A Call for Accountability

One difference between good organizations and great organizations is how they handle accountability. Good organizations allow poor behavior to occasionally slide, or are unclear on the discipline for certain actions. Within great organizations are plans that do not allow poor performance to go unnoticed. Accountability breaks down generational gaps, decreases litigation and increases employee engagement.

The most appropriate way to summarize this topic is, "What you permit, you promote." As a manager, if you are unsure of how to have conversations with your high, middle and low performers, I suggest reading one of my previous articles around the Studer Group's High, Middle and Low Performer Conversations (see related links below). As a leader, you must nip poor behavior in the bud. Adhering to your policies consistently is one of the best ways to defend your organization in the event someone tries to sue.

EMS is a specialized job and we think anyone who's certified is appropriate to fill the schedule. Absolutely not! Hire the best candidates; do not just have a cattle call for those who are qualified. People who threaten to leave, even in abstract language, need to understand that their comments can fall under the category of insubordination, especially if they are using the threat as leverage for their bad behavior. Once employees are hired, adhere to your standards of behavior consistently! This means having difficult conversations and eventually terminating those who misbehave. It means keeping accurate HR files and documenting all the occurrences accurately to keep them from fighting back. Turnover in and of itself is not a bad thing; however, inconsistencies in policy enforcement make attorneys drool.

Establish a standards committee, inviting members from all aspects of the organization, like logistics, BLS, ALS, critical care, flight (if applicable) administration, legal and HR. Do not include low performers. The one overarching theme of all committee candidates should be professionalism. That does not mean they must be the most senior people on the schedule. They will set the standard for what you expect from your employees. Allow the committee to come up with what they believe are absolute, non-negotiable standards of behavior. People will support what they help create.

Introducing New Standards to Staff

Next, allow the committee to introduce these new standards to the staff. This serves two purposes: First, because they own the process, they will hold each other accountable; and second, there can be no excuses for not adhering to the new policy because "It was something management forced us to do."

At the meeting where the new expected behavior policy is introduced, require all employees to date and sign the new policy, and tell them, "Today is a new day. From here forward we all agree and expect to follow this document."

Typically, within the first two weeks, someone will decide to not follow your new standard, just to test the waters. He must receive the first part of progressive discipline to show that this is something your organization is taking seriously. Leadership should invite the offender to a meeting, where he is given an official verbal warning or sent home without pay. If you fail to take this step, you undermine all of the committee's work, and it will become just another "project" that management took on.

Accountability is not easy, it's not comfortable, and it's not a natural process for those of us in healthcare. On average, we don't like to be the "bad guy." We are drawn to EMS because we want to help people. However, if you fail to demand accountability, you are allowing poor behaviors, which will most likely deteriorate into dangerous and risky behaviors. Taking control and keeping everyone on a level playing field is imperative to reducing litigation, staffing issues and favoritism. You can be friendly with your staff, but you must have the ability to hold them accountable and have difficult conversations when the need arises.

Patrick Pianezza, MHA, NREMT-P, is a consultant experienced with Studer, HCAHPS, Gallup and Press Ganey principles. Along with nearly a decade of experience in the prehospital arena, he has worked for Johns Hopkins Hospital and Studer Group. He is currently the manager of service excellence for San Joaquin Community Hospital in Bakersfield, CA. E-mail ppianezza@gmail.com.