“If you don’t get culture right, nothing else matters.”

Few have gotten a handle on retention and many struggle to captivate their workforce long term.  Research has demonstrated that EMS providers do not choose this field of work expecting a six-figure income. Pointing a finger at industry wages becomes an excuse when the focus on workforce culture is absent inside organizations. The EMS workforce culture is beginning to shift, and the future will be more people centered than ever. We are just beginning to understand the impact of culture and leadership on EMS recruitment and retention.

What we’re learning is that employees want to come to work and thrive. The future of the work industry will involve people centered health and wellness. Many industries, EMS included, will be competing for employees as some already are. It won’t be an additional .50 cents an hour that will win hearts and minds.

The EMS current industry research (2018) shows the following items as desirables and motivators for our workforce:

• Flexible scheduling

• Competitive pay and benefits

• Workplace friendships, a sense of belonging

• Work balance, extreme workloads are out

• Company ownership

So you may ask, what repels our workforce?

• Inability to take time off, inflexible scheduling

• Low accountability

• Favoritism & unfairness

• A poor relationship with a direct supervisor

• A lack of professional development and growth opportunities

What happens when workplace culture is unintentional? If culture isn’t defined and invested in daily it defines itself. Many organizations create mission and value statements, which is a great place to start, but then don’t take action to support their mission. Culture left unattended can lead to alarming employee turnover. The cost of employee turnover averages 10-20K, but can be as high as 80K per person when it’s all said and done.

Let’s take a closer look. How does an organization’s culture influence staffing?

Unstructured field training and unclear expectations

Field training officers and supervisors are the heart of any organization no matter the size or structure. A small rural agency may have one person structured for both roles. If organizations do not ensure these pivotal roles are vetted, structured, and promotional this will translate within the organization. For example, a poor performer decides to serve the organization by signing up for the field training position. The position has no vetting process and is unpaid. You simply sign up as a volunteer. There is no additional training outside of a right of passage live training where paperwork is briefly discussed. The candidates are simply told “be sure to set a good example” and they are all “promoted.”  Field training officers are needed and in high demand within the organization. The turnover for this position is high.

The poor performing field training officer trains six new employees within his/her first year. The organization carries on. Poor clinical and operational habits are learned and passed on from one provider to the next. The newly trained poor performer becomes a field training officer and the cycle continues and no one is watching.

If a field training program is not structured the training provided will also be unstructured. Expectations will be individualized in a low accountability environment. Inconsistency will be widespread and clinical and operational quality will be sub-par. Deviance will be normalized.

Low accountability

Accountability starts at the top and translates.

“If you’ve ever worked in an environment with low accountability, you know the impact it can have on the workplace culture. High performers feel like they have to pick up the slack for problem employees. Leaders are either micromanagers or they’re just watching the clock. And workers feel like they’re undervalued and under constant surveillance”.

When there is no consequence for poor performance and no reward for good performance, there is no motivation. We must face organizational fears associated with loosing employees to a healthy culture. A toxic employee will not stay in a healthy thriving work environment. Plan for the loss or stay on the Ferris wheel.

Poor operational & clinical quality

Without clear organizational expectations and accountability operational and clinical quality suffer. Operationally, organizations will grapple with sentinel events such as driving accidents, broken or lost equipment, poor response times, safety violations and inefficiency. Clinically, organizations will see poor provider clinical knowledge, protocol violations, a lack of continuing education and training, clinical errors undiscovered until the lawyers are involved and an overall disengaged attitude around education and learning.

Poor clinical and operational performance will impact the community and patients served.  Many organizations strive for shiny ambulances and crisp uniforms, but fail to do the real work when it comes to quality. The public knows no different but, your rock stars will and your workforce should.

The EMS Professional

Negative work environment & rock star exit

“How it starts is generally how it ends.”

Easy come easy go. Organizations that don’t invest in onboarding and training have little chance at retention. Retention of high performers requires a constant investment and effort from the organization.

The rock star grows tired of poor performers and will not play politics within a clinical environment. They will feel out of place and realize to fit in they will have to go against their inherent values. A true rock star will try all avenues to create a fit, but there will be an eventual exit from a negative work environment.

The exit interview is paramount to gathering information and will have a direct impact on how the former employee views their experience with the organization. There is opportunity in every letter of resignation to dig deeper. Further, if the employee brings value, be prepared to communicate this to them. Perhaps the reason for the departure is repairable? If you have an opportunity to retain someone that brings value to your organization take it! How an employee exit’s matters. They will remember their exit vividly and will carry the sentiment from your organization, or lack thereof, with them forever.

Staffing crisis & increased provider workload

Providers that are privy to high workloads are exposed to tragedy after tragedy without the necessary time to process what’s occurred. Often our clinical providers are asked to forego bathroom breaks and meals to respond to calls pending. The work environment becomes unhealthy and so do our providers. Our providers become resentful, morale declines and burn-out rears its ugly head.

There is organizational value in monitoring turnover and investigating the reasons behind it. The future success of organizations will hinge on having a high emotional IQ, EMS will not be an exception.  We need to understand where we are falling short so we can address the blind spots.

To reverse the cycle, organizations may need to step away from contracts and decrease their call volume. Additionally, if a culture transformation is planned expect and plan for poor performers to exit. Staffing may worsen before it improves.  

Urgent non-selective hiring

Is something better than nothing? What is that something? Is the interview process thoughtful? Are candidates screened for the organizational culture? Is there testing or skills verification before or during the hiring process? Is there a probationary period upon hire?

DanSun Photos

When we feel the pressure from a staffing crisis it can be tempting to let everyone through the door. If we do, we can pay dearly on the back end. This is the difference between short-term and long-term decision making. We’ve got to consider the cost of onboarding, the difficulty that can come with addressing performance problems and the inherent risk to our organizations when we don’t hire smart. We must be mindful and intentional even when facing a staffing crisis to stop the Ferris wheel.