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A Schedule Staff Can Live With

Recruiting, screening and training employees is a costly venture. A study on the cost of turnover in EMS, published this past year in Prehospital Emergency Care, found that the weighted median cost of turnover was more than $71,000 per employee.(1) Therefore, retaining employees—particularly top performers—should be an organizational priority.

Work/life imbalance is often cited as a reason good employees decide to call it quits. Traditional rotating EMS shift schedules make it difficult for employees, especially students or those with young families, to achieve a satisfying work-life balance. Rotating shifts wreak havoc on the body, disturbing sleep rhythms and imposing irregular eating habits. Rotating schedules also make it difficult for employees to attend college courses, work around spouses’ schedules, arrange childcare, participate in such social activities as sports leagues, or meet any obligations requiring set days each week.

Years ago, Timothy Earles, a paramedic with Wake County (N.C.) EMS, noticed the high rate of turnover across multiple systems; the single most predicable factor was the schedules being worked. “Either you’re working 24 hours or rotating days and it doesn’t go along with the rest of society, or you’re trying to raise kids or go to college.” He decided there had to be a better way to schedule staff. “The goal was to figure out how to design this around the most popular lifestyles and needs in EMS but also make it more cost effective to use than others.”

In his experience, a mix of 12- and 24-hour units tends to be the most cost-effective and efficient way to provide coverage 24 hours a day, seven days a week, across a service area with varying degrees of demand corresponding to location or time of day.

After a lot of number crunching, Earles developed an unconventional schedule that uses a combination of 12 and 24-hour shifts scheduled the same days each week. (See sample schedule.) His “51s” schedule results in fewer hours or fewer days worked than traditional EMS schedules. Also, resources are distributed more efficiently to meet system demands.

Employees choose their shifts according to:

  • The pattern of set days worked every week of each option;
  • The overall number of shifts worked;
  • The number of days off in between shifts; and
  • The preference for 12- or 24-hour shifts.

    Employees are then “assigned to two units that have been matched inversely to assure even distribution of workload throughout the system for each employee,” he says. For instance, the higher the call volume of the 12-hour unit worked, the lower the call volume of the 24-hour shift worked for each schedule choice—or vice versa. Reducing inequities in individual workload and contribution of time boosts staff morale.

“There are five combinations, and two of the combinations result in 40% of the workforce having long weekends off every week. Some work just the weekend, and others can attend college without their work schedule interfering—anything you want to do, because it’s all set days, the same days each week just like the rest of the world. That’s the biggest draw.”

Other benefits
Beyond boosting job satisfaction and reducing turnover, the 51s schedule can cut staffing costs in the vast majority of cases, Earles says. For example, his schedule takes only five people to run each truck for a typical 24-hour shift, compared with the six people—three shifts of two—required for a typical 24-hour shift. If the system runs 12-hour shifts, it takes eight employees total—four each day for two shifts. “And it’s the same thing with 24/72 schedules,” he says. 

Eliminating rotating days by requiring the same days worked each week can accommodate multiple lifestyles, Earles says. The 51s schedule has proven popular with employees because it reduces each one’s number of shifts, decreasing individual workload, fatigue and overnight assignments, he says.

“The use of less benefit time that was previously necessary to take long expanses of time off also results in savings for the system when less overtime is paid to cover these shifts, and even more when combined with a benefit-time buy-back program in which staff are paid for the time they didn’t have to use to take a vacation, or attend school or be home with their children,” he says.

Earles noted that it’s not necessary to implement the 51s schedule across the board. Flexibility is key to finding the right combination to meet the system’s needs and accommodate staff preferences. “There can be staff who have managed to construct their lifestyle around the limitations of their existing schedule, for which a change might lead them to no other option than leaving. Some fine-tuning will probably be necessary to find the right balance, and 51s can provide that too.”

The limitations
Any staffing model, including 51s, has its limitations. For instance, because of the pattern of days worked on each schedule, it isn’t recommended that the peak load units assigned to the day shift be scheduled past 10 p.m. This is to ensure adequate time is allowed for rest on those few occasions when staff may be assigned to work the next day. This was intentionally designed into 51s, Earles says, and since many systems experience a drop in call volume by this time in the evening, it’s not frequently an issue.

Earles also cautions against changing salaries to reflect a decrease in the number of hours worked, as is the case when converting from a schedule averaging 56 hours a week, like the traditional 24-hour ABC schedule. “The idea here is to do what we can to keep people in our field and attract others to it,” he says. “Once the savings in attrition is realized, combined with the reduction in costs of recruiting, added to the literally millions saved in many cases when further hiring over the next several years can be avoided if need be, there really becomes no reason to consider reductions in pay.”

Many systems that have explored the switch to a 51s schedule have done so quietly, because crews are naturally suspicious of any scheduling changes. “There often is the initial hesitation and rejection that come wiht any change until more is learned adn realized about its replacement,” he says.

Little more than a year after writing an article on this “Smarter Schedule,” Earles says 34 agencies in three countries have inquired and either implemented or evaluated a transition—some saving millions of dollars. As a service to the industry, he offers free consultations with agencies and will develop a 51s schedule at no cost. The payback, he says, is seeing the EMS community retain employees and weather the economic downturn without cutting staff or reducing unit hours.

Timothy Earles, EMT-P, a paramedic with Wake County EMS based in Raleigh, N.C., evaluates staffing needs and advises on how a 51s schedule can apply at no charge. For more information, visit www.lifestyleschedules.com. E-mail him at tearlesnc@yahoo.com.

1. Patterson PD, Jones CB, Hubble MW, et al. The longitudinal study of turnover and the cost of turnover in emergency medical services. Prehosp Emerg Care. 14(2):209–221, 2010.


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