Smart Leaders Address the System

Recently, a large EMS organization disciplined almost 50 employees for issues surrounding documentation of electronic patient care reports (ePCRs). This equated to about 10% of the organization’s providers. Not only did the management team penalize the care providers who wrote the reports, but the care providers’ supervisors as well.

Here’s the problem with this disciplinary approach: they failed to address basic leadership issues. If 10% of the EMS workforce needs to be disciplined, perhaps the problem is the system itself. It’s naà¯ve for EMS managers to address problems by fixing the employee instead of the system.

There’s something wrong with the leader who sees the employee as the problem and not the solution. Instead, managers should look at how they can work with their employees instead of how they can fix their employees. Disciplining your way to a solution is a prescription for killing morale and can lead to employee dissatisfaction, poor work performance and attendance issues.

Find the Cause, Not the Problem
I encountered a similar situation when I was employed by the Memphis (Tenn.) Fire Department in 2005. Some hospitals in Memphis were complaining paramedics weren’t leaving a paper PCR after bringing in a patient. As it turns out, Memphis paramedics were only leaving one about 30% of the time. When I spoke with a battalion chief in our EMS division about the problem, he recommended giving the guilty employees a 10-day suspension to send a message to all the other employees.

I then asked the paramedics why they didn’t leave a PCR at the hospital. I consistently heard that it was too difficult because they had to make a copy of the report in order to leave it. They said sometimes the copier at the hospital was broken, being used by someone else, needed a code, was out of paper or used the wrong format. I asked about tearing off a duplicate sheet to leave but was told there was no tear-off copy.

The simple fix was to print blank PCRs with a duplicate sheet that could be torn off and left with the patient at the hospital, and after we implemented this, compliance went up to almost 100%. Of course, the long-term goal was to get away from paper and move to an electronic format–which Memphis eventually did.

Instead of trying to fix the employee, smart EMS leaders identify and manage problems through quality planning, control, assurance and improvement. One improvement strategy is called Six Sigma. The goals are to improve quality and eliminate anything that may cause errors or mistakes.

You don’t have to be a Black Belt in Six Sigma to fix your EMS system; you can still examine a process and analyze each step to determine where errors and defects are occurring. When you discover where the breaks in the chain are occurring, you can place fixes to minimize reoccurrences. This addresses the core problem.

Some argue there’s no room for error in EMS. They use the analogy, “What would happen if this was an airline?” What they don’t realize is airlines continually work on reducing errors. They’ve put systems in place to prevent errors either through redundancy, crew resource management or other quality improvement processes. If EMS followed this approach, errors would be significantly reduced as well. You can’t compare the two until EMS follows the same extensive process to reduce errors.

EMS managers who use discipline as a method for fixing problems are unable to lead. Excellent leadership requires addressing system-wide problems by determining and fixing processes causing the errors. When you attempt to solve a system-wide problem by fixing the employee, you risk other areas falling into mismanagement.


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