How EMS Leaders Build Cultures That Drive Performance

Creating a culture of excellence requires EMS and Fire Service leaders to take an intentional approach to blending optimal clinical outcomes, meaningful continuing education, consistent compliance, and thoughtful organizational management.  

In our recent webinar, More Than Mandatory: How EMS Leaders Are Building Cultures That Drive Performance, we asked a panel of experts to share how they guide their teams to balance everyday challenges with building a culture that can sustain a thriving agency. 

Across three very different organizations—Area Ambulance Service in Iowa, Plum EMS in Pennsylvania, and the Oklahoma City Fire Department—these leaders described culture not as a side initiative, but as a core operational strategy. Their message was consistent: Strong culture doesn’t happen by accident. It is built deliberately, reinforced daily, and led from the top. 

Leadership Sets the Tone 

The conversation opened with a reality familiar to EMS leaders everywhere: The job has never been more complex. Agencies are navigating workforce shortages, financial pressures, evolving clinical demands, shifting regulations, and the cumulative mental strain placed on providers. 

Our panelists agreed that in a constantly shifting landscape, culture is a vital stabilizing force, shaping how EMS teams respond to challenges. Across the board, it was agreed that leadership needs to set the tone to ensure a culture in which employees feel supported rather than burned out.  

“We can talk about culture all day,” said Jennifer Zahrt, CEO of Area Ambulance Service, “but if we’re not out front setting the example, it’s just not going to take root.” 

Oklahoma City Fire Department Chief Richard Kelley emphasized the importance of authenticity in leadership, as culture shows in how leaders communicate, how they handle challenges, and how visible they are to their teams.  

“People don’t care how much you know until they know how much you care,” Kelley said, underscoring a philosophy that prioritizes trust and connection as the foundation of performance. 

All three panelists emphasized the role of transparency in building that trust. Rather than limiting access to information, the leaders described a deliberate effort to share everything from financial data and operational performance to areas where leadership needed to improve. At Area Ambulance, regular town halls provide a forum for employees to ask questions directly, with no topics off-limits. At the Oklahoma City Fire Department, engagement surveys and open communication channels allow leaders to identify employee concerns and respond in real time. Ultimately, the goal is not just to inform, but to align with those they are leading. 

Defining Standards and Holding to Them 

While culture is often discussed in broad terms, the panelists emphasized the importance of making it concrete through clear expectations. 

At Area Ambulance, that clarity is distilled into a simple but powerful mindset designed to avoid fruitless venting and promote action: “Fix it or forget it.” Team members are encouraged to either take ownership of a problem by finding a solution or to let it go, eliminating the kind of subtle negativity that can quietly erode culture over time. 

More broadly, Zahrt framed accountability not as a punitive measure but as a cultural strength—a call to the standard. In EMS environments, where much of the work happens without direct supervision, that distinction matters. Adhering to a cultural standard becomes the guide that informs decision-making, reinforces expectations, and shapes how individuals respond under pressure. 

Or, as Zahrt put it: “What happens when nobody’s watching is what determines your outcomes.” 

Plum EMS Director of Operations Brian Maloney says his agency puts focus on collaboration and continuous learning to create a culture where employees take initiative and pursue excellence together.  

“We try to create an environment where people feel supported rather than scrutinized,” he said, adding that the result has been improvements in clinical performance, documentation, and patient satisfaction. 

Measuring Culture Like Any Other Priority 

Another key theme of the discussion was measurement. Culture, the panelists agreed, should be evaluated with the same rigor as clinical or operational performance. Chief Kelley said Oklahoma City Fire leverages engagement surveys to track employee sentiment and identify areas for improvement. At Area Ambulance, Zahrt’s team uses structured “people metrics” to assess trust, accountability, and leadership effectiveness. Low scores in areas like trust or accountability are treated as signals, prompting conversations, guiding training, and informing leadership decisions.  

Over time, data measurement and tangible responsiveness reinforce credibility and demonstrate that feedback leads to change. It can also create a culture that people want to be a part of, according to Maloney. 

“In the history of Plum EMS, we’ve only posted to hire for a position once. We’re lucky to have always been fully staffed and if or when someone does resign, we have good quality people in the pipeline,” he said. “It’s one of the things the culture and the people here have created, and I can’t give them enough credit for it.” 

A Continuous Commitment 

Finally, all three panelists agreed that building agency culture isn’t a one-time initiative. It requires ongoing attention, focused on finding ways to connect leadership, teams, operations, and outcomes. 

“There’s no magic recipe,” Zahrt said. “If you’re not proactively driving your culture, you’re going to fall behind.” 

To catch the full panel discussion, you can watch the webinar on demand.