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How to avoid costly turnover in your EMS service

From engaging staff in strategic planning, and collaboration in organization goals, 5 strategies to EMS staff retention


Excessive work hours, chaotic schedules, compassion fatigue, limited staff engagement, poor management and lack of career advancement opportunities are circumstances that make the profession exceedingly demanding.


By Thomas Moore

Healthcare is in a continuous state of progress. It’s also in an incessant state of transition. An unfortunate key element in this transition is employee turnover. The axiom medicine in motion describes this state well, and EMS is not immune to this predicament.

In fact, in the 2020 EMS Trend Report, when asked what the most critical issue facing EMS today, the one choice that appeared in the top three of all demographics was retention of personnel, above and beyond
public perception, integration with healthcare and quality of care. Additionally, the American Ambulance Association completed a study in 2021, aimed at understanding the turnover rates in different occupations within the industry. The results: voluntary and overall turnover remained in the 20-30% range for EMTs and paramedics. A 25% turnover rate means 100% turnover in an organization’s staffing every four years.

Industry leaders often point to the environment and overall nature of EMS as one of the reasons for such high turnover. Excessive work hours, chaotic schedules, compassion fatigue, limited staff engagement, poor management and lack of career advancement opportunities are circumstances that make the profession exceedingly demanding.

When compared to a similar healthcare environment, hospital emergency departments, there’s truth to be found in the belief that emergency services create an environment ripe with obstacles. According to data from NSI Nursing Solutions 2021 National Healthcare Retention and RN Staffing Report, emergency room registered nurses have a higher turnover rate at 20% than the national RN turnover rate of 18%. In essence, every five years, the average emergency department will turn over its entire RN staff.

Now armed with this information, what can be done about it? When turnover at your service is high, it’s easy to identify the increased costs associated with recruiting, selecting and training replacement personnel. However, additional effects, such as declines in efficiency and productivity, employee engagement, clinical care and patient satisfaction are not always as easy to distinguish. Understanding that each of these effects must be addressed is the first step in developing these 5 strategies to reduce EMS turnover.

1. Define what cultural contributions your agency needs from staff and hire accordingly

Industry-leading organizations in any sector don’t settle for individuals who are technically sound yet are unwilling to put in the work to support the organization and its team. Finding the right person for the job involves more than identifying someone with the requisite experience, licenses and certifications. Prior to interviewing an applicant, provide them with a copy of your agency’s mission, vision and standards and ensure they understand that you are not only hiring a clinician, but someone who will invest in the agency and its team members.

Many agencies have started using culture assessments to determine whether a candidate’s personality traits align with the agency’s mission, vision and values. Others have incorporated in-depth pre-interview screening phone calls to select applicants with the highest potential for success.

Regardless of which methods are used, a comprehensive applicant examination process will pay dividends by increasing the caliber of applicants interviewed, thus reducing the potential for lower quality employees and reducing employee turnover. It will also serve as a foundation towards building a patient-focused, team-oriented organizational culture.

2. Create an environment that encourages collaboration

One characteristic of high reliability organizations (HRO) is deference to frontline staff expertise. This is because HROs understand and appreciate that the people who are the closest to the work being performed are the most knowledgeable about the work. In HROs, every employee is expected to identify and voice concerns, and they feel comfortable speaking up.

Communicate to everyone in your agency that input is encouraged, but also define the difference between collaboration and consensus. Having a team full of people that say yes, while communicative, isn’t very effective. Instead, challenge your staff to be collaborative and open-minded. It takes courage to challenge the status quo, and your agency is filled with diverse perspectives and fresh ideas. Without feedback from others, your ideas are limited to your own abilities as well as your own bias.

3. Make employee goal planning an integral part of your strategic planning process

We often start the beginning of the year with a list of things we want to accomplish, yet we don’t always have defined strategies or outcome measures that illustrate what success looks like. When creating your agency’s annual strategic plan, consider this: are individual employee goals aligned with the overarching goals for the agency? Agency goals and strategies should cascade down into individual employee goals. This ensures both the agency and the employees have skin in the game.

For example, if one of your annual goals is for your communications center to be recognized as an Accredited Center of Excellence (ACE) by the International Academy of Emergency Dispatch (IAED), individual employee goals should be geared towards specific elements in the Academy’s Twenty Points of Accreditation. This approach ensures employees are responsible for their individual success, which ultimately is the agency’s success as well. Every member of the team should understand the agency’s goals and should be part of the processes to achieve them. Although strategic objectives are established by senior leaders within each agency and administrators are responsible for moving those objectives forward, results must be achieved agency-wide.

4. Recruitment doesn’t stop when the applicant accepts the offer

Healthy organizations understand that in order to continually evolve, they must develop strategies focused on re-recruiting employees. This, at its core is a preventative but necessary measure. Devising strategies aimed at re-recruiting employees creates a service differentiator in the form of loyalty. This competitive advantage fosters positive relationships with peers and agency leadership, which also results in pride in the agency itself.

One re-recruiting approach used in healthcare organizations world-wide is Quint Studer’s high-middle-low behavioral tool. The tool provides a systematic approach for organizations to coach and develop staff. The ultimate goal is to re-recruit employees who role model excellence; coach middle performers with affirming feedback on areas of improvement; and outline performance improvement steps as well as consequences for low performing employees.

5. Exercise engagement

One reason is employees feel like they are not known by the people they work for. Anonymity results in people feeling like the person they report to is not interested in who they are professionally, much less personally. When leaders are inundated with meetings, conference calls and the overall need to get things done, it’s easy to forget to take time and interact with the core of your business: people. Getting to know your team could be the investment opportunity you’ve been missing.

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About the author

Thomas Moore is a senior associate at the EMS/public safety consulting firm, Fitch & Associates. He currently serves as the firm’s contracted director of EMS for University Medical Center in Texas. In addition to coordinating client engagements, his expertise includes system design, operations and technology optimization, EMS economics, data and strategic analysis, and stakeholder relations.

This article was originally posted June 18, 2019. It has been updated.

For more than three decades, the Fitch & Associates team of consultants has provided customized solutions to the complex challenges faced by public safety organizations of all types and sizes. From system design and competitive procurements to technology upgrades and comprehensive consulting services, Fitch & Associates helps communities ensure their emergency services are both effective and sustainable. For ideas to help your agency improve performance in the face of rising costs, call 888-431-2600 or visit