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 鈥� and stay 鈥� competitive. Here鈥檚 what he had to say.
麻豆原创: What separates TCAD from other agencies?
Coontz: It鈥檚 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 and . What that does for an agency is it builds a sense of rapport and pride, because we鈥檙e 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鈥檙e in class, so, basically, they鈥檙e not losing any revenue. Because of this, we鈥檝e 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鈥檙e a small agency 鈥� 65 full time employees, 20 part time. So, we鈥檙e not huge, and we don鈥檛 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鈥檚 the wages and benefits. If you鈥檙e not paying more or at the same level as your competitors, then you鈥檙e 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鈥檝e also got a really solid benefits package. We have a retirement program for the . It鈥檚 one of those programs where you can retire at age 60. There鈥檚 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鈥檚 a good program.
We鈥檝e also got a very consistent management team. We haven鈥檛 had any turnover to speak of in forever. I鈥檝e been here nine years, the deputy chief has been here 28 years, human resources has been here 27 years. It鈥檚 because we鈥檝e 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, 鈥淥K, what鈥檚 everybody鈥檚 pay, and are we there?鈥� [Employees] don鈥檛 have to leave, they don鈥檛 have to go shopping around.
We鈥檝e created a real family-like atmosphere, and we all love each other. It鈥檚 just as simple as that.
EMS is often used as a steppingstone to other career fields 鈥� the fire service, traditional healthcare. Do you think it鈥檚 important to encourage employee career growth even if it means losing them down the line?
Yes, and I鈥檒l tell you why. The difference is, if you鈥檙e 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鈥檝e actually created a good human being. We鈥檝e trained them how we do things. They鈥檝e seen our methodology; they talk our language. Now, they鈥檙e going to go to another community agency, hopefully someplace close by, and they鈥檙e going to carry on with what we taught them. It鈥檚 not like they鈥檙e being wasted; they鈥檙e not going away. They鈥檙e actually going out and being soldiers in their own world, and who knows what they鈥檙e going to do in a decade or two.
But we鈥檝e 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鈥檚 rare that somebody would leave us and go be a nurse. It鈥檚 not unheard of, because it鈥檚 very difficult to compete with a hospital that wants to put on a bridge program. We know there鈥檚 some people like that out there and we don鈥檛 stop them. I mean, I would never criticize anybody or burn bridges. Because, guess what? Some of them will come back, and say, 鈥淵ou know what, that nursing thing was terrible. That was a bad idea.鈥�
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鈥檒l 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鈥檇 have to hide some of the comments because they were crude. But, after so many years, they realize that we鈥檙e just trying to improve the system. They tell us about the managers. We鈥檙e very transparent. I tell perspective managers, 鈥淚f you鈥檙e going to be a manager, then you got to be able to take it to heart. If you鈥檙e doing something wrong, the employees are going to tell us, and then we鈥檙e going to work to figure out how to make it better. I鈥檓 not terminating you, it鈥檚 about having deficiencies that we need to work on.鈥� 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 鈥� it鈥檚 because of management. Unfortunately, in my personal experience, there鈥檚 a deep chasm between a good professional manager and somebody who is a good paramedic. Let鈥檚 make [the paramedic] a supervisor, and then they turn out to not be such a good manager. In our world, we don鈥檛 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鈥檝e got one foot in the field and one foot in management. They鈥檙e seeing both sides, they鈥檙e 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鈥檝e got a supervisor who鈥檚 not engaged, not on board with what management鈥檚 doing or talking behind your back, you鈥檙e in for a long haul, because that means your employees are not going to go along with you.
What is TCAD鈥檚 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鈥檚 the most important function that a manager can do, because you鈥檙e 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鈥檙e doing the job that they鈥檙e 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 鈥� you need to be able to talk to doctors, nurses, fire crews, your own crews, the call center and others 鈥� so, communication is the number one thing.
Another one is, if you鈥檝e ever worked in the field, you know you鈥檝e 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鈥檝e got to figure out the diagnosis: what鈥檚 wrong with this guy? So, problem solving is another one.
There鈥檚 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鈥檚 good at conflict resolution? For example, one of the questions on our interview is, 鈥淭ell us about a time when you had to interact with someone who didn鈥檛 like you or you didn鈥檛 get along with. Tell us the situation and tell us how you handled it.鈥� So, now, they鈥檝e got to go back in their life and think about it, and then they鈥檙e going to regurgitate an answer to us, and we give a score.
Here鈥檚 a real example. One lady said, 鈥淲ell, 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.鈥� So, obviously this person got a very low score on the communication side, because that鈥檚 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鈥檙e answering the question right or wrong; they鈥檙e 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鈥檚 very difficult to hide those things, because we鈥檒l ask the same question in different ways, maybe three or four times. So, we鈥檒l figure it out.
It鈥檚 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鈥檚 about keeping pay up and the workload manageable 鈥� and there鈥檚 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鈥檚 great, but you鈥檙e not going to be around forever. You鈥檒l be the rare dog if you鈥檙e still in this fight. The time for your retirement comes around because you鈥檙e 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鈥檛 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鈥檙e just on the margin, your employees are going to take it. They鈥檙e not going to get the benefits they want.
