Okay, so a few days have passed since I left my private ambulance job.  I have expressed my feelings about what happened.  I have probably displayed too many feelings and too much expression.  But now comes the part where I try to learn from this experience and try to pass on some wisdom.  This post will have information for managers as well as employees.  When applying for an EMS job, it is very important to not get into a mindset where you are desperate for a job and will take anything that comes along.  You may be leaving a job that you consider to be undesirable, but you may be leaping from the frying pan into the fire.  EMS managers are often so detached from their employees that they have no idea how bad things have deteriorated.  There are lessons to be learned from both sides of the fence.

First of all, it is important to remember that an EMS manager never fails on purpose.  Sometimes I think most employees think that a bad manager sits in a smoke filled room in the back of headquarters, wringing his hands, planning the next evil plot that will lower morale.  Nothing could be further from the truth.  No one looks in the mirror thinking that he is staring at an evil man.  No one curls his mustache, or says, “Muahahahaha!” when writing the next ineffective policy.  No matter how ineffectual your manager is, he or she actually thinks they are doing the right thing.  What the employee has to assess is the level of denial that is allowing the situation to occur as well as the barriers between the employees and the manager that affect the situation.  Knowing that the manager did not fail on purpose doesn’t absolve him from culpability.  But it will give the employee more insight into how to handle the situation.

Employees are often part of the problem too.  How many people in your organization do you consider to be lazy or incompetant?  Chances are almost everyone reading this can name a few names if given the chance.  Do you think that these employees look into the mirror and say, “Yep, you’re part of the problem.  You have no idea what the hell you’re doing.”  I heard a comic explain this perfectly once.  He said, “I can get up on stage and do a rant on how 90% of the human race is complete retarded.  I can do this rant in front of a packed house full of thousands of people.  100% of them will laugh.  If anyone in the audience was being honest with themselves, only 10% of the audience would be laughing.”

So what makes a well meaning manager fail so badly?  The same thing that will make an employee fail, poor training and poor information.  How many EMS supervisors or managers do you know who have some sort of degree or formal training in management?  Chances are that very few people in your organization have had any management training before they accepted their position.  I takes three to six months to go through EMT school.  It can take up to two years to achieve paramedic licensure.  Most supervisors are hired for their skill as a practitioner and their professional demeanor with no formal training and no licensure.  This does not necessarily translate to good management skills.  Managers are often picked from this pool of supervisors and the result is that the person running the service is not in the least bit qualified to perform his or her job. 

EMS management can be overwhelming.  The job is vastly different than a field position.  Applying policies to a service is much like administering a drug to a patient.  The policy will have an effect on the physiology of the service, and it is up to the practitioner to decide whether the possible complications of the treatment are worth the side effects.  As a new manager, one sees many problems for the first time of which he or she was unaware.  The first instinct is to pounce on this and make your mark.  However, not everyone who walks with a slight limp needs knee replacement surgery.  Every policy you write will be viewed with scrutiny as an imposition.  Do not do this without good reason.  When you do make a change, try to put a human face to it.  Employees don’t need to know everything, but telling a few key people that “it is harder to get into the stock room now because loss from this room is probably the biggest unnecessary expense we have” goes a lot farther than simply changing things so that the night crews can never get to stock.

Management should also resist the urge to please everyone.  I once heard that, “You should try to please the masses as a whole.  It is inevitable that you will anger a few.  If you have delighted anyone, then you have probably made an error.”  This is true in most cases.  People will not usually be delighted with anything you do, but cautiously optimistic at best.  It takes time to gain trust and make truly popular decisions.  Making everyone angry is not your goal either.  Most employees simply want to work in a safe, well equipped environment, do what they were trained to do, and get paid a decent wage.  If you can provide that about 80% of the time you will be doing well.

So what went wrong with my last job?  The management staff had almost no experience, very few resources, almost no training, and a minuscule budget.  This isn’t a good recipe for success.  The mature employee looks at a management job not as a position, but a project.  The mature manager thinks, “I am being hired to accomplish ____________.  Is this a good fit for me?  Have I been given the right tools for the job?  Is this possible, or is failure inevitable under these circumstances?”  If the project seems sound with the available resources and the compensation is reasonable, accept the project.  In contrast, the immature employee will look at the position as a title, or a promotion.  They have daydreams of walking around with everyone’s respect and admiration.  They have not given a thought to things like budgets or resources.  He or she is only dreaming of the social ramifications of the position.

Unfortunately, private ambulance services are filled to the brim with new and inexperienced people.  Compensation is dictated by profits, and this usually means low wages for people beginning their careers.  This creates a very shallow pool from which to pick management candidates.  The maturity level of the applicant will be a reflection of who was hired to do the field jobs.  This creates an out-flux of good employees while they pursue jobs at other services with better pay and benefits.  The employees left to apply to management positions are immature and inexperienced people with zero management training who desire the position because of their daydreams of being the boss.  If this filter is allowed to remain in place for a few years the service will be poisoned beyond repair.

Employees wishing to apply to other EMS services should keep this in mind.  If you have just obtained your certification, you may have no choice but to work for one of these private filters, but that doesn’t mean you have to stay there very long.  Separate yourself from the crowd by learning about your craft.  Participate in problem solving, and network to leave this filter as soon as possible before you become a dreg.  In many towns where the emergency services are separated from the private filters, being employed at one of these places for too long can create suspicion when you do finally apply for a 911 service.  I have been consulted about many candidates and the questions is usually, “Why did they spend the last four years at a private?  Didn’t they ever want to do something else?  Why would they put up with that?”

How are you supposed to spot when bad things are happening?  Well, is there a 20 foot brick wall between management and the crews?  If there is, there is probably a reason.  Management can get into a spiral where every decision they make creates more animosity.  The more tension exists, the less management wants to actually talk to crews.  At the first service for which I worked, all managers had an open door policy.  They loved to talk to employees.  There was even something called the employee advisory committee which was a meeting held every two weeks where employees could come and have the attention of management for two hours while ongoing problems and solutions were discussed.  The common catch phrase of every supervisor was, “My job is to help you do your job!”  No one was afraid to call for help or ask a question.  The environment was wonderful, and was obviously indicative of a healthy service.

Lets contrast my last job.  I worked there for seven months and still cannot name the Medical Director.  Most employees could not recognize the Regional Manager who worked in our building.  Some employees knew that I was familiar with him, and would point and ask questions, “Who is that guy again?  What is his position?”  Crews were not allowed to post at base.  If they were caught posting at base they were actually turned away and made to go post at a nearby intersection.  The further they drifted from the average field employee, the more they looked at them as the enemy.  The more they looked at them as the enemy, the less they cared about what they thought.  After awhile everyone kept their eyes to the ground, read the memos next to the time clock, took their cardboard box and hit the road without asking questions.  The results were miserable.

And so concludes this series.  Do you work for a service like this?   Do you manage a service like this?  Look in the mirror.  Look hard.  Take a deep breath.  Something is wrong.  What are you going to do about it?

Soon I will be writing a post about what can happen in a town where poorly run private services feed the separate 911 service for years.  In this case, one service can poison another over the course of years through a strange toxic symbiotic relationship that benefits neither.  Stay tuned.