More than medicine
How to identify, onboard and manage community paramedics to succeed in their unique role in improving community health
In a session at the 2020 EMS World Expo conference, Dan Swayze, DrPH, MBA, MEMS, vice president of community services, University of Pittsburgh Medical Center Health Plan, partnered with Michael D. Wright, NRP, fire captain for the Milwaukee Fire Department, Milwaukee, Wisconsin, to tackle the force behind community wellness: community paramedics.
Memorable quotes on managing and supporting community paramedics
As community paramedicine/MIH programs continue to spread, the success of a program begins with hiring the right people for this challenging position, and supporting new providers in a very different role than traditional EMS response.
Here are some memorable quotes from Swayze and Captain Wright:
- We’re putting our people out front in someone’s home to help them through some intimate, delicate and sometimes embarrassing situations and to gain their trust to tell us what we need to know to sift through this thing called life and get down to the social determinants of health. — Michael D. Wright, NRP
- I’m looking for the person who’s on scene too long, because they’re feeding the cat, calling the aunt to let her know we’re about to take her niece and nephew to the hospital, making the phone calls, locking the door, making sure we have the keys … that’s the kind of person who realizes there is more to what we do than just the medicine — Dan Swayze, DrPH, MBA, MEMS
- A hostage doesn’t make a good anything, you want people to have the freedom to think and express themselves and make sure you have the right people there ... this isn’t for everyone; that doesn’t mean you’re not perfectly suited for the EMS side. — Michael D. Wright, NRP
3 takeaways on managing and supporting community paramedics
Swayze and Captain Wright shared insights into their community paramedicine programs’ inception, their MIH candidate interview process and the characteristics that define a successful community paramedic.
Following are three takeaways you can bring home to build and strengthen your own community’s mobile integrated healthcare program.
1. How to identify candidates who will succeed in community paramedicine
Swayze noted he has not found a correlation between the amount of experience CP candidates have and their success in the role. “We find that brand new EMTs and paramedics are equally up to the task of helping patients as more experienced veterans are.” Instead, Swayze has found three predictors of success which he shared with the audience:
- Education. Though the amount of EMS experience itself doesn’t seem to be predictive of the candidate’s success or happiness in the role, Swayze noted that in working closely with the University of Pittsburgh’s EMS training program, he has noticed that candidates who have or are working on a degree seem to come to the table with a broader world view. It gives them a different perspective, he noted. Not to say they are head and shoulders better than people who don’t come to us with a degree – that’s not the case at all – it just seems that they take a little different track … are maybe a little more effective with our patient population.
- Shared lived experience. More important than a degree by far is shared lived experience, which unfortunately, many of Pittsburgh’s community paramedics have, Swayze related. “It can be hard to make ends meet when you’re working as a paramedic or firefighter in many parts of the country,” he said. “So when they come at it from a sense of ‘hey I’ve been there before, I understand what the struggle is between the rent, your medications and all of your other living expenses,’ that really helps resonate with the patients they’re serving.” Sharing common ground, like personal experience or a family member/friend’s experience with homelessness or food insecurity really helps cement relationships with patients.
- Advocacy in action. The most important experience a community paramedic can bring to the table is advocacy, Swayze noted. Those who have taken up a cause, who have stood up for somebody in a vulnerable or marginalized position, and helped them get the services they need or articulate their needs, have at a micro level the passion to correct injustice and to get through the barriers systems of care present, and to really succeed in their roles as community paramedics.
2. Community paramedicine program success begins with CP interviews
Wright noted the success or failure of your community paramedicine program begins with the interview. He pointed to a management tenet that his organization swears by, “Put the right people on the bus, take the wrong people off the bus, and put the right people in the right seats on the bus.” The right people for the community paramedic seats must be comfortable delivering customer service, and must exhibit compassion, empathy and soft skills, he explained.
To identify the candidates with the greatest potential to serve the community paramedicine cohort of patients, the UPMC CONNECT Community Paramedicine Program asks candidates 3 core questions:
- Tell me about a time when you wish you could have done more for your patient
- Tell me about a time you witnessed a partner mistreating a patient
- Tell me about a time you had a patient in a mental health crisis
If the candidate responds that they wish they could have done suturing, or given a patient a prescription – in other words, if they are looking at this as an expanded scope of practice opportunity – then community paramedicine may not be the profession for them. Similarly, Swayze is not looking for the candidates who call police, or activate a safety protocol – it’s absolutely the correct thing to do, he noted – but he’s looking for someone who steps in to verbally de-escalate the partner and who steps in and advocates for their patient. When candidates can provide examples where they have handled these situations, it resonates as someone who will be willing to have the difficult conversations and assist patients in moments of crisis that community paramedics often encounter.
3. Providing continuous growth opportunities
Swayze outlined the 3-step process to continued professional success UPMC CONNECT Community Paramedics follows for its personnel:
- Onboarding. New community paramedics begin with a 40-hour didactic training program which sets the stage for the issues they may encounter and the barriers they will need to navigate to assist their patients. Once training is completed, the CPs begin precepting and learning by shadowing a senior CP, to learn more about the dynamics and the relationship between community paramedic and patient. Finally, the new CP takes the lead, with the support of the senior medic, and once they have seen enough cases to develop their conversational techniques, goal setting and the resources to successfully navigate the system for their patients, they are signed off and ready to begin.
- Management. Swayze noted the complex workflow and emotionally taxing cases in community paramedicine require a delicate managerial approach to balance caseloads, resources and capacity, to prevent burnout and compassion fatigue. They have also implemented a time out system, where providers can take a break to clear their head after being immersed with a draining case, or can be encouraged to take a time out if their colleagues notice their demeanor has changed or they aren’t engaging with the rest of the team.
- Professional development. UPMC CONNECT also offers several continuing education, as well as special operations and research projects and opportunities that community paramedics can step up and get involved with. To show their personnel this is a livable job, they’ve created a clear career path from community paramedicine up to the manager level, with opportunities to open more doors.
Additional resources on community paramedicine and employee development
Learn more about community paramedicine and employee retention with these resources:
- Special coverage: Diffusing community paramedicine
- Q&A: Creating a healthier, safer community with MIH-CP
- How 4 community paramedicine programs are positively impacting healthcare
- How to prove the value of community paramedicine
- Integrating student interns into your community paramedicine program
- Employee retention: Engage EMS providers with opportunities for advancement
- Defying the EMS retention crisis: Why are great people leaving EMS?
- Q&A: How to encourage employee growth and maintain high standards
- 3 ways you’re losing EMS providers and how to stop the revolving door
This article was originally posted Sept. 16, 2020. It has been updated.