Maintaining a fully operational staff trained and equipped to respond to any call is the goal of every EMS agency, but one that is too often missed. Over the past 4 years, the annual EMS Trend Report has consistently revealed that agencies struggle to recruit and retain quality providers, forcing many smaller and rural departments to close their doors.
Darryl Coontz, chief of Taney County Ambulance District (TCAD), believes his agency has found a solution, which includes a combination of improvements in several areas, from a scientific approach to hiring, to a robust professional development program and wages that are – and stay – competitive. Here’s what he had to say.
EMS1: What separates TCAD from other agencies?
Coontz: It’s taken several years to build this up to a certain level, where the employees are proud of working here; this is sort of like the place to be, in the region, and we have a good reputation.
The first thing we want is for people to feel good about themselves, so we got a CAAS accreditation and ACE accreditation. What that does for an agency is it builds a sense of rapport and pride, because we’re very unique; not many agencies are CAAS accredited. All of the things that come along with the accreditation make us a better agency. It forces us to do things smarter. It forces us to eliminate waste. It just forces us to be a better agency and more responsive to the needs of our employees.
We also fund professional development, and not only for people that are going to college. To keep our paramedic pipeline going, we put our EMTs through paramedic school; we pay for the schooling, and we also pay for their time off while they’re in class, so, basically, they’re not losing any revenue. Because of this, we’ve been able to keep ourselves with plenty of paramedics through this pipeline program. There was a stretch of three years where we only hired one outside paramedic because we basically grew everybody from the inside. Now, obviously, we’re a small agency – 65 full time employees, 20 part time. So, we’re not huge, and we don’t have a lot of the complications that big agencies have. We know all of our people, and they know us.
The other thing is, and this is kind of a no-brainer, but it’s the wages and benefits. If you’re not paying more or at the same level as your competitors, then you’re going to lose people. So, our board has committed to keeping our wages and benefits as high or higher than any of the agencies around us. We’ve also got a really solid benefits package. We have a retirement program for the State of Missouri Public Workers called Lagers. It’s one of those programs where you can retire at age 60. There’s an 80 and out rule that we actually pay up for. So, if you come on board at age 20, you can be retired within in 20 years, so 45 or 50. That’s a good program.
We’ve also got a very consistent management team. We haven’t had any turnover to speak of in forever. I’ve been here nine years, the deputy chief has been here 28 years, human resources has been here 27 years. It’s because we’ve created a place where people can actually retire, and we keep the pay up. Every year, when budget time comes around, we survey the region to find out, “OK, what’s everybody’s pay, and are we there?” [Employees] don’t have to leave, they don’t have to go shopping around.
We’ve created a real family-like atmosphere, and we all love each other. It’s just as simple as that.
EMS is often used as a steppingstone to other career fields – the fire service, traditional healthcare. Do you think it’s important to encourage employee career growth even if it means losing them down the line?
Yes, and I’ll tell you why. The difference is, if you’re a private EMS agency, the last thing you want to do is subsidize the fire department or the hospital or your competitor by creating this perfect employee. The advantage I have here is we are districts, and half our revenue comes from a tax base and half of it comes from our billing. So, if I send somebody to paramedic school and they decide they want to go work at a fire department, we’ve actually created a good human being. We’ve trained them how we do things. They’ve seen our methodology; they talk our language. Now, they’re going to go to another community agency, hopefully someplace close by, and they’re going to carry on with what we taught them. It’s not like they’re being wasted; they’re not going away. They’re actually going out and being soldiers in their own world, and who knows what they’re going to do in a decade or two.
But we’ve got to the point where the people that are working here, they want to stay here. We have created a good environment for them to work in. It’s rare that somebody would leave us and go be a nurse. It’s not unheard of, because it’s very difficult to compete with a hospital that wants to put on a bridge program. We know there’s some people like that out there and we don’t stop them. I mean, I would never criticize anybody or burn bridges. Because, guess what? Some of them will come back, and say, “You know what, that nursing thing was terrible. That was a bad idea.”
How can leadership encourage employee growth in a way that maintains high standards?
As far as management goes, we survey our employees every year. We’ll ask them a battery of questions and give them the opportunity to tell us how they feel, anonymously, done through a third party. We get somewhere around a 90% return rate on it. In the beginning, when morale was lower, we’d have to hide some of the comments because they were crude. But, after so many years, they realize that we’re just trying to improve the system. They tell us about the managers. We’re very transparent. I tell perspective managers, “If you’re going to be a manager, then you got to be able to take it to heart. If you’re doing something wrong, the employees are going to tell us, and then we’re going to work to figure out how to make it better. I’m not terminating you, it’s about having deficiencies that we need to work on.” So, the annual employee survey really sets the tone.
The number one reason people leave jobs is because of management. Not because of wages and salary and benefits – it’s because of management. Unfortunately, in my personal experience, there’s a deep chasm between a good professional manager and somebody who is a good paramedic. Let’s make [the paramedic] a supervisor, and then they turn out to not be such a good manager. In our world, we don’t have a very good program to train people and get them ready for that next step.
So, we focus on professional development for our supervisors, too. We will send them to Save Tech, we send them to ASI, we send them to conferences. We do in-house training. We make sure that if you think about it, especially in that first step, the supervisor, these are the people we consider the most important people in the entire organization. Why? Because they’ve got one foot in the field and one foot in management. They’re seeing both sides, they’re hearing the complaints.
Somehow, they have to take the policies and procedures and the things management wants, and relay that information to the field crews, and then the field crews relay that information back up to us. If you’ve got a supervisor who’s not engaged, not on board with what management’s doing or talking behind your back, you’re in for a long haul, because that means your employees are not going to go along with you.
What is TCAD’s approach to the hiring process, and how do you find those individuals who are the best fit for the job?
The hiring process is critical. It’s the most important function that a manager can do, because you’re bringing people on that may be with you for decades. We use a process called behavior-based interviewing (BBI). We seek the candidates that the personality characteristics and temperament of the job, of being a paramedic on the street. We search for those people, and we have a much better fit; they’re doing the job that they’re meant to do.
Decades ago, when I was working in Kansas City as a clinical manager, we got turned onto this thing called behavior-based interviews. What makes a good paramedic or EMT? Well, you have to be a good communicator – you need to be able to talk to doctors, nurses, fire crews, your own crews, the call center and others – so, communication is the number one thing.
Another one is, if you’ve ever worked in the field, you know you’ve got to be a problem solver. You have to figure out how to get this person from the bed out to the ambulance. Or, you’ve got to figure out the diagnosis: what’s wrong with this guy? So, problem solving is another one.
There’s a list of things that go down in order of importance. Top one is communicator, next one is problem solving, next one is the ability to adapt, or conflict resolution.
Then, you ask questions. What question can I ask to ascertain whether this guy’s good at conflict resolution? For example, one of the questions on our interview is, “Tell us about a time when you had to interact with someone who didn’t like you or you didn’t get along with. Tell us the situation and tell us how you handled it.” So, now, they’ve got to go back in their life and think about it, and then they’re going to regurgitate an answer to us, and we give a score.
Here’s a real example. One lady said, “Well, I was a paramedic, and we just kept getting drunks all the time. And, I really hate drunks. I mean, drunks really piss me off.” So, obviously this person got a very low score on the communication side, because that’s what we pick up most of the time are drunk people or people who are altered in some way. So, they would never make it in this system.
We just keep asking these questions, one after another. The theory is that how you behaved in the past is a good predictor of how you are going to behave in the future. These candidates have no idea if they’re answering the question right or wrong; they’re just giving what happened in the past. They may be able to paint it in a good light, but, having done thousands of these interviews, I can tell you this, it’s very difficult to hide those things, because we’ll ask the same question in different ways, maybe three or four times. So, we’ll figure it out.
It’s a whole battery of questions that are designed to look for good communicators, good problem solvers and people that can handle conflicts.
In your opinion, why is the EMS industry struggling to retain providers and keep up with the needs of the population?
It’s about keeping pay up and the workload manageable – and there’s a delicate balance between workloads. How many calls are you running? Are you going into work on a 12-hour shift and running seven to eight calls a shift? That’s great, but you’re not going to be around forever. You’ll be the rare dog if you’re still in this fight. The time for your retirement comes around because you’re going to be broken, probably.
One thing is the way Medicare is subsidized. You transport, you get paid for it. But the problem is, you don’t get paid what it costs you. So, you have to cut everything to the bone and that means wages. In any service industry, wages are like 75% of your payroll. If you’re just on the margin, your employees are going to take it. They’re not going to get the benefits they want.
