5 signs you've got an unhealthy EMS agency

An EMS organization with one or more of these problems is in severe distress and needs immediate managerial interventions


By Jay Fitch

EMS agencies, like patients, have recognizable vital signs. These five indicators can help you determine if your organization is in need of routine preventive measures or requires intensive care. The indicators can also help you decide what specific types of managerial interventions may be required to return the agency to a healthy state.

1. Response time troubles

A pattern of not meeting response times due to poor planning, staffing shortages or other internal issues is an early warning sign of system decline. While the impact of response times on health outcomes can be debated, a system’s poor performance cannot be disputed.

Performance measurement against defined targets is one of the best objective indicators of an agency’s overall health. Inability to meet response time goals is often a sign of several underlying problems. Increased use of sick days, unfilled shifts, communications center problems, technology troubles, poor logistics, vehicle maintenance and supervision issues may need to be addressed before they cause further damage to the system.  

2. External investigations

Media and council investigations or a spike in inquiries related to service complaints, deaths, crashes, poor care or poor response times are often a late indication that the agency is headed for intensive care or that a “do not resuscitate” order may soon be written for the system’s leaders. Immediate corrective action is required.

It’s not impossible to return from death’s door to good health but it requires significant leadership effort. Mending relationships with the media, the public or politicians can be both painful and time consuming; however, if you work hard at it and stick it out, a full recovery is possible, and is critically important to the health of your organization. 

3. Internal issues

These can range from easy-to-remedy maladies to a full-blown multi-system shutdown. Issues often include labor strife, ineffective leadership and development, sexual harassment complaints, inequities in compensation or workload, or difficulty recruiting and retaining workers.

In services experiencing increased turnover, caregivers often cite job stress, poor working conditions, lack of promotional opportunities and poor compensation as reasons for leaving. Some surveys have indicated that the number one reason American workers leave their jobs is a poor relationship with their immediate supervisors.

The EMS workforce is constantly changing, and managers must lead a diverse group of caregivers. Leaders have to adapt to the changing attributes and expectations of the EMS workforce or risk being in a constant state of leadership fibrillation.

4. Lack of accountability and transparency

Hidden processes and policies are often early signs that a service is sliding. When individual caregivers or supervisors are not held accountable for their actions by top leaders, it should be no surprise that the system’s health is going to be compromised.

Likewise, if a leader does not walk the talk and ensure transparency at every level in the organization, then holding others accountable is like trying to give oxygen to a COPD patient while he continues to smoke a cigarette. Eventually the disease process overtakes the superficial treatments of symptoms, killing the patient — or in the case of a troubled agency, the leader. Both outcomes are predictable and avoidable, but only if the underlying problems are addressed systemically. 

5. Financial distress

Agencies can experience financial distress for a number of reasons. Constant monitoring of expenses and revenues is as important to managers as watching a patient's vital signs and heart rhythm are to caregivers. Costs per unit hour, per capita and per transport are important to routinely benchmark.

Because of variations in the mix of payers and service levels, it is difficult to compare reimbursement performance among services. Nevertheless, it is important to analyze these four benchmarks internally as well as against similar services: collection rate, the number of days in accounts receivable, the number of process days and the denial rate.

An EMS organization with one or more of these problems is in severe distress and the problem cannot be ignored. Having underlying good health is critical before an agency can move forward and grow and innovate. Meeting current service demands, having good relationships with both external and internal stakeholders, creating a culture of accountability and transparency, and maintaining financial stability are all necessary for an EMS agency to succeed.

About the author

Jay Fitch, PhD, is the Founding Partner and President of public safety consulting firm Fitch & Associates. In addition to consulting, Dr. Fitch frequently speaks at conferences and serves as the program chair for the Pinnacle Leadership Forum. Contact Jay directly at jfitch@emprize.net.

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