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.