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Are you making the $345,800 mistake many EMS leaders are making?

3 steps to stop staffing problem solving and start reinventing your agency


“Stop thinking of recruitment and retention as the problem, and go upstream to the root cause, and focus on creating an organization worthy of highly engaged people,” writes Giruzzi.

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There is little dispute that EMS is in crisis. We don’t have to tell you that. You are living it every day.

Last year, some prehospital organizations saw turnover rates as high as 38%, which equates to $345,800 in direct costs to an organization with 100 people, or $1,729,000 for a 500-person organization.

Indirect costs of turnover are even more expensive – that’s the burning-out of your mid-level and senior management. Just think about those in charge of scheduling and onboarding new hires – and what would happen if they decided to leave.

Many attribute EMS staffing challenges to “quiet quitting” or the next generation’s lack of work ethic, or justify their staffing levels because other industries are facing similar challenges.

Consider that these are not the real causes. In truth, the cause of the current state of EMS is the culture of EMS organizations.

Most leaders focus on fixing the staffing crisis, which is like trying to fix the exhaust problem of a carbon engine. If you’re sick of the exhaust from a carbon engine, you don’t try to plug the exhaust; that will blow up the engine. Instead, smart leaders become focused on redesigning a new engine, one in which zero emissions is the goal.

That’s our invitation to you, to stop thinking of recruitment and retention as the problem, and go upstream to the root cause, and focus on creating an organization worthy of highly engaged people. This is easier than you might think, because the No. 1 driver of culture is leadership.

What paramedics want in 2023: 72% of respondents to the 2023 EMS Trend Survey believe poor leadership is having an impact on the retention of experienced EMS providers. Learn more.

Most organizations were designed by default from an outdated paradigm that no longer serves the intended purpose. It’s an innocent mistake and once people catch wise to it, it’s easily rectified. Unfortunately, because it’s a huge blind spot for most leaders, it continues to have a negative impact. Following are three steps to reinventing your agency culture:

1. Self-development. The first and most important step to culture change is developing yourself to become the kind of leader people want to follow. Let go of your preconceived notions of what leadership is and get curious about what your people need from you – and then – provide it. Leadership is a verb, not a noun.

Become interested in leadership that works to produce the result you want rather than thinking that there is one right way to lead.

2. Develop your personnel. The next step in culture change is developing others. Too often, when someone is hired, they are treated like a finished product rather than like a human on a learning curve, continuously progressing and growing. This approach doesn’t foster or utilize providers’ abilities and potential. When you lead from the context that your No. 1 job as a leader is to grow and develop the people you lead, it alters your relationship with them and every interaction. For example, delegating tasks in the context of developing people is different from the traditional way tasks are delegated.

3. Think big. The third step to transforming your culture is to gather stakeholders from within and outside your organization to create a new, bold vision for your organization, using a question such as, “If anything were possible, what do we want to create?” Sometimes, when we talk about limitless goals, participants will say that it’s unrealistic. And we say, so was every single impossible result we see in the world today, from the electric car, to the mobile phone and thousands of other examples.

Creation is only possible when we free ourselves from the past constraints of our thinking. Consider, a problem-solving approach is what has led to the situation EMS and other organizations are in. It’s not that problem solving is bad or wrong; it’s that the overuse of it has led to past-based “solutions” that innocently cause as many problems as they solve.

When you engage in limitless goal setting with others without any resistance, it is amazing the creativity that gets unleashed. New and innovative ideas will flow. Yes, objections and “yea buts” will arise, but don’t resist those either. It’s all part of the creative process.

Once you have come to a consensus on a vision, then it’s time to design your organization to fulfill that vision. It can be helpful to imagine your organization from scratch as a way to stay in the creative mindset. Begin to think about and wonder what structures are needed to fulfill that vision. Structures for areas such as training, onboarding, internal and external communication, recruitment, employee wellbeing, feedback, recognition, safety; and policy and procedure creation, implementation and review all need to be designed in alignment with the ideal organization you want to have.

While it may seem like a long road to achieve the stability EMS needs, consider, more short-term fixes will only perpetuate the crisis. And, as you focus on developing yourself, you will notice your results changing right away.

Learn more

For a more in-depth exploration into EMS stability and development, join the EMS Leadership Academy for a free recruitment and retention training workshop to learn the 3 mistakes most EMS leaders make that lead to workforce challenges and how to avoid them, as well as actionable strategies to immediately begin transforming your organization’s culture.

Lisa Giruzzi is the co-host of the EMS Leadership Summit, and co-founder of the EMS Leadership Academy, an organization that provides leadership resources for EMS providers worldwide to address the difficulties they are facing on a daily basis and create magnetic, thriving, sustainable organizations. Lisa has been a business and life coach for more than 25 years and specializes in causing breakthrough results for clients by giving them access to a whole new level of power and performance. Learn more at and