What is “Performance” in EMS? Part 4

This particular series began with the new year in thinking about the characteristics that make and keep an EMS as an efficient, “High Performance” system.   The previous criteria were all focused on factors including “Response Time,” “Effective Care,” and being “Community Connected.”  Each of these criteria obviously affects patient care either directly or more indirectly as part of the community, but in order for a high level of performance to be sustainable in an agency, it must take the welfare of the providers themselves into account.

Part 4: Provider Culture

Protocols and Standards of Care are documents that describe what should be done for patients, however these actions must be implemented by the people who work for a service.  Since the quality of care (and even patient satisfaction) is exclusively implemented by these individuals, often in extreme conditions, it seems counter-intuitive that the jobs they fill are regularly listed in surveys of The 10 Most Underpaid Jobs.  Part of the reason the pay remains so low for a position that is so widely recognized as being critical by the public is that it is still seen as a vocation taught at community colleges and even high schools rather than as a profession.  In some cases, EMS is even treated as a certification that simply becomes a gateway to another job.

The demands on Emergency Medical Technicians (EMTs) and Paramedics is strenuous both physically and mentally.  Some statistics I have heard suggest that one in four EMS workers will suffer a career ending back injury within the first 4 years of service while others may last only 5 years before the accumulated stress becomes almost intolerable.  Those who make it longer often become jaded and cynical due in part to monotony or exposure to patients who seem to routinely abuse the system.  It is important that the culture of a highly performing EMS service not view an employee seeking help in dealing with stress as being weak but rather look to support that comrade through their feelings.  There are resources readily available to help EMS personnel facing burnout Learn to Cope with Stress.  From a very practical perspective, it is typically cheaper to retain a senior employee, even one facing issues, than it is to train a new hire in the organizational way of thinking.

Another real fear that EMS agencies should understand is the problem of complacency.   Disengaged employees cost the US economy around $300B year.  And worse yet, for EMS agencies, this behavior means lawsuits, bad press, patient dissatisfaction, and employee retention problems.  A service culture than promotes performance encourages positive role mentors at all levels.  It is important to pay attention to the characteristics of new hires and to personally examine what type of personality you bring to your organization.  The chart to the right highlights some important character traits to look for in potential employees as well as yourself.

There are two ways to look at the problem of employee satisfaction: is your service hiring the right sorts of people and are you the type of person that the service you actually want to work for is actively hiring?  If you don’t know what the criteria of a good employee are, here are 8 Qualities To Look For When Hiring A Responder.  But again, the other consideration is whether your service is a place with whom professional minded individuals are interested in working.  Here are  6 Culture Building Principles for Your Response Team that promote professional performance and loyalty within the organization.

Leadership is key to authority in any group.  Unfortunately, the only form of authority that can be confirmed on anyone is just “command.”  The role of “leader” must be earned.  True leadership comes from developing respect, not demanding loyalty.  It is developed through an understanding of the job you request others to perform and an appreciation for the way the tasks of that job are carried out.  A high performing EMS promotes a “just culture” where positive behavior is rewarded at least as much as poor behavior is reprimanded.

Just as their is no single “correct” model for EMS delivery, there is no single pattern of employee relations.  Professionally minded employees must find the right service provider culture for them.  Similarly, agencies should demand high performance from those who wear their uniform in order to instill pride both ways.

1 Comment

  • EMT’s: It is a vocation. It can be taught almost anywhere, with a minimum of 110 hours (3 weeks of Mon-Fri 8a-5p). You can make a career out of it, and many are happy doing just that. There’s nothing wrong with it, and you can become the epitome of the professional. It takes all types and levels to make the wheels go round. There is no less value in an EMT than in a Paramedic (any don’t ever believe anyone who tells you otherwise!).

    Once you have committed to the extended learning to become a Paramedic (another 1,200+ hours), you have entered a profession, backed by a higher standard of education and skills verification (all arguments about the testing process aside, please). With the NREMT mandating Paramedic school accreditation, I expect this will in turn cause more “professionalism” of the job, but this will be slow materializing in the public’s purview. There will always be substandard performers (dare I mention lawyers here? – and nurses, too, are no exception) and companies looking to operate EMS for a buck without consideration to the impact on the profession. We can’t help that other than apply peer-pressure to them to improve. Agencies that lead (municipal services, EMS Authorities, regulatory agencies) should be setting the example. Paramedics, I feel, should eventually be required to have a minimum Associate’s degree by five years from now, and a Bachelor’s degree to become a specialist, like an Advanced Practice Paramedic (APP), Community Paramedic, CCEMT-P, or a Flight Paramedic (FP-C).

    Nurses aren’t too different. If you want to touch management and specialty certs like CRNA, CCRN, or CEN, you better have a BSN or you won’t get far. EMS should follow suit. Nursing is a far older, more established profession.

    The first step in getting people to view EMS as a profession, and not just a vocation, is to take some stock in yourself and demonstrate your professionalism. It starts with you! It can be contagious and others may do it too. I place a high emphasis on continuing education. I expect my partners not to be sloppy. My unit is clean and orderly and not a harbinger of infectious doom. Hey! When you look good, you feel good. More people will recognize you for what is negative or unfavorable that for what is perfect, so why give them any reason to complain? I’d rather be ignored for having good appearances and demeanor than to be chastened for inadequacies.

    EMS is often a stepping stone to the fire service. FDNY got bad press because a couple of poor decisions of EMT’s who were working the system to get into the fire service a little faster. If you volunteer for a combo-paid/vol fire service, aren’t you doing the same thing? I’ve heard numerous testaments of this from colleagues. You put in the time, you get rewarded with a higher score on the selection board. Don’t bad-mouth it. You chose to be there. In SoCal, you’d be hard pressed to make it to the top of the pick lists for any municipal department if you don’t already have your MICP (California’s Mobile Intensive Care Paramedic license is equivalent to everywhere else’s Paramedic license, but their name is fancier). You can get there without it, but more often than not, you gained an extra 20% points towards selection due to it, and it pads your paycheck ta boot. Why does this happen so much? Pay, benefits, and retirement, for one. Maybe for some it’s the paramilitary discipline and camaraderie that isn’t as prevalent in EMS. The problem is people who use EMS as a stepping stone and forsake the tenets of EMS and patient care once they get there or they look upon EMS with disdain while using it as a springboard into their choice of career since they couldn’t get there on their previous merits due to stiff competition. Who’s the weaker now?

    Dave Konig posted on The Social Medic about this topic, and I replied in jest about how FDNY is now forced to change its name to EMSNY due to the “weaker” service now becoming the driving force in the department. 150 years of tradition uninhibited by change, and all that. Realistically, the public will never see that happen. Too bad since an excess of 75% of their calls are handled by less than 10% of their people. That’s a department that has an opportunity to change the world’s view on the value of EMS, and to show what true professionalism is all about. I bet TOTWTYTR has an opinion on that.

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High Performance EMS

High Performance Emergency Medical Services (HP-EMS) systems provide effective clinical care promoting positive patient outcomes and community wellness while maintaining a focus on improving economic efficiency of the system. This site is dedicated as a community seeking to increase agency performance by promoting useful information regarding the developing trends and improvements in the efficiency of delivering basic and advanced medical care in the field.