There are many reasons why providers leave, from safety concerns, to the physical and mental toll EMS can take, to outdated technology and policies, disconnected management, and low pay. In our Special Coverage package, “Defying the EMS retention crisis,” learn how to combat these and other retention challenges.
The EMS Trend Report/EMS trend survey consistently identifies recruitment and retention as two of the top issues facing the profession today. EMS agencies are in constant competition with private EMS organizations, municipal fire/EMS departments, hospitals, stand-alone ER and urgent care centers for qualified caregivers.
And turnover is costly. Replacing an EMS provider involves backfill, recruiting costs and training time, as well as potential overtime expenses to cover shifts.
Salary certainly has a role to play in retention, as the gap between what is expected of an EMS professional in terms of job skills, training, education, responsibility and dedication compared to standard wages. But it’s clearly not the only factor involved in why EMS providers leave.
Here, EMS leaders offer the strategies they see working to engage talented providers, improve morale and optimize patient care.
Pulse surveys reveal brewing retention issues
While employee surveys will tell you that wage rates are way down on the list of retention issues, the reality is that wage rates are still close to the top retention driver in the EMS world. The struggle to find and retain EMTs and paramedics can come down to a difference as small as 25 cents per hour in some of the more competitive markets.
Working in conjunction with operations and finance on an annual basis, human resources conducts local market surveys and wage analysis to determine where we rank in relation to other EMS providers. Recommendations for any necessary market adjustments are made during the budget review process for inclusion in the upcoming budget year. At times, when recruiting and retaining staff creates a wage war with competitors in a market, we complete a wage analysis and, if shown to be feasible and sustainable, the adjustment is made as soon as possible.
We also have an annual merit process that provides salary increases based on the performance ratings. The merit budget percentage is generally set above the national average for merit percentage across all industries.
In the past, we have used HRQA assessments where an HR team member interviews supervisors and employees to ascertain the pulse of the operational unit and identify any gaps that may need to be closed from a retention perspective.
We are currently engaged with a company called CultureIQ to begin using their survey/engagement platform to begin conducting anonymous, third-party applicant, new hire and pulse surveys to provide us with data to better understand if our processes are creating barriers to become an employee or if there are retention issues brewing within our employee ranks.
Additionally, we recently launched the AMR Connect app for smart phones that provides employees access to AMR information relative to their respective operational unit. The app can push out notifications and pertinent communications. And finally, we have programs that help EMTs become paramedics. So, they are getting paid on-the-job training and advancing their careers at the same time. Tuition is covered for those EMTs on the paramedic career path.
We continue to offer a competitive wage and benefit package and will also work diligently using training, technology and transparency to make it easy to become and remain an employee of AMR.
We think having an engaged, informed employee population will go a long way in improving employee retention.
— Richard Barr, vice president, Human Resources, AMR
Servant leadership puts EMS providers first
When solely speaking on retention I think that salary plays a part, but is not the primary reason most people stay with the organization. I think that salary is the first thing that an applicant will see about your organization. This will definitely get you more people applying. However, once you have the employee, the salary will not be what retains them.
We are currently working on adjusting our pay scales with our part-time employees. The main way to do this is perform informal salary surveys of departments within a reasonable driving distance. We also understand inflation and that goods and services constantly increase, and pay must do the same.
We hold informal meetings with all staff members to evaluate our retention efforts. When I took over the agency, I met individually with all the employees. Some of the questions included asking them:
- Why do you choose to work here?
- What keeps you here?
- Do you have any plans to leave?
After this I have informally followed up with employees to include full time and part time. This allows an evaluation to determine if there are any changes to the answers as time goes on. Additionally, I asked all the employees what works and what isn’t working. I made every effort to not change what was working and we have worked to rapidly stop everything that wasn’t working. Ideally, I think performing period surveys would be a good way to evaluate retention efforts.
The employee is the most important asset we have and they must be treated as such. The employees are put first in every decision we make. The next concern is for our patients and then the elected officials we answer to. When employees know that you do everything for them and nothing you do is self-serving, they want to stay.
It is often said that people don’t quit organizations, they quit bad leaders. Our leadership team focuses on not being bad leaders.
— Weston Davis, licensed and critical care paramedic, firefighter and EMS instructor, and EMS director for the City of El Campo
Scheduling practices improve provider morale, patient care and operational efficiency
Individuals are drawn to EMS work for many reasons; however, scheduling often plays a key role in the satisfaction or dissatisfaction of your team.
Nobody likes working for an understaffed organization. Providing good patient care requires attention to detail and time to interact with customers. It also requires time to take care of your tools and equipment, plus some downtime to rest and recharge between calls.
Overworked and tired crews are more prone to making mistakes. Driving ambulances all over town to cover calls is both bad for response times and dangerous to crews and the community. Mandatory overtime might be a financial benefit for employees, but is costly to employers and gets old quickly for employees who are mandated to work extra time.
It’s also important for paramedics to know they can get a day off when they ask for it. It is reasonable for the department’s paramedics to actually have a day off without being called in to work.
Determining appropriate workload and staffing requirements requires the following:
- Having enough crews on duty to meet expected call demand. This means planning for scene times that are sometimes over 10 minutes, reasonable hospital drop-off times, time to write reports and meal breaks. It should not be assumed that non-response tasks can be accomplished by staying after the shift’s scheduled end time. That’s disrespectful of people’s time.
- Anticipate time off requests. Team members sometimes need to call-in sick and take vacations. In many cases accrued time off requires close to 1.3 people for every full-time employee. This coverage need is real, so plan for it.
- Medicine doesn’t stand still. Ongoing training in EMS is essential and most organizations build in time for training which improves clinical performance, builds job satisfaction and improves your organization’s reputation. In person training is great, however, a variety of tools now exist to make training more convenient for staff members and easier on training staff. Figure out which methods work best for your organization. For in person training be sure to schedule adequate coverage while crews are training or you’re cheating your staff out of these opportunities.
Be open-minded, proactive and adaptable. If you provide your team with a good scheduling system, they’ll likely do plenty to help your recruitment and retention efforts without you even knowing about it. If your staffing plan is poorly designed, expect the opposite.
Read more here.
— Sean Caffrey, president elect, NEMSMA, and the EMS programs manager at the University of Colorado Anschutz Medical Campus
Understanding EMS providers’ needs allows a culture change
As leaders of EMS agencies, it is up to us to make sure the era of hiring caregivers with “a patch and a pulse” is truly over.
Preparing caregivers to play a much larger role in managing the health and healthcare of our patients and communities is only half the battle. Leaders and organizations must change culture to retain those caregivers.
What makes employees stay?
What makes them leave?
The answer to both questions is leadership. It’s been said that the biggest reason employees jump ship is that they’re tired of working for lousy bosses. People are willing to put up with certain negatives if they enjoy who they’re working for. When employees are dissatisfied with their managers, retention plummets. Organizations must foster positive relationships between managers and their direct reports; communication, transparency, and respect are all part of this puzzle.
Wouldn’t it be great to see leaders invest in improving the work environment for paramedics and EMTs? It would start with offering better pay, shift schedules, deployment patterns and career development opportunities to help make sure they don’t burn out.
Beyond that, we need to pay attention to whether our caregivers are engaged and then find ways to engage them further. Providing employees or volunteers the necessary tools to succeed and grow, both personally and professionally, is critical to keeping caregivers involved. That can come in many forms, including educational opportunities, leadership development and mentoring.
Transparency and communication – both sharing information and actively listening – are essential to understanding the needs of our caregivers. We have more technologies than ever before to solicit feedback and monitor performance. But no app will ever beat what you can learn from visiting with crews at their stations, while they wait with a patient at the hospital or during a training session.
Read more here.
—Jay Fitch, PhD, founding partner of Fitch & Associates, EMS leader, author, speaker, educator and consultant
Outside industries provide innovative retention solutions
If you’re looking to build innovative processes that improve recruitment, retention or general business practices, you can’t be myopic and limit your research to the EMS bubble. If you want to be great at customer service, ask the best – like Disney.
Royal Ambulance offers customer service training from the Disney Institute and provides scholarship opportunities for employees that can be used to further their careers.
We want our team members to see Royal as a building block instead of a stepping stone. Here’s the difference: Stepping stones are disconnected pieces, implying that one job is merely a necessary intermediary from which one can hop to another job. A building block is a strong foundation upon which one can build future success. We want Royal to be their strong foundation.
If you want to build new products or services that differentiate you from your competition, see what Silicon Valley’s most innovative tech companies are doing and figure out how you can apply that to your business. We took a page from user experience research best practices by consistently getting customer feedback and iterating on our services.
Or, if you want to improve your processes and get alignment with your customers, follow the example of the world’s most forward-thinking healthcare institutions and adopt the Lean model – a method for increasing efficiency, simplicity and transparency while eliminating practices that waste time or resources.
In this day and age, staying within the EMS bubble will prove severely detrimental to the growth of your EMS company. But, at the same time, it’s not just about following trends – you need to be able to identify what’s really helpful and what’s just another shiny object.
For EMS, the core of our business is people; patients, providers and team members.
As such, there must always be a steadfast focus on the human element and on building a strong culture that everyone on your team can get behind. If your team is happy, your patients are happy and your customers are happy, then you’re already winning.
Read more here.
— Eve Grau, co-founder and director of human resources, Royal Ambulance
This article was originally posted March 19, 2019. It has been updated.
