No margin, no mission? How emergency medical service crews attend to competing financial and social goals on 9‐1‐1 calls

Timothy Gubler, Haibo Liu and Alexandru Roman

Strategic Management Journal, 2025, vol. 46, issue 13, 3118-3151

Abstract: Research Summary We study how autonomous Emergency Medical Service (EMS) teams prioritize competing financial and social goals during 9‐1‐1 calls. Prior research highlights organization‐level solutions that enable single‐goal pursuit, but it remains unclear how frontline professionals manage competing goals that are interdependent and inseparable during task execution. We argue EMS teams will dynamically prioritize goals across calls depending on contextual factors. Using quasi‐random assignment of 9‐1‐1 patients to EMS crews in 31 US states, we find that crews prioritize the financial goal on private insurance calls but shift toward the social goal when agency financial need is low or call acuity is high. Surprisingly, these patterns are most pronounced in non‐profit EMS agencies. Our study offers new insight into how professionals manage goal trade‐offs in real time. Managerial Summary What happens when professionals must pursue competing goals—like financial performance and equitable service—but organizations cannot separate them across tasks? Using data from 31 US states, we examine how Emergency Medical Service (EMS) teams navigate this tension during 9‐1‐1 calls. We find that crews dynamically prioritize goals based on perceived risk and opportunity—even without managerial intervention or immediate incentives. Teams provide more services to privately insured patients to increase revenue but shift toward equitable care when patient needs are more urgent or agency finances are stable. Surprisingly, these trade‐offs are most pronounced in non‐profit agencies. Our findings suggest that when goals collide within tasks, managers can shape frontline decision‐making by influencing how professionals understand goal risk and opportunity.

Date: 2025
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