Dealing With Low Performers in EMS

In EMS, we are trained to deal with every conceivable emergency, from the choking infant to the dementia-riddled geriatric patient. EMS management, however, can seem far more frightening to some than the calls we respond to. Dealing with chronic low-performers can be one of the most daunting tasks in any management team's purview. But, if executed well, a simple, straightforward method based on best practices in healthcare can transform any organization.

The first step is identifying the low-performers, which can be done by myriad objective criteria: who consistently calls out, has low patient satisfaction records or complaints against them, number of reprimands in their file, number of occurrences (if in a union environment), etc. Or the non-objective criteria: Who do your employees hate to work with? Who do they always complain about for seemingly insignificant issues that aren't termination worthy? Who consistently has a bad attitude? Which names do your family members or significant others know by heart because you constantly talk about them? These are the people who need to be coached in the right direction or shown the way to the unemployment line.

At this point, it is essential to note that documentation is key. Just like PCRs, HR records and personnel files are the objective defense if or when employees try to take action against your organization. You must document effectively every time you reprimand or even give verbal warnings to employees.

Assuming these are not egregious problems, like violence in the work place, blatant and perverse sexual harassment, or any other instantaneous termination-worthy offense, most organizations have a four-step model for non-represented employees: 1) The free pass: "Don't do that again;" 2) official verbal warning; 3) official written warning; 4) termination if the problem persists.

So how can an employer get rid of the low-performer? When meeting with the difficult employee, it's important to be brief, straightforward and blunt. Following the axiom "praise in public, but reprimand in private," ask the employee to meet with you in the office (it is perfectly acceptable to have another person there if you need one, especially in cases dealing with opposite sexes). Do not start with a compliment, since the point of this discussion is to make the low-performer feel uncomfortable, but do not insult him either. Here's a Studer Group tool called the DESK approach, which I learned while working for the organization:

Describe what has been observed--observed being the key word. Point out one thing that needs immediate action and focus on that single thing. For example: "Steve, I noticed you failed to clean the stretcher with bleach solution again."

Evaluate how you feel: "Steve, I'm disappointed that you've done this again after I mentioned it to you last week."

Show what needs to be done. Do the chore, showing him exactly what you want done and how, and what you are looking for in the future. "Steve, this is what I expect and how I expect you to clean the stretcher after every call. We do this to protect ourselves and our patients."

Know the consequences of continued same performance. "Steve, you need to know the consequences. This is a verbal warning. If it continues, you'll get a written warning, and if it happens again, you'll be terminated."

Most important is documenting that this coaching session occurred. As a manager, you must document the fact that you gave the employee a verbal warning on what date and time. Next is the actual follow-through with accountability. If the problem persists, follow the consequences all the way through termination.

Do not allow yourself to be side-tracked. Low performers have an uncanny ability to elicit pity or sympathy, or to misdirect. You need to realize that you're being side-tracked and bring it back into focus by saying, "Yes, I understand your issue, but we're discussing your behavior right now."

This is an easy, effective and consistent way to deal with your organization's poor performers. It is essential to get rid of the anchors who drag down your system for many reasons. By eliminating those who do not do their jobs well, you will increase employee satisfaction among your top performers and motivate middle performers to do better. Some employers believe that even a poor performer is better than none, and that is 100% wrong! By keeping the low performer and rewarding him with a paycheck, you are essentially letting him lower your standards. By getting rid of the poor performer, your star employees will feel rewarded for the work they do and will take pride in working for your service.

In EMS, we treat, transport and care for the most critically ill and injured people. As cliché as it sounds, lives are on the line when we respond. Do you want a low performer representing your organization on scene, or would you rather have star performers you know you can depend on to give quality care every time they are called?

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 currently works as a paramedic crew chief with Lexington County EMS in Lexington, SC. Contact him at