Leadership in Street-Level Bureaucracy: An Exploratory Study of Supervisor-Worker Interactions in Emergency Medical Services

Street-level bureaucrats operate in a world relatively free of supervision, exercising discretionary abilities often without the presence of formal authority figures or managers. Although wide latitude in decision making is a norm of frontline work, leaders may occasionally be present to supervise service provision. This exploratory research employs narrative inquiry to examine the interactions of street-level personnel and formal authority figures during service provision in emergency medical services. Results indicate that occasions for compliance and disregard for managerial directives are manifest. Compliant behavior was evident when patient clinical needs were relatively clear and the effects of the directives were reasonably consistent with the paramedic’s preconceived notions of appropriate action. Deviation from managerial directives was apparent when patient’s positive outcomes were dependent on ignoring orders. Contributions to theory and practice, as well as avenues for future research are discussed.