regression
coefficients for Business and, Health leaders and
Effectiveness, as measured by the survey tool,
once the affect of other variables has been
accounted for. This data used Emergency Leaders
as a comparative reference for the employment
fields, and ineffective leaders as comparator for
effectiveness. The results reinforce the
aforementioned deduction that being an effective
leader positively correlates to high P, C and E
scores (P<0.001 for all models). Furthermore it
demonstrates that Health leaders have a
significant positive correlation with high E scores
(P<0.001), however a negative correlation with
Change focus that did not achieve statistical
significance (P<.076). Business leaders however
failed to achieve a significant correlation with any
of the leadership characteristics.
6

Discussion
Emergency and Health
Our analysis showed clear differences in the mean
values of Change focus and Employee focus
between effective and ineffective emergency
leaders and health leaders. However, both sectors
returned high Production focus in all sectors. The
high Production focus across the three sectors
may suggest that employees always prefer their
leader to take a more active role in planning,
communicating and directing tasks showing an
effective leader in any sector must be a
productively focused leader.
It is evident from the results that emphasis on
change focus differs between effective emergency
and health leaders, with significantly lower C
scores (34.48 vs. 41.19) in health suggesting that
effective health leaders need to adhere to current
protocols rather than generate growth and new
ideas. This is in contrast to leaders in the
emergency sector for whom, adaptability to
changing situations and the ability to incorporate
new ideas and methods to solve evolving
problems are perceived to be important
characteristics. It can be inferred that as leaders
in health deal with recurring situations in an
unchanging environment, there are already
evidence-based protocols in place on best
practice. This is in contrast to emergency leaders,
who operate in unique and novel situations within
variable environments. There may be set
protocols in these emergency situations but as the
circumstances of each situation differ, the leader
must then either adapt current protocols to the
novel situation or generate new ways to resolve
issues.
Similarly, there are significant differences in the
Employee Focus Mean Scores between
Emergency leaders and Health leaders. Effective
health leaders had a significantly higher E value
(42.48 vs. 34.58) than leaders in emergency

suggesting that health leaders are more relationoriented towards their subordinates. Both
emergency and health work in small teams which
require different styles from their leaders. Teams
in health, however, are designed to incorporate
ideas and opinions from many disciplines, with
each team members input being actively
encouraged by the team leaders. In contrast,
leaders in emergency are in a position where
executive decisions need to be made and the rest
of the team need to follow the instructions with
minimal input(19). The immediacy with which
actions need to be taken in emergency situations
also augments this effect.
These differences in leadership qualities between
Emergency and Health leaders may have
implications when the two sectors need to work
in tandem, as in a disaster relief situation. A good
leader working with both types of employees
would need to interact with health employees in a
more relation-oriented manner, being open to
suggestions and advice from their team. They
would also need flexibility in order to deal with
the rapid changes that may take place. The unique
circumstances of disaster relief may, however,
alter the required characteristics for an effective
leader, making it hard to extrapolate from our
current data.
Emergency and Business
In contrast, our results indicate that there is little
difference between qualities of effective leaders
in the emergency sector and the business sector.
Both sectors valued Production and task
orientation in their leaders, with high values of
Production focus (42.19 vs. 41.53) for their
effective leaders. The other mean values of focus
on change and employee-oriented focus were also
very similar between the two sectors (41.19 vs.
39.98 and 34.58 vs. 33.18, respectively), with the
means not statistically significantly different.
Similarly, adjusted regression coefficients
comparing business and emergency leaders
7

Change and Employee foci failed to reach

significance and so were not included in the final
results. From these results, it can be inferred that
effective leaders in business and emergency
possess similar qualities and can therefore share
similar models in training or recruitment.
Employees in both these sectors appear to value a
leader who is task oriented, providing clear and
concise direction for the employees while seeking
their input less often(17). They also value leaders
who are change focused and are able to adapt to
varying situations or proceed with new ideas(17).
This may reflect similar organisational structures,
with leaders being empowered to make executive
decisions affecting their whole teams. It also
reflects the speed with which changes happen in
both business and emergency fields, changes
which leaders need to readily respond to.
The implications of these similarities mean that
although emergency leadership has been poorly
researched today, future researchers may be able
to draw on the vast amount of literature which
has already been conducted on leadership in
business. Similarly, those charged with the
training of emergency services staff, could apply
methods commonly found in training programmes
for business executives. Conversely, business
leaders may be interested to know that the same
attributes which enable effective leadership in
disaster management could find a place in the
boardroom.
Methodological considerations
The use of a survey as a method of obtaining data
in any research is both the solution and the
answer. Questionnaires allow the researcher to
obtain responses relating to intangible, qualitative
data and place an ordinal value on the responses.
The problem they pose however is then whether
the data gathered by the survey reflect the true
situation. As such, one of the limitations of our
study is that in using a novel survey in our study,
we are uncertain of its instrumental validity. The

other significant limitation in our study is that we

were unable to do comprehensive case selection
prior to the distribution of the survey. This means
that we are not aware of attributes of the nonrespondents and with only a 40% uptake rate of
our survey, there may be some systematic bias in
our results.

Conclusion
Consistent with our initial aim, the results of this
study outline the differences in leadership style
between effective and ineffective leaders in the
fields of health, emergency services and business.
Minimal significant difference was found between
effective business and emergency leaders,
indicating that in the future these fields could
perhaps share leadership research data and
effective leadership development techniques. A
significant difference was however found
between effective health and emergency leaders,
with health leaders shown to be more employee
focused and emergency leaders more change
focused. These differences are important to
consider given the close relationship these fields
have in situations such as that of a major
disasters.

Acknowledgements
The authors would like to thank all the staff across the
fields of emergency, health and business who took the
time to fill out this survey and also their leaders, who
permitted them to do so. We also thank Dr Deon
Canyon for providing us with our survey and Dr. Juliann
Lloyd-Smith for providing assistance with the statistics.

References
1.
Drucker PF. Innovation and Entrepreneurship. New
York: HarperCollins; 1985.
2.
Hall RH. Organizations: Structures and Process. 3rd
ed. Englewood Cliffs, N.J.: Prentice-Hall; 1982.
3.
Yukl G. Managerial Leadership: A Review of Theory
and Research. Journal of management. 1989;15(2):251.

4.
Mumford MD, Zaccaro SJ, Connelly MS. Leadership
skills: Conclusions and future directions. The Leadership
quarterly. 2000;11(1):155.
5.
Sellgren SS, Ekvall GG, Tomson GG. Leadership
styles in nursing management: preferred and perceived.
Journal of nursing management. 2006;14(5):348.
6.
McGregor DM. The Human Side of Enterprise.
Management review. 1957;46(11).
7.
Perrow CC. THE ANALYSIS OF GOALS IN COMPLEX
ORGANIZATIONS. American sociological review.
1961;26(6):854.
8.
Fleishman EA, Harris, E.F. Patterns of leadership
behaviour related to employee grievance and turnover.
Personnel Psychology. 1962;15(1):43-56.
9.
Burns JM. Leadership. New York: Harper & Row;
1978.
10.
Robert R Blake JSM. An Overview of the Grid.
Training and development journal. 1975;29(5):29.
11.
G Ekvall JA. Change centered leadership. an
extension of the two dimensional model. Scandinavian
Journal of Management. 1991;7(1):17-26.
12.
Ekvall G, Arvonen, J. Leadership profiles, situation
and effectiveness. Creativity and Innovation Management.
1994;3(3):139-61.
13.
Bass BM. Leadership and performance beyond
expectations. New York: Free Press; 1985.
14.
Ekvall G. AJ. Change centered leadership. an
extension of the two dimensional model. Scandinavian
Journal of Management. 1991;7(1):17-26.
15.
Vance CC, Larson EE. Leadership Research in
Business and Health Care. Journal of nursing scholarship.
2002;34(2):165.
16.
Waugh W, Streib G. Collaboration and Leadership
for Effective Emergency Management. Public Administration
Review. 2006;66(1):131-40.
17.
Klein K, Ziegert J, Knight A, Xiao Y. A Leadership
System for Emergency Action Teams: Rigid Hierarchy and
Dynamic Flexibility. Academy of Management Journal. 2004.
18.
Yehuda B. Response rate in academic studies--a
comparative analysis. Human relations. 1999;52(4):421.
19.
Martin R, Martin R. Battle-Proven Military
Principles for Disaster Leadership. Fire Engineering.
2007;160(8):69-90.