Administration and Leadership, Exclusives, Operations

Paramedic and EMT Staffing Crisis Prompts New Organizational Disciplines

Above photo: National Highway Traffic Safety Administration

Many EMS organizations have spent the last few years trying to establish themselves as a go-to-culture for experienced and newly minted paramedics. EMS policy makers and managers are under no illusions about the issue of turnover and the yawning staffing gap that can suffocate an organization.

A major reason for EMS employee turnover is salary. However, the findings of the 2019 annual EMS Employee Retention survey (conducted by the American Ambulance Association and Avesta) suggest the need for more creative human resource approaches and strategies that enhance employee engagement. As well, there are implications that improved management training may also impact EMS employee turnover.

The survey collected responses from 54 public/private EMS agencies with more than 15,000 employees. The survey compares turnover rates from the previous year, including direct replacement cost for full- and part-time EMTs and paramedics. The survey also explores the reasons for year-over-year escalation of voluntary and involuntary EMS employee turnover.

When considering recruitment and retention strategies, most EMS agencies are on a reasonably level playing field; each has access to the same information, maintaining similar pay scales and benefits. Yet, some organizations defy norms simply by applying daily best practices to enhance company culture.

Turnover is increasingly expensive

The approximate costs for replacing EMT’s and paramedics do not factor in the staff time involved to recruit, hire and on-board new applicants. Nor does it factor in that during labor shortages or periods of low unemployment, organizations may lower their standards and rely upon a “warm body” approach to recruitment and hiring.

The 2019 survey contends that organizations with 100 employees must budget more than $200,000 per year just to replace employees who leave voluntarily or involuntarily. As it stands for most EMS employers with 100 employees, the entire workforce will have to be replaced within four years. For these employers, voluntary turnover occurs at rates as high as 38%. As well, 20% of those hired will walk off the job during the on-boarding or probationary period.

Let’s be blunt, turnover is strongly driven by competitive wages, but organizations that lack hiring and retention discipline will fall behind.

EMS employers may not always be able to affect turnover by offering the highest salary. However, it is possible to create a workplace culture that encourages the best employees to stay. This requires adopting a professional workforce development strategy that each member of the leadership team understands and has a stake in. As the EMS industry continues to battle a growing employee turnover challenge, there is also concern that some EMS organizations have not adapted the necessary internal controls to attract, recruit, on-board and retain quality EMS employees.

Here are some fundamental strategies to help reduce employee turnover and boost your EMT, paramedic and overall employee retention rate:

1. The entire management team must buy into recruitment, hiring, onboarding and retention

For the second consecutive year, the data indicates that the gap of unfilled jobs in EMS is growing rapidly.

“To combat the gap of unfilled jobs, EMS organizations must focus on advanced systems and disciplines for sourcing EMS talent,” said Scott A. Moore, Esq., of Moore EMS Consulting. This includes organizations establishing a culture guided by their ‘why,’ which must be beyond the intrinsically altruistic nature associated with a career in EMS. Further, this must be coupled with organizational investments in the most cutting-edge technological tools available to attract, engage, hire, onboard and retain EMS professionals.”

Maria Bianchi, Executive Director of The American Ambulance Association, agrees. “The AAA considers the national EMS staffing and retention as one of our top priorities. We’re looking to offer our association’s members turn-key solutions and useful tools that address our survey’s results.”

The entire management team must make hiring and retention a daily priority. This includes a commitment to hiring standards, reviewing the recruitment funnel, meeting with candidates, requiring continuous updates on the hiring process, especially during onboarding.

Time-to-hire and monthly turnover statistics should be key performance indicators. These statistics tell a story about your organization’s hiring practices, onboarding procedures, leadership and culture.

2. Have a consistent and measurable hiring and selection process

Behavior-based interviewing and online psychological assessments are techniques that have been used successfully in many industries for a number of years. This type of selection process helps EMS organizations screen and hire better candidates.

High turnover makes greater hiring scrutiny more imperative. EMS organizations that invest in and maintain a high-level system for carefully selecting employees should expect less turnover and higher employee job performance.

3. Focus on retaining employees who are engaged

Employee engagement is the degree of passionate commitment an employee demonstrates to the organization – this is a two-way street. A culture that demonstrates a meaningful valuing of people gets valued employee contributions in return. 

Alternatively, some are simply a bad fit. Actively disengaged employees undermine your organizational culture. Sometimes EMS organizations have a habit of accepting certain levels of bad behavior because they need to fill a seat. The truth is, many EMS workplaces experience bad employee behavior. Organizations that gain a reputation for consistently and fairly managing employee behavior can create an advantage in the war on turnover.

4. Employees don’t leave companies – they leave managers and supervisors

It is important to ensure that the leadership team is trained to properly support a modern EMS workforce. There are several ways that management and supervisory practices can affect employee turnover rates in EMS organizations. For example, based upon organizational studies and exit interviews completed by Avesta, many EMS employees who leave an organization have concerns with their supervisors or senior leadership team. Most often, EMS workers believe that that managers fail to keep promises that were made during the onboarding or hiring process. As well, EMS workers frequently believe that some supervisors do not administer organizational policies consistently and fairly. 

Supervisors who appear to consistently dismiss other people’s opinions, often push good employees to seek other opportunities. EMS organizations should consider using 360-degree feedback tools, or meaningful continuous performance reviews that allow subordinates to rate their managers. Modern human resource tools should also be used to select, promote, coach, and develop supervisors, managers and organizational leaders.

A strong strategy for reducing turnover is to ensure that your workforce feels appreciated. Although supervisors and managers are often pulled in multiple directions, it is critical to make every employee feel valued through recognition, honest feedback and ensuring consistent communications. 

5. Declare your culture

If you want a reputation as a professional, high-quality EMS provider; earn it. Set a no-tolerance policy for misconduct, unprofessionalism and bullying. Build employee accountability through transparent and multi-pronged communications (i.e., social media, website, newsletters, personal interaction). After all, you are paying your EMS professionals to decide if patients are in life-threatening conditions in about 60 seconds. Don’t be surprised if they can spot a disingenuous company claim or communication. News travels fast in EMS. Reward and recognize employees’ outstanding dedication and commitment to their career and everyone in your employ will experience a morale bump. Take a ride with your crews often and as a surprise. Ask engaging questions and truly listen and react without defensiveness to honest feedback.

And lastly…

EMS organizations that intentionally manage their cultures and human resource systems will always significantly outperform those that lack workforce development disciplines. Organizational culture drives conflict management, employee engagement and leadership character. Ultimately, your culture has a direct influence on your reputation and how long an employee remains with the organization.