Updated Jan. 5, 2015
Walk into the training center at Allina Health EMS in Minnesota and you may be surprised to see an entire wall lined with a series of paintings depicting the history of EMS. Even more surprising is the fact that the pieces were painstakingly created by the organization’s president, Brian LaCroix.
EMS wasn’t LaCroix’s first calling, you see. Having received a degree in fine arts, he had worked as a commercial artist for a billboard company and was freelancing in 1981 when he experienced a medical emergency and called 911.
“I was 22 years old, had a pulse of greater than 220 and was having syncopal episodes,” LaCroix recalls. “The EMTs who came to take care of me were probably more scared than I was because they had no idea what was wrong, but they connected with me on a very personal, human level. The impact they had on me was extremely powerful.”
So powerful, in fact, that LaCroix became an EMT and started working for the same system that took care of him when he had his episode of PAT (paroxysmal atrial tachycardia). He went on to become a paramedic, working the streets for several years before joining Allina Health EMS as an operations manager in the late ’90s. He eventually got a business degree and worked his way up to president, though he admits that wasn’t always his aspiration.
“I didn’t have designs to be an EMS chief or president of an EMS organization,” he says. “I loved being a field medic, but I was intrigued by working with and for a few very good leaders and eventually became interested in leadership.”
Even as the head of a large EMS organization—Allina Health EMS serves 1 million people in a state with a total population of 5 million—he’s never lost sight of why he got into the business in the first place. “We respond to nearly 90,000 calls each year; 260 times each day, someone, potentially having a similar experience as I had years ago, calls on my service and asks us to help,” he says. “I find this to be a profound responsibility.”
Now in his 17th year with Allina Health EMS, LaCroix spoke with Best Practices about how he keeps the fire burning in himself and his 570 employees.
Allina Health EMS is part of a large hospital system. What benefits does that bring you? Our parent organization, Allina Health, is a collection of 12 hospitals, more than 100 clinics and a group of specialty operations including pharmacies, homecare and hospice agencies, durable medical equipment providers and of course EMS. So, yes, it’s a very large organization with a large number of employees: 24,000.
Being part of this type of organization brings us many benefits, but one of the most important is our connection to a lot of physicians. This connection allows us to participate in a systemwide development of emergency medicine that has a significant impact on patients. For instance, through this relationship we were among the first in the nation to develop a systematic way of identifying STEMI patients and bringing them straight to the cath lab. We knew the cardiologists and they knew us, so we were able to work together to come up with an effective, patient-centered program.
Another example is our stroke program: We sat down with the neurologists in the hospitals and asked what mattered to them when it came to stroke care. One illustration of what we found is they wanted us to use at least an 18-gauge needle to administer thrombolytics, so now when we start IVs on these patients, that’s what we use.
Do you have your own culture within Allina Health?
Allina Health EMS, like all EMS systems across the globe, lives in the worlds of both public safety and healthcare, yet the rest of our parent organization is all about healthcare. Our EMS folks interact with firefighters and police officers as well as hospital workers, but the hospital side of our company doesn’t do that, just by the nature of the work they do. So, yes, we’re very much a standalone culture.
What services does Allina Health EMS offer?
My division is primarily a 911 ambulance service—75% of our work is related to emergency response. The other portion of our work is related to interfacility work: wheelchair, BLS, ALS and critical care. I’m particularly proud of our partnership with Children’s Hospitals and Clinics of Minnesota, which allows us to offer neonate transport.
We also have our own dispatch center, with 30 PSAP dispatchers. I’m proud to say we are well on our way to achieving ACE accreditation—our hope is that we will have our accreditation wrapped up by the third quarter of this year.
What sets Allina Health EMS apart from other EMS organizations?
Culturally, we care a lot about people, and I don’t mean that in a corny way. It is deeply rooted in all of us that the work we do is vitally important. On a personal level, I get up every morning and think about our patients. I remember my own experience as a patient and try to instill in our employees a sense of deep importance that we do good work.
The other part of that is that we care about each other. Our organizational culture is that we have high expectations but deep support.
Structurally, being part of a large, healthy organization makes us fiscally strong and allows us to buy the equipment we need and to hire good people. And, most important, it gives us access to and interest from a lot of physicians, and we enjoy extraordinary medical support.
We are also unique in that we have two half-time medical directors. They each work half of their time with us in EMS, and the other part of the time they work clinically as ER physicians in different Allina ERs.
So, yes, we are part of a large organization, but that alone does not make us good. What I always say is that when a crew steps out of a rig and touches a patient, that’s what makes us good.
Is it true that you have a chaplain on staff?
It is. We decided to create this position post 9/11 because we wanted to engage our staff in terms of their own well-being.
Our chaplain has a phrase: high expectations and high support. We expect a lot out of our people: to know the protocols, to give great clinical care, to be nice to someone who just threw up in their shoe. We expect them to do good work, but we have their back in turn. We support each other.
His role is not to pontificate or to advocate for any religious position at all, but simply to support the well-being of our caregivers. He sees himself as a teacher of self-care.
Physical and emotional wellness is a benchmark of your company. Why is it so important to you?
Yes, we want to take good care of our employees, but at the other end of the spectrum is the business case for wellness: Burnout, or employees who are not in a good place emotionally or physically hurt patient care, hurt job satisfaction and hurt the bottom line. It’s not just that we have this Pollyanna view.
How do you benchmark wellness among your employees?
This is another advantage to being part of a big healthcare organization: We have epidemiologists and other social scientists whose job it is to do a lot of research. And part of that research is on employee wellness.
Among other clinical work they do, this group of researchers studies the well-being of Allina physicians, and recently they started including paramedics in that group. What they found is 25% of the general population identify themselves as being burned-out. Among family-practice physicians, that number is about 50%. Among our paramedics, just 17% identify themselves as being burned-out. What’s the secret sauce we’re feeding them? We don’t really know, but we’re learning.
Another measure is our annual employee engagement survey. This is a high priority for our leaders, and their compensation is based partly on their employees’ engagement. If their employees aren’t engaged, they need to figure out why, and how to help them become re-engaged.
I’m very proud of the fact that 87% of Allina Health EMS workers are fully engaged. When I started here, that number was at 34%. Every year we’ve made a little headway, but it didn’t happen overnight.
Two of your employees were involved in a crash while on duty this year. What were some of the lessons learned from this?
Our vehicle was transporting a patient without lights and sirens in a heavy snowstorm at 1 a.m. and was hit by another car head-on on a rural highway. The patient was uninjured, but two of our staff members were severely injured, and the woman who struck us was killed.
It was a tragic situation, but I’m just really proud of this organization. People from every corner of Allina Health were there to support our injured colleagues, as were our partners at the fire department and in law enforcement.
The extraordinarily happy note is that both staff members have recovered and are doing very well. They have a long road of recovery, but both are highly functioning.
When all is said and done from an investigation standpoint, I don’t think we’ll learn a lot that we could have done differently from a safety point of view. What we did learn has more to do with the cliché that when the chips are down, your family will rally. We’ve enjoyed an ever-growing culture of caring within our organization that was absolutely lit on fire after this incident. The outpouring of support has been phenomenal.
Your company has a reputation for having employees who take great pride in their work. How do you help engender this?
There’s a concept of line of sight: Everyone is invited and encouraged to think every day about how they impact patient care. It’s easy for a medic to understand how he or she affects patient care, but it isn’t so easy for a janitor or a mechanic. But if you ask Arthur, one of our janitors, he can tell you exactly how important his job is and how he impacts our patients. The neat thing about Arthur: Our EMTs and medics see him talking about it, and it only reinforces their line of sight. It seeps into people’s pores around here.
I’m really proud of the fact that 15% of our workforce has worked here 20 years or more. Sure, they’ll tell you there are days when it’s tough to come to work, but this is as good a place to do that hard work as anywhere.
In your opinion, what are the greatest challenges facing EMS provider agencies today?
The first one is increased violence against providers. Across the board, we’re living in a culture of increased violence, and by the very nature of the work we do, EMS providers are in the midst of that on a regular basis. We’re seeing this even in rural areas, where there is an increased use of opioids, particularly heroin.
The second challenge is being able to attract and keep job candidates. We need to work hard to provide continuing education that is relevant and meaningful so people stay on the job and stay engaged and motivated. We also need to be able to pay them a good living wage.
Finances for EMS is always on this list. It’s very challenging to run an EMS organization and provide good wages when nothing gets cheaper.
Lastly, we need to figure out how we can speak with one voice as a profession and not get fractured by our tax status (firefighter, municipal, private, etc.). We are often our own worst enemy in this regard. There’s an ever-shrinking platform of resources, and we need to figure out how to work as one or we’ll all pay the price.
What are some first good steps for an EMS leader wanting to improve his or her organization?
First of all, look outside our profession. If you have come up through the ranks of EMS and only know EMS practices and processes, it can be a big eye opener to look at processes and systems through a different lens. Look at leaders in the hospitality industry for how they deliver customer service. Take a look at FedEx for how they run their delivery service. When it comes to employee engagement and job satisfaction, what’s the best place and what are they doing? Take your myopic blinders off and try to find an industry that’s not involved in healthcare.
Most importantly, stay close to patients. If you really want to know how to be a good EMS operation, ask your patients what matters to them. It’s an obvious but often overlooked way of delivering top-notch patient care.
