It’s a typical board of directors meeting at the North Boro Volunteer Ambulance Corps, and it seems the same questions keep coming up about the agency’s future. There is discussion about its strengths and weaknesses and opportunities, yet no one seems able to speak knowledgeably about these areas. You think to yourself, What’s wrong with this place, and can we do anything about it? You feel as though everyone else on the board is paying attention to the here and now and not focusing on larger issues that may occur in the future. You mention the possibility of developing a strategic plan to help guide the organization, and your suggestion is met with blank stares and a comment of, “What do we need that for?”
What Did You Sign Up For?
In volunteer EMS organizations, people with regular lives and full-time careers spend countless hours providing services for their communities. These dedicated professionals are responsible for the most intricate parts of running organizations, and most did not have these intricacies in mind when they joined. Their thoughts were on answering emergency calls.
The number of emergent and nonemergent calls answered by EMS rises every year. This increases administrative responsibilities. The majority of EMS organizations are run by volunteers who, due to the nature of their positions and the overall need, have the potential to become more wrapped up in administration than patient care. Whether volunteer, career, not-for-profit, fire-based or third service, every EMS agency organization should, in its strategic planning process, continually reevaluate its standing, mission and vision. Volunteer EMS agencies face all the same stressors (operational and administrative) as career EMS agencies, but they do so without a paid staff to act as a support structure.
The ABCs of an Organization
Common required management tasks of EMS organizations can include finance and budgeting, strategic planning, human resources and training. If these functions don’t look familiar, they should. They are essential for running almost any business in America. For the most part, volunteer EMS entities fall into the pit of not viewing their organizations as businesses that incorporate the above tasks. But why should emergency services suffer by not having the benefits of straight-line communication, a well-researched strategic plan, or the advantage of earnings as a byproduct of appropriate budgeting and finance?
Proven quality improvement programs, such as ISO 9000 and Six Sigma, can be helpful to an organization that hopes to run more efficiently. However, before you spend a lot of money training individuals to implement these programs, there are more fundamental steps you can take.
Evaluate Your Organization
EMS providers are trained to examine patients’ signs and symptoms and determine the best treatment course. Evaluating your organization and determining its best treatment is not much different. There are three essential components to an organization that can be evaluated in a way similar to how we evaluate patients: staffing/personnel (airway), call volume (breathing) and organizational structure (circulation).
Adequate staffing provides the means to deliver patient care, much like an adequate airway allows for the delivery of oxygen and removal of carbon dioxide from the human body. Staffing can be paid or volunteer. When a combination of personnel is utilized, make it clear there is one standard expected of all personnel, much like there is only one way into and out of the lungs. Without proper staffing, your EMS organization cannot provide a pathway to deliver the care it intends.
A well-staffed organization that is unable to adequately manage its call volume or complete business for any number of reasons indicates a problem. Call volume is analogous to breathing in that it dictates the tempo of an organization. The inability to complete or manage work suggests something is wrong. There are only 168 hours in a week. That’s 14 12-hour shifts. Most small agencies have a call volume that requires one or two ambulances per shift; therefore a total staff of 20 people could manage the volume if each person dedicated 36 hours per week.