EMS Today 2020 Quick Take: The forgotten art of customer service

Be proactive about meeting the needs of internal and external customers to improve the care provided by EMS


TAMPA, Fla. — Lillian Bonsignore, EMT-P, CIC, chief of EMS Operations for the FDNY, presented a session titled “Customer Service in EMS: The Forgotten Art,” at EMS Today.

Bonsignore noted that those in EMS are “people people ... people of service, people of compassion, people of kindness.” But like anyone, “sometimes we lose focus as to what our mission is.”

By outlining who our customers are in EMS, we can address their needs before, during and after each interaction. “If you’re interacting with another human being, we need to be proactive about their needs,” Bonsignore noted.

Lillian Bonsignore, EMT-P, CIC, chief of EMS Operations for the FDNY, presented a session titled “Customer Service in EMS: The Forgotten Art,” at EMS Today. (Photo/FDNY)
Lillian Bonsignore, EMT-P, CIC, chief of EMS Operations for the FDNY, presented a session titled “Customer Service in EMS: The Forgotten Art,” at EMS Today. (Photo/FDNY)

Top quotes from FDNY EMS Chief Lillian Bonsignore

Following are poignant quotes from Bonsignore’s presentation.

“Never mix up our mission with our politics. What color pants you wear has nothing to do with the impact you have because you showed up that day.”

“Accept the fact that we’d like to transform the profession of EMS, not just maintain it.”

“If we’re going to move EMS forward, we have to accept that there are some things we don’t do well and we could do better.”

“We are people who believe we have the answer and the willingness to execute that answer for a stranger.”

Takeaways on EMS customer service

Bonsignore shared strategies to improve communication and customer service:

  • Focus on your body language: avoid crossed arms, hand in pockets
  • Get to the patient’s eye level: speaking down to a patient can appear authoritative
  • Make eye contact: let patients and family members know you’re listening
  • Give them your attention: practice active listening
  • Watch your tone: words and inflections create different meanings (Bonsignore provided the following example. Read these aloud: I didn’t say he was a bad EMT. I didn’t say he was a bad EMT. I didn’t say he was a bad EMT. I didn’t say he was a bad EMT. Can you hear the difference?)

Your tone of voice, inflection and your words should all be working together to say, “I am here to take care of you.” Try a little smile, she encouraged. One that says, “your emergency is over – I am the answer to your emergency.”

Most importantly, practice genuine empathy. An audience member noted he doesn’t get complaints about medics who read a 12-lead wrong; he gets complaints about medics who are jerks.

Here are 3 takeaways from Chief Bonsignore’s discussion on EMS customer service.

1. Focus on external as well as internal customer service

Bonsignore made the case that for EMS leaders, internal customers – the EMTs, paramedics and CFRs going out and doing the job, as well as the support staff who set them up for success – are even more important than external customers. If your employees aren’t happy, how are they going to go out and interact with patients on a daily basis, she askd. “If someone comes into work and we make them miserable, they’re going to go out there and make someone else miserable.”

“As a leader, I have to recognize that the leadership I provide is a service,” Bonsignore stressed. “I am there to serve them; their job is to serve the communities. They don’t work for me; I work for them. My job is to support them.”

That means stopping and talking to staff, asking about their families, how school is going. “We are caretakers, but we don’t always do a good job of taking care of each other,” Bonsignore said. “If we’re only talking to each other when there’s a problem, that is a problem.”

We often hear that leaders spend 90% of their time on 10% of the people who can’t get out of their own way, Bonsignore noted. Instead, “spend 90% of the time on the people who do a good job. For the other 10%, you educate them, and then you discipline them. You don’t feel bad about it. You give them the opportunity to come along.”

2. Customer service improves EMS provider safety

Another not-to-be overlooked or understated benefit of good external customer service in EMS is it can be a de-escalation tool.

“When you show up to someone’s bad day, they’re generally not throwing you a party when you get there,” Bonsignore said. But, “Nobody deserves to come to work and be assaulted in any way.” She noted she tells her providers to remove themselves from a potentially violent incident, and retreat to safety.

Assaults against EMS providers are frequently reported, and even more go un-reported. Training in situational awareness, self-defense and how to escape a violent attack can prevent provider injury. Good customer service – kindness and compassion – and verbal de-escalation tactics, however, can diffuse a potentially volatile encounter before it turns violent, reducing the likelihood of conflicts and assaults. “If we treat people with dignity, it reduces negative reactions,” Bonsignore noted.

3. There are no excuses

A benefit of good internal customer service, on the other hand, is that is builds trust and morale.  

Back story, provided by Chief Bonsignore: The FDNY has 4,100 EMTs and paramedics in the EMS Bureau, as well as more than 10,000 firefighters trained to the CFR level and additional volunteer partners. More than 1,200 ambulances fight the gridlock each day. The FDNY EMS runs 800-plus different tours every day, with hospital-based EMS partners contributing an additional 400-plus tours. They serve 8.5 million residents – which increases to 17 million when visitors and workers are added, and surges by millions for holidays and events. EMS responds to 1.5 million calls a year and over 4,000 calls each day – each which has the very real potential to be an MCI with that many people sharing 303 square miles.  

And yet, Bonsignore has gone the extra mile when it comes to engaging with her staff. One of the first things the did after her promotion, from FDNY training chief, was to set up town hall meetings, in every borough. She and Assistant Chief of EMS, Alvin Suriel, bring the BBQ, cook for the providers and support staff, and spend 2-3 hours getting to know the people who serve the mission in New York City.

She also cut out the chain of command in field feedback forms, ensuring provider concerns are directed straight to her office.

Each month, her leadership team recognizes the unit of the month, which has exceeded expectations, with a celebration followed by a lunch with Chief Bonsignore and Assistant Chief Suriel at a restaurant with “the best chicken parmesan in the city.” After which, the recognized providers are invited back to headquarters to spend the afternoon with the rest of the senior leadership team of the FDNY.

“If we can do this in a city that runs 1,200 ambulances a day, anyone can do this. If we can find the time in 4,000 runs a day, I would argue anyone can,” Bonsignore opined. Though she invited dissent, no one in the audience could disagree.

Additional resources on providing good customer service

Learn more about how to care for your patients and your personnel with these resources from EMS1:

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