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The best employee you never hired

A guide for hiring for longevity and fit as opposed to the best technician/clinician


The important thing in EMS recruitment isn’t how much you know or what skills you can perform, it’s more about are you a good person and do you want to do good work.


Throughout EMS history, organizations have strived for one of two extremes: hiring the “pulse and a patch” or looking for a clan of technically proficient clinicians who can treat any ailment in the most austere conditions.

However, what both of these models yielded was high turnover rates and subpar patient care delivery models.

What our agency has found is that about the important thing in EMS recruitment isn’t how much you know or what skills you can perform (because we can teach you all of that), it’s more about are you a good person and do you want to do good work.

Here’s what we have done to create and foster a culture of retention and a positive work environment.

Balancing objective and subjective EMS recruit evaluation

First, our agency moved away from the technical skills during our new hire testing process. When we started this venture several years ago, we started with evaluating the skills of incoming providers in a very “skills sheet” oriented fashion.

What we discovered over time was that those students who had recently mastered those technical components of their craft were shining stars, and those who had not visited those lately, not so much. But, that did not yield the results we were looking for.

We had employees who had the ability to memorize a skills sheet but that did not correlate to high quality patient care or retention whatsoever.

We decided to move our testing to more of a scenario-based model. We realized that technical skills, while they are important, could be taught in either our classroom or by our field training officers. However, what we were able to see through scenarios was the ability of the candidates to manage a patient. We could evaluate critical thinking skills and we could see their ability to interact with the patient, bystanders and family.

While this model did introduce more subjectivity, we embraced that. We did put together a list of critical components that we expected the candidates to achieve, however, much like in any freelance environment, anything can happen in those rooms. To compensate, we allowed our panel of evaluators – which included senior medics, field training officers and EMS supervisors – to use their collaborative judgement.

Also, we found that during these interactions, some invaluable interactions occurred, including conversations that often could define a candidate’s future with our organization. These informal conversations between the candidate and our panel led to the creation of a peer evaluation. This was a subjective evaluation in which we included some objective criteria to so we could help determine if a candidate would be a good fit within our system.

Initially, there was a great deal of concern from our HR department, as introducing subjectivity into a hiring process was a scary thought. However, after we explained that this was a small component of the entire process and that there were objective criteria used by the panel, HR became a lot more receptive.

Recruiting EMS providers’ peers

The last piece of our puzzle to foster retention rates and create a culture of growth potential is to encourage our staff to recruit their talented peers to come and join this wonderful atmosphere we have created.

Everyone knows someone in this industry who they believe are great medics or would be a great fit. Find a way to recruit those providers. We found that we were able to recruit about 10 percent of our current staff by recruiting from our providers’ peers.

The benefits are two-fold. First, they get the ability to work with people they know and trust. That is important in EMS. Next, you further create a happy work environment by removing that awkward honeymoon period of getting to know your new work peers.

Since we decided that our turnover rate had fallen victim to the industry standard and decided to make a change, our retention rate has remained over 80 percent in the past two years and counting. We have created a culture of professional growth while maintaining the ability to continue to encourage our young leaders and further challenging our established leaders.

We want to continue to push the envelope and encourage growth from every member of our organization. That is what will keep “butts in seats” and “tires on the road.”

Xavier A. De La Rosa is chief clinical officer for Harris County ESD 11 Mobile Healthcare. He has held multiple roles including for-profit EMS, 911 EMS, flight medicine and EMS-based fire service, and as a lieutenant in the Training Division of Fort Bend County EMS in Texas.

He has a degree in Emergency Health Sciences from the University of Texas Health Science Center San Antonio and a Master’s of Business Administration from Johns Hopkins with concentrations in Private and Public Sector Leadership; and Health Innovation, Technology and Management.