I know an EMS organization that continually brags about its accomplishments. It has an unbelievable, sky-rocketing save rate for victims of cardiac arrest. Its response times to scenes are phenomenal. It has the latest and greatest new ambulances and gadgets.
But if you talk to the people who work there, they're unhappy and leave in droves. They continually call in sick, and the amount of discipline carried out against them is through the roof.
Underneath all the hype, it's truly a dysfunctional organization.
Albert Einstein once said, "Everything that can be counted does not necessarily count; everything that counts cannot be necessarily counted." This can be especially true when you're talking about an EMS organization.
We're very quick to measure EMS systems by their save rate on out-of-hospital cardiac arrests. But these calls usually amount to less than half of 1% of all calls in the EMS system. The other major way we measure EMS systems is by their response times. The theory is that if we get our crews to the scene in the allotted time or less, we're good.
These are things that can be measured. But what about things we don't traditionally measure in our systems?
Take the Test
Do you know what direction your organization is headed? Do your crews lie to cover things up or falsify patient documentation because the truth would result in punishment? Do employees in your organization criticize and backstab others without mercy? Does management have difficulty communicating or connecting with employees? Do you do everything you can to stay loyal to the organization but get nothing in return?
If you answered "yes" to several of these questions, your organization may be dysfunctional, regardless of how many patients you've saved or how fast your vehicles get to the scene. A dysfunctional agency is prone to distrust of the administration by the employees, distrust of the employees by the administration and distrust between employees themselves.
One sign of a dysfunctional EMS organization is a high rate of employee turnover. To measure your turnover, take the total number of employees who left your agency in one year, divide that by the total number of employees authorized in your budget, and multiply by 100. The resulting number is your turnover percentage. Anything above 15-20% is not a good thing. In fact, it should worry you.
Of course, employees leave for various reasons, including retirement, termination, or leaving for another department or job with better pay or benefits. But if most of the turnover is caused by unhappiness among your people, that's really not a good thing.
What about a high absentee rate in the organization? Do you have an employee who takes a sick day as soon as they accrue enough hours of sick leave? One or two employees who are constantly absent might not be a problem in a large organization, but when a high percentage consistently find some excuse not to come in to work, that's also not a good thing and may point to a dysfunctional EMS organization.
Another sign of agency distress is the number of citizen complaints the department receives. Many complaints likely means a large number of employees are unhappy and their unhappiness is negatively influencing how they interact with patients and the public. Generally, people will call in complaints about the attitudes of the EMTs and paramedics who cared for them, not about their medical skills. Our patients don't usually call to complain because we didn't put them on oxygen or failed to take an ECG reading. They complain if they weren't treated with compassion and professionalism.
This issue leads to a key sign of a dysfunctional organization, which you might be exhibiting yourself -- a top manager who never accepts responsibility when something goes wrong, but instead points a finger at a subordinate. Ironically, these same managers are quick to take the credit when something goes right.
Get Out There
Changing a dysfunctional organization into a more productive and efficient one takes time. You can't expect things to change overnight, but you can make an impact by starting the process to make things better. We need to be out there where the rubber meets the road and constantly talk to our employees to determine their problems. Communication is necessary to ensure your employees are happy, which will help get your organization headed in the right direction. And remember that after you learn what motivates and demotivates them, you can empower them to make decisions or take ownership of a project, instilling in them more organizational commitment.
The first step in changing any dysfunctional organization is admitting that it's dysfunctional. Are you brave enough to take that first step and begin steering your ship in the right direction?