Building Political Capital

Every EMS agency could use a little more political clout. After all, we deserve it. We actually save lives! “They” should just automatically recognize “our” value, right? Well, if you have ever thought/said that statement, you are going about it all wrong. I don’t care what financial/political model your agency operates under, politics work basically the same in any situation. There is seldom a true political “win,” your mindset should be at least to seek a “win/win,” if not a “win/win/win.” What do I mean? Imagine going for a hike in the woods when you and a friend come upon a hungry bear. You know they can run faster than you, but then you realize that you really only need to outrun your “friend.” Sure, you won that time, but at what cost? Now imagine that instead of running, you kill the bear (this is only an analogy, I do not advocate harming animals in any of my posts.) In this story, both you AND your friend win. Besides that, you are now a hero. You built political clout with that friend. Not bad. Finally, however, let’s consider a third option. This time you drop a pack of “wholesome organic bear treats” on the trail to distract (and feed) the bear while you and your now loyal companion escape. Everybody won!

The common primary mistake most people make in political situations is to begin with an “us” versus “them” mentality. “We obviously need more money for <fill in the blank> so ‘we’ need to build a justification that is more impressive than any one else’s.” In economic terms, this is called a “zero sum game.” There are finite resources available; so my gain is, by default, someone else’s loss. These are difficult games to win, so I prefer not to play them at all. One of the first rules of politics is to only engage in battles where you have a good chance to “win” (or preferably “win/win/win.”)

So, how do you change the game? This is why a good “leader” thinks outside the box of the normal paradigm of thinking of a county budget (or whatever your funding source) as a fixed pot of money that is available to dip into if you can get there before its all gone. If you have to hurt someone else in order to get what you want, you will not build any useful political capital – only political fear. You may be hailed temporarily within some small tribe of constituents, but you become an enemy of all others outside your particular clique. It can be more effective to think of of ways to change the pot itself.

One way to change the dynamics is to bring outside money to it – or at least reduce your dependence on it as your only sustenance. This can be done by forging new partnerships. Most of us already partner with CMS as an outside funding source, but trying to get more reimbursement from Medicare/Medicaid is a tough sell right now. Build your political capital stockpile before going after that bear. So, how about your local hospital instead? What financial pains are they facing that you might be able to impact? The ACA law has changed the rules for their reimbursements so that if a patient is readmitted for the same condition too soon, they lose funds. You are uniquely positioned between the patient’s home and the ER door that leads to readmission. If you can ensure that a patient is safe, happy, and healthy at home (a win for them), you can save the hospital money (a win for them) and possibly partner to share in that savings (a win for you.) This is not my idea, it is called “Mobile Integrated Healthcare” (or “Community Paramedicine.”) To implement this idea, you need a partner and a willingness to change your operations if the savings are greater than the costs. This is called “increasing the size of the pie” in economics. Your slice may not be any bigger proportionally, but you still get more of it.

Another way to “sweeten the pot” is to help others become more efficient in their use of funding. You don’t have to look too far outside your organization to find effective partnerships. There may be departments you work beside that could use help you can easily provide. When your vehicles are out driving the county doing “road surveys” can they watch for anything else? Who handles your addressing in the county? Do you ever visit an address that is not in the system? Do you find roads that aren’t correct on the GIS map? Do you see recurring potholes in roadways or recognize water leaks coming from cracks in the pavement? Is there a particular curve or hill that consistently has motor vehicle accidents? Do you ever pass these discoveries along to those who are responsible? It is called “good citizenship” and it can be great politics as well. Building a report with other agencies builds political clout. And if you help them become more efficient, the pie grows again.

Finally, you can do better at utilizing resources yourself. Don’t take that necessarily to mean unilaterally cutting your own budget. Sometimes a financial investment returns a significant cost savings. When you make a good decision, do you have a means to promote the savings to your political officials? But wait, before you go tooting your own horn to prove what a shrewd financial steward you are; consider sharing that credit first. Politicians love praise and in reality you didn’t do it all yourself (even if you really did) because the funds were somehow allocated to you. When you promote a new cost saving idea, do the work of calculating the actual cost/value and jointly publish it as a wise decision on the part of those who hold your purse strings to have given you the opportunity to save so much money. Be sure to quantify the savings in dollars. Intangible benefits (like “saving lives”) is nice, but saving a specific number of lives – or even a single life BY NAME – is political gold. If an external consultant was instrumental in the process, stroke them too. If they helped you once, they may do so again. Don’t leave any valuable partner out in the cold or you may never see them again. There are always bears stalking the financial woods.

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