It has been a season since I’ve written to all of you and it’s time to get back at it. Much has changed over the past year in the medical transport industry—release of the 2014 FAA HEMS Final Rule and changes in states’ acknowledgement of new options for accreditation services for medical transport programs. As important, new advances have been occurring with NAAMTA also — the uniting of the IAAA with the NAAMTA flag which is now taking NAAMTA into the international market, the addition of 4 new accredited transport programs with several other new programs in progress (not to mention the renewal of all current alliance members), and the explosive growth of the NAAMTA Learning Center.  The bottom line…NAAMTA is having a tremendous impact on the medical transport industry.

It is the mission of NAAMTA to “be the example to the medical transport industry,” to “embrace a higher standard” and to “inspire people to be better.” As NAAMTA has traveled the globe (literally) talking with transport programs, it is obvious that this kind of industry leadership is sorely desired. In keeping with NAAMTA’s mission of leadership, I wanted to help us understand the bigger picture by sharing some principles on leadership.

Lesson 1:  Being responsible sometimes means pissing people off.
Good leadership involves responsibility to the welfare of the group, which means that some people will get angry at your actions and decisions. It’s inevitable — if you’re honorable. Trying to get everyone to like you is a sign of mediocrity. You’ll avoid the tough decisions, you’ll avoid confronting the people who need to be confronted, and you’ll avoid offering differential rewards based on differential performance because some people might get upset. Ironically, by procrastinating on the difficult choices, by trying not to get anyone mad, and by treating everyone equally “nicely” regardless of their contributions, you’ll simply ensure that the only people you’ll wind up angering are the most creative and productive people in the organization.

Lesson 2:  The day soldiers stop bringing you their problems is the day you have stopped leading them.
They have either lost confidence that you can help them or concluded that you do not care. Either case is a failure of leadership. If this were a litmus test, the majority of CEOs would fail. One, they build so many barriers to upward communication that the very idea of someone lower in the hierarchy looking up to the leader for help is ludicrous. Two, the corporate culture they foster often defines asking for help as weakness or failure, so people cover up their gaps, and the organization suffers accordingly. Real leaders make themselves accessible and available. They show concern for the efforts and challenges faced by underlings — even as they demand high standards. Accordingly, they are more likely to create an environment where problem analysis replaces blame.

Lesson 3:  Don’t be buffaloed by experts and elite’s. Experts often possess more data than judgment. Elite’s can become so inbred that they produce hemophiliacs who bleed to death as soon as they are nicked by the real world.
Small companies and startups don’t have the time for analytically detached experts. They don’t have the money to subsidize lofty elite’s, either. The president answers the phone and drives the truck when necessary; everyone on the payroll visibly produces and contributes to bottom-line results or they’re history. But as companies get bigger, they often forget who “brung them to the dance” things like all-hands involvement, egalitarianism, informality, market intimacy, daring, risk, speed, agility. Policies that emanate from ivory towers often have an adverse impact on the people out in the field who are fighting the wars or bringing in the revenues. Real leaders are vigilant-and combative-in the face of these trends.

Lesson 4:  Don’t be afraid to challenge the pros, even in their own backyard.
Learn from the pros, observe them, and seek them out as mentors and partners. But remember that even the pros may have leveled out in terms of their learning and skills. Sometimes even the pros can become complacent and lazy. Leadership does not emerge from blind obedience to anyone. Xerox’s Barry Rand was right on target when he warned his people that if you have a yes-man working for you, one of you is redundant. Good leadership encourages everyone’s evolution.

Lesson 5:  Never neglect details. When everyone’s mind is dulled or distracted the leader must be doubly vigilant.
Strategy equals execution. All the great ideas and visions in the world are worthless if they can’t be implemented rapidly and efficiently. Good leaders delegate and empower others liberally, but they pay attention to details, every day. (Think about supreme athletic coaches like Jimmy Johnson, Pat Riley, and Tony La Russa). Bad ones (even those who fancy themselves as “progressive visionaries”) think they’re somehow “above” operational details. Paradoxically, good leaders understand something else. An obsessive routine in carrying out the details begets conformity and complacency, which in turn dulls everyone’s mind. That is why even as they pay attention to details, they continually encourage people to challenge the process. They implicitly understand the sentiment of CEO-leaders like Quad Graphic’s Harry Quadracchi, Oticon’s Lars Kolind and the late Bill McGowan of MCI, who all independently asserted that the Job of a leader is not to be the chief organizer, but the chief disorganizer.

Lesson 6:  You don’t know what you can get away with until you try.
You know the expression “it’s easier to get forgiveness than permission?” Well, it’s true! Good leaders don’t wait for official blessing to try things out. They’re prudent, not reckless. But they also realize a fact of life in most organizations you ask enough people for permission you’ll inevitably come up against someone who believes his job is to say “no.” So the moral is, don’t ask. I’m serious. In my own research with colleague Linda Mukai, we found that less effective middle managers endorsed the sentiment, “If I haven’t explicitly been told ‘yes,’ I can’t do it,” whereas the good ones believed “If I haven’t explicitly been told ‘no,’ I can.” There’s a world of difference between these two points of view.

Lesson 7:  Keep looking below surface appearances. Don’t shrink from doing so (just) because you might not like what you find.
“If it ain’t broke, don’t fix it” is the slogan of the complacent, the arrogant or the scared. It’s an excuse for inaction, a call to non-arms. It’s a mind-set that assumes (or hopes) that today’s realities will continue tomorrow in a tidy, linear and predictable fashion. Pure fantasy. In this sort of culture, you won’t find people who proactively take steps to solve problems as they emerge. Here’s a little tip. Don’t invest in these companies.

Lesson 8:  Organization doesn’t really accomplish anything. Plans don’t accomplish anything, either. Theories of management don’t much matter. Endeavors succeed or fail because of the people involved. Only by attracting the best people will you accomplish great deeds.
In a brain-based economy, your best assets are people. We’ve heard this expression so often that it’s become trite. But how many leaders really “walk the talk” with this stuff? Too often, people are assumed to be empty chess pieces to be moved around by grand viziers, which may explain why so many top managers immerse their calendar time in deal making, restructuring and the latest management fad. How many immerse themselves in the goal of creating an environment where the best, the brightest, the most creative are attracted, retained and-most importantly – unleashed?

Lesson 9:  Organization charts are frozen, anachronistic photos.
In a workplace that ought to be as dynamic as the external environment around you, if people really followed organization charts, companies would collapse. In well-run organizations, titles are also pretty meaningless. At best, they advertise some authority – an official status conferring the ability to give orders and induce obedience. But titles mean little in terms of real power, which is the capacity to influence and inspire. Have you ever noticed that people will personally commit to certain individuals who on paper (or on the org chart) possess little authority – but instead possess pizzazz, drive, expertise, and genuine caring for teammates and products? On the flip side, non-leaders in management may be formally anointed with all the perks and frills associated with high positions, but they have little influence on others, apart from their ability to extract minimal compliance to minimal standards.

Lesson 10:  Never let your ego get so close to your position that when your position goes, your ego goes with it.
Too often, people who cling to familiar turfs and job descriptions stifle change. One reason that even large organizations wither is that managers won’t challenge old, comfortable ways of doing things. But real leaders understand that, nowadays, every one of our jobs is becoming obsolete. The proper response is to make obsolete our activities before someone else does. Effective leaders create a climate where people’s worth is determined by their willingness to learn new skills and grab new responsibilities, thus perpetually reinventing their jobs. The most important question in performance evaluation becomes not, “How well did you perform your job since the last time we met” but “How much did you change it?”

Lesson 11:  Fit no stereotypes. Don’t chase the latest management fads. The situation dictates which approach best accomplishes the team’s mission.
Flitting from fad to fad creates team confusion, reduces the leader’s credibility and drains organizational coffers. Blindly following a particular fad generates rigidity in thought and action. Sometimes speed to market is more important than total quality. Sometimes an unapologetic directive is more appropriate than participatory discussion. To quote Powell, some situations require the leader to hover closely others require long, loose leashes. Leaders honor their core values, but they are flexible in how they execute them. They understand that management techniques are not magic mantras but simply tools to be reached for at the right times.

Lesson 12:  Perpetual optimism is a force multiplier.
The ripple effect of a leader’s enthusiasm and optimism is awesome. So is the impact of cynicism and pessimism. Leaders who whine and blame engender those same behaviors among their colleagues. I am not talking about stoically accepting organizational stupidity and performance incompetence with a “what, me worry?” smile. I am talking about a gung-ho attitude that says, “We can change things here. We can achieve awesome goals. We can be the best.” Spare me the grim litany of the “realist”; give me the unrealistic aspirations of the optimist any day.

Lesson 13:  Powell’s Rules for Picking People
Look for intelligence and judgment and, most critically, a capacity to anticipate, to see around corners. Also look for loyalty, integrity, a high energy drive, a balanced ego and the drive to get things done.” How often do our recruitment and hiring processes tap into these attributes? More often than not, we ignore them in favor of length of resume, degrees, and prior titles. A string of job descriptions a recruit held yesterday seem to be more important than who one is today, what she can contribute tomorrow or how well his values mesh with those of the organization. You can train a bright, willing novice in the fundamentals of your business fairly readily, but it’s a lot harder to train someone to have integrity, judgment, energy, balance, and the drive to get things done. Good leaders stack the deck in their favor right in the recruitment phase.

Lesson 14:  Great leaders are almost always great simplifiers, who can cut through argument, debate, and doubt to offer a solution everybody can understand.
Effective leaders understand the KISS principle, or Keep It Simple, Stupid. They articulate vivid, overarching goals and values, which they use to drive daily behaviors and choices among competing alternatives. Their visions and priorities are lean and compelling, not cluttered and buzzword-laden. Their decisions are crisp and clear, not tentative and ambiguous. They convey an unwavering firmness and consistency in their actions, aligned with the picture of the future they paint. The result? — Clarity of purpose, credibility of leadership, and integrity in organization.

Lesson 15: Laws of Instinct
1) Use the formula P@ 40 to 70, in which P stands for the probability of success and the numbers indicate the percentage of information acquired.

2) Once the information is in the 40-70 range, go with your gut.

Don’t take action if you have only enough information to give you less than a 40 percent chance of being right, but don’t wait until you have enough facts to be 100 percent sure, because by then it is almost always too late. His instinct is right. Today, excessive delays in the name of information-gathering breeds “analysis paralysis.” Procrastination in the name of reducing risk actually increases risk.

Lesson 16: The commander in the field is always right and the rear echelon is wrong, unless proved otherwise.
Too often, the reverse defines corporate culture. This is one of the main reasons why leaders like Ken Iverson of Nucor Steel, Percy Barnevik of Asea Brown Boveri, and Richard Branson of Virgin have kept their corporate staffs to a bare-bones minimum. (And I do mean minimum. How about fewer than 100 central corporate staffers for global $30 billion+ ABB? Or around 25 and 3 for multi-billion $ Nucor and Virgin, respectively?) Shift power and the financial accountability to the folks who are bringing in the beans, not the ones who are counting or analyzing them.

Lesson 17:  Have fun in your command. Don’t always run at a breakneck pace. Take leave when you’ve earned it. Spend time with your families.
Surround yourself with people who take their work seriously, but not themselves, those who work hard and play hard. Herb Kelleher of Southwest Air and Anita Roddick of The Body Shop would agree; seek people who have some balance in their lives, who are fun to hang out with, who like to laugh (at themselves, too) and who have some non-job priorities, which they approach with the same passion that they do their work. Spare me the grim workaholic or the pompous pretentious “professional”; I’ll help them find jobs with my competitor.

Lesson 18:  Command is lonely
Harry Truman was right. Whether you’re a CEO or the temporary head of a project team, the buck stops here. You can encourage participative management and bottom-up employee involvement but ultimately, the essence of leadership is the willingness to make the tough, unambiguous choices that will have an impact on the fate of the organization. I’ve seen too many non-leaders flinch from this responsibility. Even as you create an informal, open, collaborative, corporate culture, prepare to be lonely.”

                                                                                   —General Colin Powell