The dawn of "Internal Affairs" in EMS

No disciplinary system can be discretionary if you hope to achieve consistency

When I graduated Paramedic school in 1989, the world was a much different place. The Internet was a rumor among computer geeks. Digital cameras were the stuff of science fiction and spy movies. Cell phones came in briefcases and video cameras were for rich parents to record dance recitals. And when a citizen complained about something we (allegedly) said or did, a supervisor handled it and it was over.

Those days are gone.

Today the world can surf the Internet, look at photos, and watch digitally recorded videos on cell phones that capture those high definition photos and videos and are small enough, light enough, and economical enough that everyone has one.

In other words, photos and videos are hitting the public eye before the call to the supervisor; a million people have seen what the caller is complaining about long before the call is ever made. That, my friends, is called Lawyer Food.

The exponential and supersonic growth of the Internet has, in my estimation, led to the equally swift escalation in law suits against anyone and everyone whose misstep is captured and broadcast.

At the same time, businesses and agencies that are particularly vulnerable to liability exposure have worked feverishly to get out ahead of any lawsuits and the bad PR they bring. In EMS across the country, policy manuals are expanding, conduct restrictions are tightening, and entire divisions are being developed to stave off even the appearance of weakness when it comes to the very perception of transgression.

Witness the dawn of "Internal Affairs" in EMS.

EMS has had so-called Quality Improvement (QI) programs for decades. Traditionally, however, QI has been limited to very specific issues of patient care and clinical compliance. Today, though, internal-affairs-type divisions are cropping up all over and replacing traditional clinical QI with more aggressive oversight of performance AND behavior.

Long overdue
In theory, such oversight is long overdue. However, like everything else in this rapidly advancing world of ours, it seems that these new bodies are growing faster than our understanding of how they work and what they can and what they should do. Like the Internet in the early 1990s, Internal Affairs in EMS is that lanky 13-year-old with knobby knees, a goofy haircut, and body parts that require some getting used to.

Case in point: I received a call from a provider whose agency recently established a specific internal-affairs-type division to investigate all matters ranging from patient care errors to simple citizen complaints. She had been called before the [IA] board because her partner had allegedly been "rude" to a patient.

The patient was ultimately transported -- despite the absence of a specific, verifiable complaint -- and the Paramedics continued on with another regular day. Although the rude behavior was non-descript and not in my client's presence, nor was it alleged that she had engaged in any rude or unprofessional behavior, she was ordered to serve a suspension that cost her five shifts.

My inquiry into the draconian action taken against the provider uncovered the following: The newly formed IA-type division arose from an order by the chief on a directive from the mayor to cut costs by reducing the city's exposure to the kind of legal claims that stem from personnel complaints as much as clinical issues. And it was done.

A deputy chief spearheaded the creation of the new IA-type division and staffed it with senior paramedic supervisors. However, the new division lacks a specific mission, there are no disciplinary guidelines, there are no algorithms or matrices for equating conduct to punishment, and none of the new "investigators" received sufficient training on how to...investigate.

Instead, they were thrown into the deep end of a murky pool and told to make sure the public knows that [the department] takes all citizen complaints seriously and will hold every member of [the department] accountable for all substandard conduct. Substandard conduct is not clearly defined.

Overloaded division
As it stands now, the division is so overloaded with investigations and complaints, and so many department members are appealing ruthlessly imposed and outrageous discipline, often on no more than the word of an anonymous caller, that investigations into legitimate and serious clinical issues are backed up as much as a year or more. Department members can be held in disciplinary limbo for months and months, which has led to a sharp increase in employee stress and worker's comp cases...which costs the city more than they were paying to deal with complaints in the first place.

This scenario is not unique to the unnamed city to which I am referring. Anyone with more than five minutes in private EMS knows that such conditions have been a way of life at every level in that environment forever.

Nevertheless, as more and more public and private EMS agencies move toward aggressive IA-type divisions or entities, it seems that, absent proper training and established systems and procedures, they are costing more money than they are saving and causing more problems than they are fixing.

The solution is simple!
IA-type programs or divisions or whatever you call them can have a positive and lasting impact on EMS everywhere, but only if they are carefully conceived, meticulously structured, and its members are effectively and thoroughly trained.

No disciplinary system can be discretionary if you hope to achieve consistency. Likewise, discipline cannot be simultaneously subjective and effective. If any given employee has no way of knowing what discipline he or she may face for any given action, the best you can hope for is a confused, frustrated, and defiant workforce.

If you have or are considering an IA-type system, then take all the time you need to develop event/conduct/discipline algorithms and matrices that are practical and effective. Understand that remediation is far more effective than punishment as an initial response to a problem. And make sure that whatever system you develop addresses actual problems and not perceived problems. That is: Investigate before you castigate.

Finally, and most of all, if you are a supervisor or leader, then supervise or lead; stop throwing your people under the bus because you want to save an image you don't even know is or would be tarnished.

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