Are Your Employees Looking to Leave?

Employees rarely leave their profession. Instead, they leave their bosses. Even in the worst job market in recent history, if employees don't feel engaged and satisfied, they will leave. The worst part is, your highest performers head for the door first.

One of the most important ways to keep employees engaged is to have them know, understand and commit to a specific set of standards. To accomplish this most effectively, have employees themselves draft standards they believe to be most important. Administration can guide the discussion and be part of the process, but the employees must be the ones who organically develop them.

The next step is to hold an in-service where all employees can read and sign a copy of the new standards they created. This accomplishes two things. First, employees know exactly how they should act. Second, it encourages complete accountability if someone doesn't follow the standards.

Once the standards are in place, ensure the organization measures what is important. Objective standards are more effective--e.g., number of sick days used, IV and intubation success rates, etc. If your service measures patient satisfaction, ensure that every employee is held accountable for that score by putting it into the evaluation and weighting it appropriately. Subjective measures are important, but they must be defended with accurate documentation. It is also essential that administration sign the document and be held to the same standards and evaluations as employees.

Reward a Job Well Done

Define employee culture objectively using a survey tool. I recommend the Gallup Q12. In my experience, it is one of the best out there. Take the survey annually and follow up with action plans to improve areas where the organization scored less than desired.

Reward and recognition are important in any organization, but they are supremely important in EMS. Here's why: We are trained to recognize the negative, find the problem and fix it. It's how we keep patients alive. However, this approach focuses on the constant identification of what employees do wrong. This is important for deviation from policy or scopes of practice, but when was the last time your employees were recognized for doing something well? What gets rewarded and recognized gets repeated.

Find out how your employees like to be recognized, then use that strategy. Some prefer to be praised in private, while others like to be put on a pillar and celebrated. Finding out what each employee prefers shows your employees you're paying attention to them and you gain some credit in the emotional bank to use when things aren't going as well.

One of the best reward and recognition tools available is handwritten "thank you" notes. They are short, simple, specific and inexpensive. The impact of "thank you" notes is one of the greatest motivators in employee satisfaction. To use them most effectively, someone higher in the chain of command than the employee must hand-write them. Be specific to the one behavior or action they did. Don't include a long diatribe or vague language that thanks them just for working at your organization. Finally, mail them to the employees' homes so they can celebrate in private, or show their family or significant others the impact they make at work.

Harvest Success with Rounding for Outcomes

EMS leaders can also gauge their organization, deal with issues before they become problems, and communicate in a way that conveys their appreciation for great performers with a tool taught by the Studer Group called Rounding for Outcomes.

Many managers and leaders may say, "I don't have time for this." Or they may deny there are any problems at all by saying, "I already know my people and what they want." Maybe you do. Perhaps when you ask how things are going, people say "fine." But how hard do you drill down to ensure they are doing more than just paying lip service? Rounding allows managers to go beyond the superficial and really figure out how employees feel, what the issues are, and most important, harvest success.

Rounding is a great tool. But it is useless if managers don't have a strong relationship with their employees. This doesn't mean you hang out on your off days, have each other's numbers on speed dial or go on vacations together. It simply means two people can have a meaningful exchange based on mutual trust. The great part is there is accountability on both sides.

Perform rounding exercises one-on-one, not en masse. Start with personal questions like, "How did your son's ball game go?" Establish a base so employees realize you care about their lives outside of the EMS world. Look for and focus on the positive.

Start the conversation by asking, "Erin, what's working well today?" It sounds a little funny, may be uncomfortable, and will most likely garner some rolled eyes from paramedics, but it's fundamental. You want your employees to think positively, and it allows you to harvest wins. When was the last time motor pool got a message that said, "Hey, guys, thanks for changing the oil in Medic12. She's running much better now."? I'm pretty sure the mechanics would be trying to spot the hidden cameras.

Ask the Right Questions

The next set of questions continues the harvest of positive wins and identifies potential problems.

Ask if there are any individuals whom you should recognize. This is important so people listed get a note from the manager saying, "Chris mentioned you did a great job on that arrest..."

Include any fire, police, etc. (ancillary personnel). Again, it is important to communicate with different agencies your system works with. Cops and firefighters like to be told they're doing a good job, too!

Ask if there is anything that could be done better. This helps find issues before they become problems. It allows managers to explain policies, identify possible shortcomings or recognize a practice that might benefit the service.

Ensure you have the tools and equipment to do your job. This means more than a stretcher and ambulance. This will give you firsthand knowledge of any minor irritations that might be bothering your crews. It could be something simple like, "It's a pain to always have to borrow the clerk's stapler. Can we get one to put on the unit?" Simple things can make a world of difference to your employees.

It's amazing what you'll find out if you ask the right questions! These specific questions allow any leader to build a relationship with their staff, engage employees, and raise their satisfaction. The ability to communicate effectively and hold one another accountable, along with providing praise and recognition among the group, will create a workforce where people are happy to come to work and where they feel like they are part of an organization rather than just employees.

Patrick Pianezza, MHA, NREMT-P, is a consultant experienced with Studer, HCAPS, 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. Contact him at

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