Creating a culture of excellence
There seems to be a growing disconnect between EMS, as it has evolved from an assignment to a profession since the late 1960s
By David Givot
Sometimes, it is almost as if I don't recognize the world around me anymore. Pop stars are getting younger and younger, but showing more and more skin. The weather has become breaking news. Snowboarding is an Olympic sport and, as pointed out by General Larry Platt, everywhere I look, I see kids "...looking like a fool with their pants on the ground."
When I see the way society is changing from when I was a kid, the only conclusion to draw is that our culture is shifting. Of course, I am not surprised since our culture has been changing and evolving since the first caveman tied his tiger-cloth over his shoulder instead of around his waist.
I see similar cultural issues in EMS. I have seen and worked with EMS providers and agencies throughout the United States and I have noticed that the similarities are as distinct as the differences from place to place. The differences don't bother me too much because every area has different needs to which local EMS seems to have adapted. It is many of the similarities that concern me.
There seems to be a growing disconnect between EMS, as it has evolved from an assignment to a profession since the late 1960s, and the culture of the agencies that provide it. It appears that, in many areas, the nobility and importance of EMS gets lost amid the culture of conformity and acceptance that underlies agency life.
The consequence is substandard care, the loss of community confidence, and most of all, the perpetuation of a negative stereotype: EMS providers are technicians, not professionals; that EMS is a job, not a career. To me, such a notion is unacceptable.
For example, wherever I go, I always look carefully at the EMS providers I come across. Whether I am driving around town on my own or traveling across the country consulting with agencies, I am noticing if ambulances, squads, or trucks are clean. Are crewmembers groomed and sharp? Is their conduct appropriate? What image is being portrayed, and what message is being conveyed?
As a layperson, dirty vehicles, disheveled providers with wrinkled, un-tucked shirts, or providers who toss finished cigarettes on the street (for example) make me seriously question the commitment of that person or crew. The message is: I don't care. This is just a job. I don't really want to be here.
As an EMS professional — and a lawyer — my unease grows when I watch providers who think they are the best at what they do (and may very well be), perform at a level that is less than what is acceptable or expected. The hand-drop test, for example, to determine whether a patient is actually unconscious is NEVER appropriate.
However, when I inquire about the use of the non-technique, the most consistent response is, "...that's how we have been doing it here forever." The oversized nasal airway on the drunk or the 14-guage catheter on the anxiety patient (that will teach 'em) or the condescension and sarcasm on the non-English speaker; these are all examples of what not to do, yet they are pervasive among certain EMS cultures because "...that's how we have been doing it here forever."
Well, if EMS is to be taken seriously as a profession, the time has come to change the culture and the only way to do that is to lead by example, and from within. Supervisors and managers do not shape field culture as much as they might like to believe. Polices and discipline will not get it done.
Creating a culture of excellence requires commitment and action from the men and women on the frontline. Not only must they lead by example, they must be willing to weed out the deadweight. They must be willing to build an environment where substandard providers simply do not fit in (in compliance with the law, of course).
Cultures do not shift overnight. The process is slow and requires constant reinforcement; being excellent has to be the "cool" way to be; the standard. Since EMS can only be a profession to the extent that each provider is a professional, shifting or creating a culture of excellence must be personal to everyone on the frontline and in the front office.
Get started. Talk amongst yourselves out there. At the station or in the ER or wherever you find yourself meeting up with another crew, commit yourselves and each other to look great, perform well, and accept only excellence. It won't be long before the naysayers out themselves, but hold firm to the commitment. Where you see appearance or conduct that is not in line with a culture of excellence, YOU and only YOU can change it.