Name 10 people who have won Nobel or Pulitzer Prizes.
Name the last decade's worth of World Series winners.
How did you do? Probably pretty poorly. None of us remember the headliners of yesterday. They were the best in their fields, but applause dies, awards tarnish, and accolades are buried with their owners.
Now let's try again:
List a few teachers who aided your journey through school.
Name three friends who helped you through difficult times.
Name five people who taught you something worthwhile.
Think of a few people who made you feel appreciated and special.
Think of five people you enjoy spending time with.
The take-away from this little exercise was best summarized by cartoonist Charles Schulz: "The people who make a difference in your life are not the ones with the most credentials, the most money or the most awards. They are the ones who care!"
The Human Resource
How do you acclimate a new paramedic or EMT to your service? Your organization may subscribe to tried but often-unsuccessful methods that breed bad habits. Testing new employees' sanity by partnering them with seasoned (and often burned-out) veterans has been a process many managers have tried with undesirable results. Having no set objectives or goals in mind for new employees' formative years will likely leave you with a mediocre caregiver at best.
In the past, new employees with my department, the Memphis Fire Department, spent 20 weeks at the academy studying aspects of firefighting and learning the department's SOPs and EMS protocols. Our efforts were misguided, focusing on reteaching them to be paramedics and not paying attention to their acclimation to our system or their own success. New employees were left to succeed or fail in their careers based in part on whom they drew for partners. Those randomly selected partners completed evaluations, but they counted for little.
A more proactive approach to service delivery, coupled with a management philosophy that human resources are an organization's most valuable asset, led to changes in our department. We embraced some simple concepts: For a strong mentoring program, leadership and quality improvement goals must be developed and put into place. Goals should be developed by the end users--the employees--and facilitated by top leadership. Improvement measures should include strong EMS supervision, education and quality improvement. With these in place, we realized, an improved mentoring program would follow. Our challenge was to develop a program that would equip new employees with the tools needed to function competently and professionally.
A primary goal in the mentoring process should be to enable procedures that allow for proper sharing, retention and evaluation of information. Time should also be an objective. One of our focuses was to place competent paramedics in the field in a timely manner. Our old process--placing each new paramedic with another medic for one year as a second crew person--was not effective because it did not create a one-on-one learning environment. A paramedic who's driving has a hard time mentoring someone rendering care in the back.
A New Approach
EMS education should focus on enhancing providers' capabilities, rather than repetitive drilling on skills learned in school. Those skills should be evaluated early in the process, and employees terminated if they do not perform to standards. The goal is to retain quality paramedics and deliver the best care available. This may lead to losing large numbers of applicants, but the goal is to have leaders and exceptional patient care—not just warm bodies. With a streamlined, enhanced EMS educational track, recruits now complete the academic portion of their training at the Memphis Fire Department Training Academy in less than half the time as before.
A new EMS mentoring program must be coupled with the proper selection of employees who share the attributes you want to impart to newcomers. One of the most successful elements of the Memphis program has been the affective domain matching of new employees with compatible mentors to accentuate both paramedics' attributes. After their classroom experience, new medics are paired with mentors who have been carefully selected through an interview and education process. New employees are paired with their mentors for 30 shift days (24-hour shifts) to complete the EMS component of their training.
Under the Memphis model, paramedic recruits mirror their mentors--i.e., if the mentor is on the ambulance, the recruit rides as a third on the ambulance. If the mentor is on the ALS fire company, the recruit rides as a fifth. If staffing requires the mentor to be detailed to another ALS resource, the recruit goes with them. If a mentor is off sick or not at work, their recruit is detailed to an alternate who's also been vetted through the mentoring selection process. This ensures the one-on-one aspect--a major missing link before.
The purpose of this program is to teach new employees how to operate independently within our system. A minimum of three hours of active instruction takes place between mentors and employees each day during the process. Recruits and their mentors must complete daily tasks outlined in a manual created to reflect important daily EMS functions.
Another successful tool has been using a behaviorally anchored rating scale (BARS) system. BARS is a performance appraisal method that blends aspects of the traditional rating scale and critical incident methods (see sidebar). Mentors distill their proteges' job behaviors, effective and ineffective, from critical incidents and describe them objectively in writing. A scale depicts various performance levels that are described in terms of an employee's job behaviors.
At or near the completion of the 30-day evaluation, new employees are scheduled to report to the training academy for oral examinations to test their comprehension of the recruit training manual, SOPs and other materials. They are evaluated by EMS chiefs and our medical director. If a recruit's performance is judged good enough to advance, they are assigned to an ALS fire company and can begin training on that equipment.
Good Things Found in BARS
Behaviorally anchored rating scales (BARS) combine critical incident and rating scale methods to judge employee performance. Employees are evaluated on a scale with points anchored to critical incidents. This lets their performance be assessed in terms of specific behaviors essential to their position, rather than on general traits or concepts. As well, it reduces subjectivity and potential bias.
Developing a BARS for any position may take 2-3 months and involve mutiple subject matter experts in defining critical incidents. Critical incidents represent extreme behavior, good or bad. The experts rate identified incidents on a numerical scale, generally from 4-9 points.
I've been fortunate to have had great mentors in my EMS journey. I cherish their leadership as well as their friendship, and still call on them today for advice and guidance. Here are some tips they've imparted along the way.
Take the good and bad from every leader you've had--learn from their mistakes and successes.
Watch your actions and what you say. It's what you say and how you say it--everyone is watching you.
Remember, there is no such thing as a private conversation.
Never write a nasty memo or letter--it's forever.
Tell the truth. Falsehoods last longer than the truth.
Nobody ever learned anything by talking. Be an active listener and keep an open mind.
Let your people know every day what they did well.
Compromise. Know the definition, and use it.
Don't be afraid to ask someone you respect for advice.
No good deed goes unpunished. Someone will always object--get over it!
The word can't should not be in your vocabulary--find a way you can.
Try very hard not to take things personally.
Don't rush to judgment--have all the facts before you act.
If it doesn't feel right, don't do it.
Learn the differences between decision-making time, critical time, sensitive time and discretionary time.
Everyone makes mistakes--learn from them.
Take 100% responsibility for your actions.
Praise in public, discipline in private.
Shoot from the heart, not the hip.
Be yourself--no puff.
Paramedics hired and trained this way, according to Lt. Pamela Kiestler, the department's field training officer and mentoring coordinator, emerge trained more consistently and thoroughly than any previous class. We think this helps increase morale and protocol compliance, and decrease burnout, turnover and lawsuits.
The department will adapt the program to create similar leadership and mentoring programs for EMTs and fire suppression. "We're consistently trying to raise the bar of performance," says Kiestler, "and believe that such programs across the board will help to achieve this goal."
EMS systems in half a dozen other states, along with cities in Germany and the United Kingdom, have adapted the Memphis EMS mentoring program to their services. They realized, like we did, that it's folly to do the same things over and over and expect different results.
What type of product are you delivering to the public? Does your system's approach to its most valuable asset--its people--need an overhaul? Remember, the only difference between a rut and a grave is its dimensions, and your service is only as good as the people you put on the streets.
To learn more about the Memphis Fire EMS mentoring program, contact Kiestler at 901/826-5377.
A 24-year veteran of fire-based EMS, J. Harold "Jim" Logan, BPS, EMT-P/IC, is a lieutenant firefighter/paramedic for the Memphis Fire Department. Contact him at firstname.lastname@example.org.