High-Performance EMS: Building and Maintaining Stakeholder Relationships

High-Performance EMS: Building and Maintaining Stakeholder Relationships

This is the ninth installment a yearlong series of articles developed by the Academy of International Mobile Healthcare Integration (AIMHI) to help educate EMS agencies on the hallmarks and attributes of high-performance/high-value EMS system design and operation. For more on AIMHI, visit www.aimhi.mobi.

It’s a typical Monday morning. You’re reviewing EMS reports from the weekend when your phone rings—it’s the city manager. She asks you about a study she read over the weekend from the International City/County Management Association about the high cost of fire-based EMS. She’s wondering what your cost/revenue ratio is and whether the city should consider trying a different model of EMS. She requests a meeting to discuss it. 

Just as you are finishing your fourth cup of coffee, the CFO from your largest hospital customer calls and explains she had a meeting with Acme Ambulance last week, and they offered to provide the hospital with ambulance services for 50% less than your rates—she’d like to discuss that. And, just to cap off a great morning, you get an e-mail from the assignment editor of a local TV station. He was reviewing a story from one of their affiliates examining the high price of ambulance services; it noted that most ambulance bills have high balances, even after insurance pays their portion. He wants to do a story about your billing practices and whether you have network agreements with payers to minimize the impact on patients.

Happy Monday!

Relationships matter. High-value relationships matter a lot. Here are some strategies you can use to develop and maintain high-value relationships.

Internal Stakeholders

New Employees

• The employee onboarding process should be a big deal. Welcome signs, introductions to key personnel and leadership, personal interactions, a warm and friendly environment and effective use of time will help with the orientation process. 

Existing Employees

• Recognize their contributions! Supervisors and managers should regularly interact with existing staff and thank them for things they’ve noticed the employee does. This should be in front of peers. For exceptional deeds provide even more recognition at staff meetings or through electronic and social media. 

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• Get to know them. Go see them in their environments—stations, post locations or hospitals. Take the time to visit—just chat, no agenda or message. Learn about them as people, what they like to do when they’re not at work, their families and hobbies. Let them ask things about you as a leader and as a person. That builds a relationship. 

• Give them a say. Today’s workforce wants to have a voice in the workplace. Empowered work teams go a long way toward demonstrating you value employee input into decisions. Choices such as equipment purchases, ambulance design, policies, even what charities you support should help meet employees’ desire to influence their organization’s direction.

• Engage families. Family involvement is important to workers. Host events that include families to help build value. On employee anniversaries and other milestones, send letters to their families thanking them for sharing their family members with you and for their sacrifices of missed meals, family events and holidays.

External Stakeholders


• Know them. Meet regularly one-on-one with the C-suite members of your hospital partners. Learn their fears, desires and goals. It will give you insight into partnering with them more effectively.

• Understand their finances. The economic models for hospitals are changing constantly. Become knowledgeable about the changes either by subscribing to news listservs or (back to the previous strategy) meeting with hospital leaders to learn their issues and challenges. Knowing this will help you offer solutions that help hospital finances.

• Be a good partner. Participate in cardiovascular, stroke, trauma and sepsis committees. Your input is valuable, and they often need EMS participation for accreditation site surveys. Provide good on-time performance and conduct and distribute patient experience surveys to demonstrate that patients are satisfied with the service you provide and your personnel.


• Know them. Analyze your payments to identify the top 5–10 payers for your services and reach out. Meet them to review your service model and why the bills are what they are; collaborate on initiatives to help meet their goals.

• Share your patient experience scores. Payers want their insured members to have positive experiences with their providers, in or out of network. Giving them feedback on patient satisfaction with your service and personnel will help with value perception.

• Provide utilization data. Many payers’ data on their members’ healthcare use may be 3–6 months old. It is based on when providers submit bills. You could offer to provide data on their members’ EMS use on a more timely basis. You could also offer summary reports on types of patients, most common chief complaints or common patient destinations. 

Elected and Appointed Officials

• Know them (seeing a pattern here?). Meet with them regularly to provide updates on your service delivery outcomes, both process and clinical measures such as response times, cardiac arrest outcomes, clinical metrics and patient experience.

• Keep them informed. No one likes surprises, especially elected officials. Determine processes to communicate events and happenings that officials may want to know about before they hear about them from someone else.

• Provide reliable service. Limit the complaints officials get about your service delivery. No one is perfect, so when hiccups happen, let them know a) what happened, b) what caused it and c) what you’re doing to prevent a recurrence.

• Support their causes. Most elected officials have pet issues such as safe streets, healthy lifestyles, economic development or homelessness. Try to find ways to support these causes with volunteers, donations, in-kind support or promoting their initiatives.

EMS Regulatory Authorities

• Know them. You should be on a first-name basis with your local and state EMS regulatory leaders. Meet with them, invite them to your agency for ride-alongs or to speak at some of your events.

• Be responsive. When they ask for information, provide it as quickly and accurately as possible. If it will take you a few days to respond to their inquiry, give them an anticipated date and time for your answer. If for some reason you’re not able to meet that commitment, notify them in advance and explain why.

• Be responsible. Provide excellent service to limit the need for authorities to investigate any complaints they receive. 

• Be proactive. Seek counsel if you have questions or ideas for service delivery enhancements. State EMS directors appreciate hearing ideas you may have to improve service delivery in your community or across the state. Also let them know of sentinel events that occur in your service area—they will appreciate the heads-up and that you thought of them.

• Support their initiatives. Whether it’s regulatory changes or changes within their department, take the time to learn their desires and offer support. EMS regulatory agencies are often prohibited from lobbying elected officials, but you can on their behalf.

The Media

• Know them. Get to know the assignment editors, health reporters and investigative reporters in your area. Offer yourself as a resource for stories.

• Be a resource. Keep the press informed of happenings related to your agency, such as community events, new equipment or even unique calls. Have a running list of potential stories in case you get a call from a reporter looking for a feature to cover.

• Be responsive. Regardless of the reason for the contact, if the media calls you, be responsive to their request. Even if it seems the story may not be complimentary, not responding to media requests is not a good strategy. Be as kind and informative as possible, and you may be able to turn a negative into a positive, or at least mitigate its impact.

By employing some of the strategies outlined in this article, you can be prepared for those awkward Monday-morning phone calls. You’ll have solid, trusting relationships, and you’ll be able to effectively navigate icebergs to prevent full-scale catastrophes.  

Not sure where to start? AIMHI has member agencies that do this very effectively. Contact Rob Lawrence at RLawrence@raaems.org or Matt Zavadsky at MZavadsky@medstar911.org for more information.

Matt Zavadsky, MS-HSA, NREMT, is chief strategic integration officer at MedStar Mobile Healthcare, the exclusive emergency and nonemergency EMS/MIH provider for Fort Worth and 14 other cities in North Texas. He has helped guide the implementation of several innovative programs with healthcare partners that have transformed MedStar into a mobile integrated healthcare provider. He is an EMS World editorial advisory board member.

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