Administration and Leadership, Equipment & Gear

Operant Conditioning EMS Management Style Proves Ineffective

Issue 12 and Volume 36.

During a recent casual conversation with another EMS manager, he spoke of how he “straightened his employees out.” He was rather proud of his accomplishment and felt as though he’d stumbled on the latest and greatest method of managing employees.

He told me about an incident whereby the staff from the percutaneous coronary intervention (PCI) center in his service area complained they weren’t notified ahead of time by his EMS crews when the crew identified STEMIs in the field. Instead, the first notice the hospital usually had of a STEMI was when the crew was hitting the door of the emergency department.

So this EMS manager reported to me that he then set out on a mission to “straighten his employees out” and ensure they electronically transmitted ECGs with any suspected STEMIs to the hospital prior to their arrival.

His method of “straightening his employees out” included giving a 10-day suspension at random to two paramedics who failed to electronically transmit a potential STEMI to the hospital. This was done randomly and without any methodology. He simply went back and found crews that hadn’t transmitted an ECG to the hospital.

Although many paramedics fell into this category, the manager randomly and subjectively picked two paramedics to suspend. His strategy was to have word quickly spread among the rest of the paramedics of the heavy-handed discipline, so the rest would fall in line.

As he told me the story, I couldn’t help but think of the horrible strategy used by the German army in World War II to occasionally execute every 10th prisoner to get other prisoners to confess or fall into line.

My EMS colleague’s methodology wasn’t as extreme, but it points out that random selection and excessive discipline is wrong at all levels.

Operant Conditioning
The psychology experts call this operant conditioning. Operant conditioning is a learning process that involves an increase or decrease in the likelihood of some behavior as a result of the consequences. Although it may lead to a learning process among the masses that changes behavior, it most often deteriorates morale.

I asked the EMS manager whether he ever considered that the problem could be a system-wide problem because it didn’t seem possible that so many employees were so unwilling to transmit an ECG to the hospital. He said that people had complained that they had trouble connecting the monitor/defibrillator to their cellular service, but that wasn’t an excuse he was willing to hear. He interpreted their lack of sending ECGs to the PCI center as being lazy—a problem that needed to be “straightened out.”

As we discussed the problem further, it was obvious there was a technological problem. His employees were, in fact, willing to transmit suspected STEMIs to the hospital, but it was cumbersome to get the technology to work, and many of the paramedics chose to transport to the hospital instead of wasting time. They then alerted the hospital about the STEMI when they arrived.

Lessons Learned
We can learn two lessons in this scenario.

First, it isn’t wise to think you can manage employees by making examples out of employees and expecting that the rest will perform exemplary. Sure, you might achieve your goal of getting everyone to transmit ECGs to the hospital, but they’ll do it out of fear and intimidation. And that is all they’ll do. They won’t step further outside the box if the patient’s situation requires for fear of being punished.

The second lesson is that sometimes employees aren’t unwilling to do the job; they’re unable. The first thing my colleague should have realized was that the problem was widespread. This should have caused him to realize he had a system problem. Often, if you fix the system, you can fix the problem. Fixing the employee instead of the system isn’t a prudent means of problem solving.

If you’re an EMS manager, don’t ever use your employees as an example to help you manage your system. You may achieve your immediate goal, but morale will suffer. Those who were punished will resent your actions, and you will diminish enthusiasm the employees have for doing their job.

A better way to manage your EMS system is to identify system problems, fix those problems and then monitor the results of your changes to identify additional tweaks that are necessary. I believe you’ll find more success as an EMS manager with this strategy. JEMS

This article originally appeared in December 2011 JEMS as “At Random: Be careful how you single out your employees.”