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Q&A: How to encourage employee growth and maintain high standards

Eve Grau, co-founder of Royal Ambulance, shares the company’s philosophy for cultivating highly-motivated employees and how it positively impacts their agency


At Royal Ambulance, employees are encouraged and given every opportunity to advance their careers through agency alumni panels and scholarships that can be used towards fire academies, paramedic school and other educational advancements.

Photo/Courtesy of Eve Grau

There are many reasons why providers leave, from safety concerns, to the physical and mental toll EMS can take, to outdated technology and policies, disconnected management, and low pay. In our Special Coverage package, “Defying the EMS retention crisis,” learn how to combat these and other retention challenges.

EMT and paramedic retention is one of the biggest concerns for EMS agencies, as high turnover rates plague the entire healthcare industry. According to a study conducted by AAA last year, the turnover rate for full-time EMTs was at 25 percent, which means 100 percent turnover for agencies every four years.

With those numbers in mind, industry leaders are usually focused on trying to retain current employees, not encourage them to look for a different career path, but that’s exactly what the officials at Royal Ambulance strive to do. The agency offers customer service training from the Disney Institute and provides scholarship opportunities for employees that can be used to further their careers, making their employee-centered organization a unique place to work.

Eve Grau, co-founder and director of human resources for Royal Ambulance, sat down with EMS1 to discuss the importance of customer service training and employee encouragement in EMS.

EMS1: Why is it important to encourage employees’ career growth?

Eve Grau: We want our team members to see Royal as a building block instead of a stepping stone. Here’s the difference: Stepping stones are disconnected pieces, implying that one job is merely a necessary intermediary from which one can hop to another job. A building block is a strong foundation upon which one can build future success. We want Royal to be their strong foundation.

Also, being an EMT ain’t easy. It’s a tough job with emotionally straining work and long hours. New first responders need to be able to put their work in the context of their greater purpose. If they don’t, then they risk quickly burning out.

And lastly, let’s not fool ourselves – high turnover is simply a reality in our industry and trying to change that is an exercise in futility. Because we care about our team members and want them to always look back positively on their experiences with us, we see no downsides to encouraging career growth. In fact, it really pays off. Hiring is not a challenge for us – most of our 15 to 20 new employees a month come from referrals. And, we consistently get “Best Places to Work” awards. In 2018, we ranked #38 for in Modern Healthcare. Besides, what’s the alternative?

Our responsibility is to help shape these already-talented young men and women from new first responders to capable, confident and compassionate healthcare professionals with whom one can feel comfortable entrusting their life. We take that responsibility very seriously.

How can EMS agencies maintain high standards in an industry known for turnover?

First and foremost, our interview process identifies those who already embody our values. They must be adaptable, engaging, empathetic and driven. These qualities are very hard to teach, especially when you may only have someone for a year or less.

Once a month we have what we call New Hire Academy – a mandatory four-day intensive for new employees focused on clinical skills, customer service, patient experience and culture. During this time, our CEO personally meets every one of our 15 to 20 new hires to understand their future aspirations so that we can personalize their experience at Royal to support their goals.

After Academy, new hires are assigned to a field training officer that is chosen based on similar career aspirations, observed teaching and learning styles and, of course, matching schedules. We encourage our new hires to see our FTOs not as managers, but as mentors. This results in quicker learning and a more compatible engagement.

Most importantly, we have a system that recognizes employees for their achievements, including:

  • Four substantial scholarships a year for our EMTs that can be applied towards the fire academy, paramedic school, a PA program or similar educational program of their choice.
  • EMTs give their partners praise on Facebook Workplace. We have three to five new public shout-outs every week.
  • During our exit interviews, one of the questions is, “Are there any team members that you want to give props to?” This question has never been left unanswered and the praise we receive is always documented and made public to the rest of the team.
  • We have an annual awards ceremony recognizing outstanding performance.
  • Every year, we have multiple employees nominated for the California Ambulance Association’s “Star of Life” award.

We don’t want our employees to ever question whether they are appreciated, whether they matter. We want them to always know that we see and value their hard work. The positive effects on performance, culture and general happiness levels can’t be understated.

What are the qualities Royal Ambulance looks for in potential recruits?

Most candidates don’t have much (or any) clinical experience so we’ve learned to look beyond a purely skill-based assessment.

We tell every interviewer to ask themselves the following about each candidate:

  • “If your grandma had a stroke, would you entrust this person with her care?”
  • “Would you feel comfortable spending 10 hours in an ambulance with them?”

This tends to put things into greater perspective.

We also ask every candidate to tell us about specific times in their lives (personal or professional) when they had to:

  • Deal with stress under conditions of uncertainty
  • Make a compromise to achieve an outcome
  • Show compassion to someone that they didn’t necessarily agree with or even like

By asking for specific examples instead of putting them in purely hypothetical situations, we get real insights into their core behaviors, beliefs and values, and gain an understanding of whether they fit ours.


Photo/Courtesy of Eve Grau

How does the Disney Institute help train EMTs?

When you think of memorable experiences and outstanding customer service, nothing quite beats your first trip to Disneyland. The characters, the rides, the food, the actors – everything and everyone goes above and beyond to accommodate.

We worked with Disney Institute to bring a little bit of that magic to the patients and healthcare professionals we serve.

They taught us to understand that everyone we interact with goes through a unique journey – our patients, our providers and our EMTs. Along those journeys, there are common critical junctures or touchpoints.

Disney taught us to pay attention to every touchpoint and identify opportunities to elevate those moments and experiences. We instill this philosophy into all of our EMTs because their insights on our process and how it can improve are critical to our success. This way, not only is every EMT a brand ambassador, but also a researcher providing valuable data to our dedicated patient experience team.

This service training gives our EMTs skills in customer and patient experience that will be invaluable to them no matter where they choose to go after, because the cornerstone of any healthcare interaction is empathetic communication.

How does Royal Ambulance help employees get to the next stage of their careers?

One of the unique benefits of working at Royal is our active and supportive Alumni Network.

Because we have very high employee satisfaction and keep our alumni engaged online and at our in-person events, they tend to remain active parts of our community, even years after they have officially moved on.

This makes it easier for us to call on them to help out current employees – be it with career panels for current EMTs, such as our Firefighter Panel, with job shadowing Royal Alumni PAs or with job referrals and introductions. This goes both ways – Royal Alumni can also reach out to Royal for help anytime, be it with introductions, advice or other matters.

By building a strong community based on respect, compassion and reciprocity, we’ve essentially built a peer-to-peer engine that helps our team members continue their personal and professional growth wherever their paths lead them.

How can other EMS agencies innovate their retention strategies?

If you’re looking to build innovative processes that improve recruitment, retention or general business practices, you can’t be myopic and limit your research to the EMS bubble.

If you want to be great at customer service, ask the best – like Disney.

If you want to build new products or services that differentiate you from your competition, see what Silicon Valley’s most innovative tech companies are doing and figure out how you can apply that to your business. We took a page from user experience research best practices by consistently getting customer feedback and iterating on our services.

Or, if you want to improve your processes and get alignment with your customers, follow the example of the world’s most forward-thinking healthcare institutions and adopt the Lean model – a method for increasing efficiency, simplicity and transparency while eliminating practices that waste time or resources.

In this day and age, staying within the EMS bubble will prove severely detrimental to the growth of your EMS company. But, at the same time, it’s not just about following trends – you need to be able to identify what’s really helpful and what’s just another shiny object.

For EMS, the core of our business is people; patients, providers and team members.

As such, there must always be a steadfast focus on the human element and on building a strong culture that everyone on your team can get behind. If your team is happy, your patients are happy and your customers are happy, then you’re already winning.

About Royal Ambulance

In an industry where punctuality, safety and patient throughput are the baseline of performance, Royal strives to be much more.

We seek to overdeliver on each patient journey by creating truly exceptional experiences. For our customers (the health care facilities and respected hospitals we serve), Royal desires to be a valued partner adding a premium perception to their businesses.

For their patients, we strive to be the highlight of their day, treating them royally through our EMTs empathy and positive nature. We innovate unique ways to better serve our customers and their patients. As a company, we support each other like family.

Rachel Engel is an award-winning journalist and the senior editor of and In addition to her regular editing duties, Engel seeks to tell the heroic, human stories of first responders and the importance of their work. She earned her bachelor’s degree in communications from Cameron University in Lawton, Oklahoma, and began her career as a freelance writer, focusing on government and military issues. Engel joined Lexipol in 2015 and has since reported on issues related to public safety. Engel lives in Wichita, Kansas. She can be reached via email.