Strategic paramedic scheduling: 3 steps for EMS leaders

Follow these steps to become an employer of choice and improve paramedic morale

By Sean Caffrey

Scheduling is an ongoing concern and challenge for every EMS organization. Providing around the clock emergency services to a community requires highly-trained practitioners and associated support services operating on a variety of shifts. Available staffing must be able to meet the both the likely and unlikely needs of the community.

Individuals are drawn to EMS work for many reasons; however, scheduling often plays a key role in the satisfaction or dissatisfaction of your team. Dave Konig's excellent article covers the ins and outs of effective scheduling.

This article, by contrast, will ask you, as an EMS leader, to step away from the day-to-day mechanics of scheduling and answer a bigger question, "How can I better position my EMS service as an employer of choice through staffing and scheduling practices?"

"Employer of Choice" is a human resources term that reflects an organization’s desire to be best in class when it comes to recruiting and retaining employees. If you can achieve this status it likely means that your team members are excited to be part of your organization, that you are able to attract the best new talent and that your customers recognize your reputation as an excellent service provider.

Perhaps you can think of an organization in your community that fits this description. Why shouldn’t it be yours?

Before you retort, "We are a volunteer organization, we don’t compete for employees," think again. Volunteer organizations compete for one of the most valuable resources of all, people's free time.

Unlike paid positions, there are often many ways to serve the community and options to volunteer are balanced against time for family and fun. As a result, volunteer organizations must compete in the most challenging recruitment and retention environment of all.

Step 1: Get the workload figured out
Nobody likes working for an understaffed organization. Providing good patient care requires attention to detail and time to interact with customers. It also requires time to take care of your tools and equipment, plus some downtime to rest and recharge between calls.

Overworked and tired crews are more prone to making mistakes. Driving ambulances all over town to cover calls is both bad for response times and dangerous to crews and the community. Mandatory overtime might be a financial benefit for employees, but is costly to employers and gets old quickly for employees who are mandated to work extra time.

It’s also important for paramedics to know they can get a day off when they ask for it. It is reasonable for the department's paramedics to actually have a day off without being called in to work.

Determining appropriate workload and staffing requirements requires the following:

  1. Having enough crews on duty to meet expected call demand. This means planning for scene times that are sometimes over 10 minutes, reasonable hospital drop-off times, time to write reports and meal breaks. It should not be assumed that non-response tasks can be accomplished by staying after the shift's scheduled end time. That’s disrespectful of people’s time.

  2. Anticipate time off requests. Team members sometimes need to call-in sick and take vacations. In many cases accrued time off requires close to 1.3 people for every full-time employee. This coverage need is real, so plan for it. 

  3. Medicine doesn’t stand still. Ongoing training in EMS is essential and most organizations build in time for training which improves clinical performance, builds job satisfaction and improves your organization’s reputation. In person training is great, however, a variety of tools now exist to make training more convenient for staff members and easier on training staff. Figure out which methods work best for your organization. For in person training be sure to schedule adequate coverage while crews are training or you’re cheating your staff out of these opportunities.

Step 2: Design a good scheduling plan
There are probably a few organizations out there that do OK with a single schedule pattern; unfortunately I’ve not found one. Utilizing only one type of schedule is perhaps the quickest and easiest way to mess up your recruitment and retention efforts.

There are tons of organizations that work around the clock and they do it in plenty of creative ways. Consider this when building your schedules:

  1. People’s lives change. The schedule someone can work as a young, single person is likely quite different from a parent with a school-age child or as student taking college classes. If your schedule is too rigid, you can certainly hold the line and enforce the work requirements. In the meantime expect that experienced people will probably leave as their lives change. Turnover costs a lot in terms of of time, money and effort. Replacing an employee can cost over $10,000 if you figure in backfill, recruiting costs and training time. It's probably better for retention and recruiting to have multiple schedule options.

  2. Avoid covering nothing. Many EMS systems maintain the same level of coverage at 3:00 am as they do at 3:00 pm. Many systems also schedule management, administrative and support staff only on weekdays. You might be able to save a good deal, or at least break even, by increasing coverage during peak call periods and reducing crews on the road at slower times. In terms of support staff, you should also examine if early morning, evening, flexible or overnight shifts could work better for some of those functions? Fleet management, in particular, is hard to do when most of the vehicles need to be on the road.

  3. Where is your surge capacity? Are you always relying on full-time employees to work extra in a pinch? If so, you better have a few extra people. If you are relying on part-time employees, do you actually have a well-established and adequately supported part-time program? Part-time and volunteer programs are similar in that they require significant time and effort to do well so don’t rely on them to magically meet your needs without a significant investment in time and energy. 

Step 3: Monitor and analyze constantly
You may have heard the famous military quotation "no plan survives contact with the enemy". While our patients should certainly not be viewed as the enemy, the quote does reinforce the fact that reality will likely alter your scheduling plan. In lieu of viewing this as a failure, consider this an opportunity to learn, adjust and adapt.

Monitor the following factors that impact scheduling:

  1. Matching supply and demand. How busy are your units? What is their unit-hour utilization? Are you effectively meeting your demand and maintaining a sufficient reserve capacity? Are your units busy enough or too busy? How can you tell?

  2. Balancing scheduled time and overtime. Is your overtime reasonable? While figuring out reasonable is a bit of an art. A good rule to remember is that an employee with benefits usually costs about 130 percent of their base salary. An employee on overtime costs 150 percent and they can quickly get grumpy with customers, which costs your organization even more.

  3. Understand a dynamic workforce. Are the demographics of your workforce changing? What are the demands on their off time? Are you able to accommodate time off requests without difficulty? Can you make small changes to meet changing needs?

  4. Equity, fairness and seniority. EMS providers are skilled at judging fairness of any system and it can be the deciding factor in whether a scheduling change is successful or not. EMS providers will probably understand what is fair or unfair long before managers do. Unfortunately, being fair often translates to treating everyone equally badly. If done well, however, fairness can mean spreading the workload in a variety of effective ways, changing to meet evolving needs, recognizing those that go the extra mile and listening to valid concerns regardless of who raises them.  

None of these steps to strategic scheduling are particularly complicated. Be open-minded, proactive and adaptable. If you provide your team with a good scheduling system, they’ll likely do plenty to help your recruitment and retention efforts without you even knowing about it. If your staffing plan is poorly designed, expect the opposite.

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