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When my kids were little, one of our favorite things was to go to Chuck E. Cheese’s, where they could burn up some energy eating pizza, playing arcade games and running around on the playthings.
One of the arcade games was called “Whack-a-Mole.” Out of five holes, a mole pops up at random, and you “whack” it in the head using a soft hammer to knock it back down. If you don’t hit it fast or hard enough, it disappears back down its hole. The more you hit and the faster you hit them, the higher your score.
This classic arcade game spurred a book on a managerial style that I find is reminiscent of how some EMS organizations manage their employees. It seems some managers think they’re playing Whack-a-Mole. They discipline employees on a routine basis and without regard for the circumstances, knocking the employees in the head as fast and as hard as they can.
In these types of EMS organizations, you’re disciplined any time a complaint is received from a nurse, physician, citizen, patient or bystander. It doesn’t matter who complains, and the circumstances of the complaint aren’t investigated. The bottom line is that management feels the employee must have done something wrong. Basically, they only follow one fundamental principle: “the customer is always right.”
The resulting morale and turnover in these EMS organizations is deplorable. Nobody goes out of their way to deliver exceptional service. They instead go about their jobs in pure fear of doing something wrong and receiving a complaint.
I contend that employees do things wrong for three reasons: They’re unaware, unable or unwilling. Many EMS managers discipline employees for all three reasons. Instead, we should be looking at the circumstances by which the infraction happened. If an employee is unaware of a policy or procedure, this is an opportunity to mentor rather than discipline. Wouldn’t the employee prefer to receive coaching rather than be whacked in the head like a mole?
Sometimes the problem occurs because of a systemic problem. For example, consider a service that keeps disciplining employees for hitting the door frame on either side when they back an ambulance into the station. This keeps happening over and over. An EMS manager should question why an employee would intentionally back an ambulance into the door frame of an ambulance station. They might come to the conclusion that the mistake isn’t intentional and perhaps suggest a policy where spotters have to be in place any time an ambulance backed into the station. I bet accidents involving ambulances backing into a door frame would drop dramatically. You could even go one step further and add back-up cameras and an alarm system to further assist the drivers.
In the above scenario, a systemic problem existed because the employees were unable to do their job without a tool they needed (a spotter or a camera and alarm system). A change to the policy and procedure supported by additional technology drastically reduced the number of accidents. Why do we think changing people through disciplinary action is an effective solution to a problem, especially when changing the system will ensure the problem will go away?
One management philosophy emerging in the healthcare industry, which is supported by the National Association of Emergency Medical Technicians (NAEMT), is “just culture.”¹ In a just culture—a concept invented by “Whack-a-Mole” author David Marx—the goal is to look at an error and classify the action into one of three categories: human error, at-risk behavior or reckless behavior. The need for and extent of any punishment is based on this classification.
Once the error is assessed and classified, the just culture concept suggests a course of action. Managing human errors is done by looking at processes, procedures, training and design. People who make at-risk decisions are usually managed by coaching and increasing situational awareness. It’s only those employees who demonstrate reckless behavior that just culture recommends that managers discipline.
Developing a just culture and taking this new approach to managing mistakes in your organization is a large-scale change. But the Whack-a-Mole mentality certainly has demonstrated it doesn’t work and can actually cause harm to an organization.
1. National Association of EMTs. (July 19, 2012). NAEMT Board Adopts New Position Statement on ‘Just Culture’ System. In JEMS. Retrieved Nov. 5, 2012, from www.jems.com/article/news/naemt-board-adopts-new-position-statemen.