Getting Them&

Keeping Them

The “4 C’s” of Recruitment and

RetentionPresenter:Matt Zavadsky, MHAEMS Director, Volusia County FloridaAdjunct Faculty, University of Central FloridaCollege of Health and Public Affairs

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Causes of HealthcareWorker Imbalance

Tub is the ‘pool’of positions...If workers entering

the pool….

…are the same asthose leaving….

Everything’s cool

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More workers goingdown the drain...

Too few from thefaucet...

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But, there is a 3rd Phenomena

ABiggerTub!

More positions open for medics….

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Bigger Tub?

Paramedics in the Hospital?--Pennsylvania College of Emergency Physicians - EMS Committee(draft version 0.1 Wednesday, April 24, 2002)At the April meeting of the EMS Committee, we discussed the topic of paramedic’srole, if any, in the hospital. More and more hospitals are looking at paramedics as aready source of trained medical personnel – and given the current nursing shortage,they’re looking at them very hard. We did come up with a resolution that weapproved unanimously and passed on to the Board forreview:Given the current shortage of trained staff, PaACEP recognizes the need fortechnicians in the Critical Care Unit and Emergency Department. If training and certification for such technicians is developed, EMT-paramedics shouldbe given full credit for their training and experience for such certification.

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• 120 page Bill in last legislative session– Included allowing Medics in the

hospital WITH full ALS capabilities• vs. the usual ‘tech’ job

– Got the ENA to agree with the Bill

They’ll be back...

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Effects of the Paramedic Shortage?

“Paramedic shortage slows response times

Sunstar EMS has missed its goals for months, but says the lagisn't a danger to patients.” By LISA GREENE, Times Staff Writer © St. Petersburg Timespublished March 9, 2003

A shortage of paramedics is the key reason ambulances have been takingtoo long to arrive at medical emergencies, say managers for American Medical Response,the company that runs Sunstar under a $21-million-a-year contract with the county. The company is offering $3,000 signing bonuses and hopes to hire 20 paramedicsand 20 emergency medical technicians.

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Based on Type of Agency?

“Paramedic shortage in Louisville

WHAS News

LOUISVILLE (KY) — A shortage of paramedics is creating an emergency

for Louisville's fire department. Louisville's EMS is so short-handed that

paramedics are working more mandatory overtime hours than ever before.

And that's driving many people away from the job.

It has also forced the city's fire department to change how it responds to

emergencies. Some firehouses no longer have a paramedic.

The fire chief says he's had to move ambulances and people around to

maintain adequate coverage. Right now the fire department has about

15 openings for paramedics. However, because certification usually takes

about a year and typically, fewer than 50 percent pass the test,

it will take time to fill those slots.”

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Based on Location??

“Ambulance crews piling up overtimeA union official worries it's only a matter of time before fatigue causes an accidentBy: GEORGE F. LEE

A chronic shortage of emergency medical workers had those in Honolulu working collectively an average of 200 hours a day of overtime last month. The emergency medical workers who operate Honolulu's 16 public ambulances collectively worked an average of 200 hours of overtime a day last month, according to records obtained by the Star-Bulletin.”

The Honolulu Star-Bulletin

What is the real scarypart of this headline?

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Effects...

Shortage of paramedicsthreatens emergency rating

Josh Hafenbrack <jhafenbrack@dailymail.com>

Daily Mail Staff Wednesday October 02, 2002 A shortage in licensed paramedics is "a critical staffing problem that is blooming" in the Charleston Fire Department and could put the city's status as the highest level emergency care provider in jeopardy, a state analyst said.

In fact, the word "paramedic" has been erased off the city's emergency service vehicles, an acknowledgement that paramedics might not always be aboard ambulances.

What's more, paramedics lose the extra pay as they move up the department ladder. Once paramedics are promoted to a lieutenant position, they lose half of the yearly paramedic pay. And when they make the next jump to captain, all $1,800 is revoked.

What’s up with THIS??

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Answers?

Critical shortage: Rescuers neededMore firefighters need to be trained paramedics, fire chiefs say. To meet that need, Pasco-Hernando Community College is expanding its programs.

By JAMIE JONES, Times Staff Writer © St. Petersburg Times

published February 24, 2003

To get more paramedics: -- Pasco-Hernando Community College has agreed to reserve 20 slots in its upcoming paramedic class for firefighters working in Pasco or Hernando counties who want to take the year-long course. -- Pasco County commissioners have agreed to give paramedics a 15 percent pay raise, rather than 10 percent. -- Lopinto is offering a medical-terminology class, required for any firefighter wanting to become a paramedic. Currently, 25 Pasco County firefighters are taking the course. -- And Lopinto has agreed to let at least two firefighters on each shift attend a paramedic classes while on duty.

To qualify, firefighters must have six years of experience with the agency.

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Answers?

Sunday, January 26, 2003 Paramedics seek improved benefits By mailto:sishikawa@honoluluadvertiser.comScott IshikawaAdvertiser Staff Writer

In an effort to help deal with a paramedic shortage, cityEmergency Medical Services Division workers are pushing abill this legislative session that would give them the same minimumretirement benefits as police officers and firefighters.

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Why Men Should NOTBaby Sit

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“4 C’s” of Recruitment& Retention

Company

CompensationCareer

Community

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Company...

• Reputation– Successful?

• Either public or private• Loved, not so loved….

– Innovative?• MCT’s, advanced clinical procedures,

liberal protocols• Nice vehicles• “Friendly” SSM plans

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Examples...SCOTTSDALE, Ariz. (March 19, 2003) -- Rural/Metro Corporation was recently awarded a significant work force development grant {$450,000} from the Arizona Department of Commerce to help train new and existing employees.

SCOTTSDALE, Arizona (April 24, 2003) Rural/Metro Corp. Thursday announced it was awarded a contract renewal to continue providing emergency and non-emergency ambulance service in Fort Worth, Texas, and 12 surrounding communities.

SCOTTSDALE, Arizona (April 9, 2003) – Rural/Metro Corporation (Nasdaq: RURL) announced today that its Southwest Ambulance division has been awarded a new $25 million multi-year contract to become the exclusive ambulance provider for Doña Ana County, New Mexico,

including the greater Las Cruces area.

GREENWOOD VILLAGE, CO, May 19, 2003 – To kick-off Emergency Medical Services Week 2003, medics from American Medical Response, along with representatives from the American College of Emergency Physicians and other fellow EMS workers will open The NASDAQ Stock Market today.

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Examples...PRIDEMARK OFFERS CAMP 9-1-1Arvada, Colorado (January 16, 2003)Pridemark Paramedics will offer Camp 9-1-1 free to the first 25 students to register for its annual two-day camp. Campers get the opportunity to interact with paramedics, fire department personnel, SWAT team members, and police officers. This two-day camp is action packed with activities teaching children ages 10 –14 about different types of emergencies and what they can do in the event of an emergency. In addition, campers learn the importance of bike safety and helmet use. Pridemark paramedics and emergency medical technicians coordinate the activities of this two-day camp.

EMS Tactical MedicsPridemark's Tactical Paramedic Program provides Paramedics to the Boulder County Sheriff's Department S.W.A.T. Team.

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Company...

• Employee friendly?– Flexible shifts

• Ease of “swaps”

– Liberal benefits• Benefit as perceived by the employee

• Family friendly?– Top 25 Companies for “Working

Families”– More focus post 9/11 on family values

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Bike Medic Programs?

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Innovative Recruitment

• Start INTERNALLY– ALBANY, N.Y., December 12, 2002 - Albany Medical Center officials

were presented with a $75,000 symbolic check today from Tom Geisel, president of KeyBank N.A.'s Capital Region District, to support the Medical Center's innovative nursing recruitment program, "Growing Our Own." Albany Med'¦s Growing Our Own" program enables the Medical Center to offer as many as 30 employed licensed practical nurses (LPN) and other health care workers the opportunity to enroll full-time in an associate degree nursing program in the department of nursing at Hudson Valley Community College. Eligible students receive full tuition reimbursement and a stipend to allow for a reduction in hours worked, in exchange for committing to work for a fixed period of employment at the Medical Center immediately following

graduation.

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Innovative Recruitment

• Look to Non-Typical Sources…Rural/Metro to train, hire welfare recipients

– ORLANDO -- Rural/Metro Medical Services plans to start training -- and then hiring -- welfare recipients as emergency medical technicians and paramedics. Rural/Metro provides ambulance service for most of Orange County. "We will guarantee them a job after they get certified," says Kathy Putnam, spokeswoman for Rural/Metro. The pay for EMTs ranges from $7 to $10 per hour, while paramedics make $9 to $13 an hour -- quite a bit higher than the minimum wage jobs many former welfare recipients end up with, says Putnam. The training program will have room for about 20 people who have good driving records and who pass a background check, and is expected to begin in mid-June. The program currently is being developed with Valencia Community College and the University of California-Los Angeles.

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Innovative Recruitment

• Look GLOBALLY– Innovative programs help newcomers overcome the massive

hurdles of Canadian practices and jargon

• In 2001, an innovative organization called CARE for Nurses -- short for Creating Access to Regulated Employment for Nurses -- was launched in Toronto. Designed to help foreign-trained nurses prepare for the licensing exam, it is operated jointly by the provincial government, local employers, community colleges and the regulatory body, which helped fine-tune the curriculum.

• Nursing recruitment has been global for a long time– Perhaps it’s time for EMS to do the same???

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More Recruitment Ideas...

• Reciprocity…– Does your state accept other medic

certifications or National Registry?• Ease of recruitment• If not, lobby for change

• Medic programs– Community College?– In-house?– On-line?

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Career...

• Why do employees at fire agencies stay for 20 years?– Career ladder– Regular promotions - advancement– Shifts!

• This is crucial for the long-term planner– Private companies may have a challenge…

•But…. You can do it!

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Public Safety...

• Firefighter / EMT• Paramedic• Engineer• Lieutenant• Captain

• Battalion Chief• Deputy Chief• Assistant Chief• Chief• City / County

Admin

It helps if there are examples in your agency...

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EMS Ladder...

• EMT / Driver• Paramedic• FTO• Preceptor• Field Supervisor

• Shift Supervisor• Manager• Director• Vice President• President / CEO

Examples here are helpful as well

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Mobility...

• Turnover a major issue in most non-fire-based agencies– Actually, an issue there recently as well

• Most ‘kids’ stay 2 - 3 years– Either move to larger agency, or– Into other areas of healthcare

• Need to build a rapid career ladder– Maybe to stay 3 - 5 years

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Compensation...

• Balancing act– Cost of employment– Cost of turnover– Straight vs. O/T pay

• Best balance is what keeps you within budget– With both O/T and benefits

Short-term mentality….

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Compensation & Career

• If turnover is high… Start with a simple goal– Start with either focus group or

anonymous surveys– Learn what your existing employees

want• They will be your best info source (and

best recruiters!)

– Recent experience...

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Out of the BoxCompensation Plan

• Goal– Double current tenure– Increase employee satisfaction– Motivate to be “best of the best”– Create community service army– Develop motivated employees

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Rural/Metro pilots new wage planA new effort to attract & retain employees Rural/Metro Corp. recently instituted a new “step compensation” plan at two locations. If it proves effective in attracting and retaining employees, other Rural/Metro operations will be encouraged to adopt the plan as well.

Rural/Metro of Central Florida in Orlando scrapped merit raises April 12 and began paying paramedics and EMTs based on the value they add to the organization. With the help of local administrators, field supervisors and medics, Rural/Metro created four job levels for EMTs and five for paramedics. Each level carries certain performance requirements and demands practical, operational and individual proficiencies.

Matt Zavadsky, Rural/Metro of Central Florida's regional manager, is convinced the plan will pay off for the company in lower turnover, reduced overtime and sick leave, fewer mistakes and vehicle crashes and highly motivated employees. “We were investing a ton of time and money in employees, and just when they got good they'd leave,” he said. “So how do we make it worth their while to stay? And how do we reward outstanding

employees for what they bring to our organization?” “Two weeks after the plan was rolled out, five part-time employees said they would [switch to] full-time, and some people who had left applied to return,” said Kathy Putnam, Rural/Metro's public affairs manager in Orlando. “It's motivated a lot of people to take extra programs,” Zavadsky said. “For example, we suddenly have 40 to 60

people who want to take a PHTLS instructor class.”

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The Plan...

Base levels determined by salary survey

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EMT Level I Proficiencies EMT Level II Proficiencies

Practical Independently conducts assessment, triage,

treatment, and documentation at EMT levelin accordance with local protocols/guidelines.

Completes assigned shifts with nodiminishment in performance of skills orproficiencies.

Demonstrates ability to independently locateon a map and navigate to specified locationswithin specified time frames.

Identifies R/M Purpose and Core Values.

Operational Meets deadlines, follows guidelines. Avoids actions that might damage or incur

loss of equipment and/or facilities.

Individual Responds constructively to feedback. Communicates professionally. Treats others with respect.

All Level I Proficiencies

Practical Meets or exceeds Level II Quality Assurance

review standards. Follows R/M policy, work rules, and protocols.

Operational Assists partner with completion or review of

run tickets and reports. Uses resources effectively; avoids waste

and/or duplication of effort.

Individual Demonstrates cooperation when working with

others. Adapts to policy/procedure changes. Maintains composure/acts rationally in

stressful situations. Diffuses conflict situations instead of

escalating them.

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EMT Level III EMT Level IVThese EMTs have demonstrated intricate knowledge of theOrlando Market and the Company. They take an active role intheir development and respond well to regular coaching.

These EMTs require little or no direct supervision. They supportand perpetuate Company philosophy, and actively assist in thedevelopment of others.

Must maintain all Level II criteria*

Must possess and maintain CPR-Instructor status and teach atleast 10 hours/quarter or FTO status and regularly acceptstudent and new employee riders.

Must have worked a minimum of 1560 hours and 9 months atLevel II.

Applicants with >3 yr. exp. in similar markets may be hired intothis level.

Volunteers to work extra shifts and special events regularly. Volunteers on at least one (1) community enhancing board or

on-going effort.

Must maintain all Level III criteria*

Must possess and maintain an Advanced Instructor certificationand teach at least 20 hours/quarter.

Must have worked a minimum of 2080 hours and 12 months atLevel III.

Volunteers and actively participates on company committees ona regular basis.

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Level III Proficiencies Level IV ProficienciesAll Level II Proficiencies

Practical Meets or exceeds Level III Quality Assurance

review standards. Manages complex incidents.

Operational Responds quickly and efficiently to

expressed needs of patients, health careproviders, and other staff.

Takes the initiative to start and completeneeded tasks without awaiting direction.

Demonstrates innovative problem solvingwith teams and peers.

Individual Displays efforts to understand perspective of

others. Anticipates service problems and takes

action to avoid them.

All Level III Proficiencies

Practical Meets or exceeds Level IV Quality Assurance

review standards. Assists other staff by demonstrating skills and

sharing knowledge beyond what is normallyshared during patient care.

Identifies issues and offers solutions toimprove processes or solve problems.

Operational Demonstrates knowledge of R/M business

plans, strategy, and the concepts of freeenterprise and integrated partnerships.

Responds quickly and efficiently to anticipatedneeds of patients/families, heath careproviders, and staff.

Generates increased/new business frompromoting operation’s Health and SafetySolutions.

Individual Initiates formation of teams in the field and/or

in the workplace. Empathizes with others.

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Level I Paramedic Level II ParamedicThese Paramedics are able to functionindependently in the field without constantsupervision. They require frequent feedback tolearn about the area's EMS system, and theCompany.

These Paramedics have demonstratedfamiliarity with Orlando’s EMS system. Theyrequire regular feedback and respond tocoaching.

Must possess and maintain:*

Paramedic Certification(s) BLS CPR and ACLS Certification(s) Appropriate attendance at required CME/in-

service training Zero preventable driving and safety incidents

Must maintain all Level I criteria*

Must possess and maintain an advancedcertification such as BTLS or PHTLS. Forimplementation, employees slotted to thisstep must take the first available course ofstudy.

Must have worked a minimum of 520 hoursand 6 months at Level I Paramedic, and/orhave been a Level III or Level IV EMT

Less than 4 late arrivals in 26 weeks. Agreeably stays late to cover needed hours. Volunteers for overtime occasionally Applicants with >2 yr. exp. in similar markets

may be hired into this level

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Level I Proficiencies Level II Proficiencies

Practical Independently conducts assessment,

triage, treatment, and documentationat Paramedic level in accordance withlocal protocols and guidelines.

Demonstrates ALS preparation/set-upfor partner crew member(s).

Completes assigned shifts with nodiminishment in performance of skills.

Demonstrates ability to independentlylocate on a map and navigate tospecified locations within specifiedtime frames.

Operational Meets deadlines, follows guidelines.

Avoids actions that might damageequipment and/or facilities.

Identifies R/M Purpose and CoreValues.

Individual Responds constructively to feedback.

Communicates professionally.

Treats others with respect.

Maintain All Level IProficiencies, plus:Practical Meets or exceeds Level II Quality

Assurance review standards.(includes documentation accuracyand protocol compliance).

Follows R/M policy, work rules, andprotocols.

Operational Assists partner with completion or

review of run tickets and reports.

Uses resources effectively; avoidswaste and/or duplication of effort.

Individual Demonstrates cooperation when

working with others.

Adapts to policy/procedure changes.

Maintains composure/acts rationallyin stressful situations.

Diffuses conflict situations instead ofescalating them.

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Level III Paramedic Level IV ParamedicThese Paramedics have demonstrated familiaritywith the Orlando Ambulance Market and theCompany. They take an active role in theirdevelopment, and respond well to regularcoaching.

These Paramedics require little or no directsupervision, and support and perpetuateCompany philosophy. They actively assist inthe development of others as FTO’s andinstructors.

Must maintain all Level II criteria*

Must have worked a minimum of 1560 hoursand 9 months at Level II Paramedic

Applicants with >5 yr. exp. in similar marketsmay be hired into this level

Volunteers for extra shifts and special eventson a regular basis

Volunteers on at least 1 community enhancingboard or on-going effort

Must maintain all Level III criteria*

Must possess and maintain CPR-Instructorstatus and teach at least 10 hours/quarter orFTO status and regularly accept student andnew employee riders.

Must have Medical Director’srecommendation

Must have worked a minimum of 2080 hoursand 12 months at Level III Paramedic

Volunteers on at least 2 community

enhancing boards or on-going efforts.

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Level III Proficiencies Level IV Proficiencies

Maintain All Level IIProficiencies, plus:

Practical Meets or exceeds Level III Quality

Assurance review standards (includesdocumentation accuracy and protocolcompliance).

Manages complex incidents.

Identifies benefits and risks associatedwith administering or withholdingAdvanced Life Support in variousoutlined scenarios.

Operational Responds quickly and efficiently to

expressed needs of patients, healthcare providers, and other staff.

Takes the initiative to start andcomplete needed tasks withoutawaiting direction.

Individual Explains need for and benefit of

performed procedures to patients andothers on-scene.

Anticipates service problems, andtakes action to avoid them.

Maintain All Level IIIProficiencies, plus:

Practical Meets or exceeds Level IV Quality

Assurance review standards(includes documentation accuracyand protocol compliance).

Assists other staff by demonstratingskills and sharing knowledge beyondwhat is normally shared duringpatient care.

Operational Identifies issues and offers solutions

to improve processes or solveproblems.

Demonstrates knowledge of R/Mbusiness plans, strategy, and theconcepts of free enterprise andintegrated partnerships.

Responds quickly and efficiently toanticipated needs of patients/families,health care providers, and staff.

Individual Initiates formation of teams in the

field and/or in the workplace.

Serves as a FTO and regularlyaccepts students and newemployees.

Empathizes with others.

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Level V ParamedicThese Paramedics have demonstrated masteryof all aspects of EMS. They function asParamedic Preceptors, and are models ofprofessionalism and commitment.

Must maintain all Level IVcriteria*

Must possess and maintain an AdvancedInstructor certification and teach at least 20hours/quarter.

Must have Medical Director’s recommendation Must have worked a minimum of 2080 hours

and 12 months at Level III and/or IVParamedic

Must teach regularly for credentialed EMSrelated programs

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Level V Proficiencies

Maintain All Level IVProficiencies, plus:

Practical Meets or exceeds Level V Quality

Assurance review standards (includesdocumentation accuracy and protocolcompliance).

Assists students/trainees andcoworkers with skill and knowledgedevelopment.

Operational Explains accurately R/M business

plans, rationale, and concepts of freeenterprise and integrated partnershipsto coworkers and clients while on thejob.

Maintains zero Written Warnings forviolation of R/M policy and work rules.

Individual Gives feedback to partner crew

members and/or students/trainees bystating constructive purpose forfeedback, identifying the specificactions to reinforce or correct, andrelating helpful suggestions.

Serves as a Paramedic Preceptor andregularly precepts new paramedicinterns.

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Other Compensation Ideas

• Benefits?– The 20 something mentality– Consider the cost of employee benefits– Offer an “opt-out” provision with higher

$ pay• ARGH!!

• ‘Standard’ referral and sign on bonus– Consider referral bonus 50/50 after 2

years

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A Case for Dental Benefits

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Community

• More than just ‘location’– Recall Hawaii? and Clearwater / St.

Pete?

• Quality of life– Cost of living (incl. Housing)– Education– Traffic congestion– Crime stats

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Social Deterioration

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Recreation...

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Central Florida…?

Metro Orlando grows by 347 a dayMay 22, 2003

ORLANDO -- Even in tough economic times, metropolitan Orlando grew at a pace that added 347 people a day in 2001, with about one in five coming from abroad, according to figures released Wednesday.

Daytona Beach OKs deal to revamp its BoardwalkMay 22, 2003 DAYTONA BEACH -- A $115 million plan to redevelop the city's historic but blighted Boardwalk was unanimously approved by the City Commission on Wednesday night.

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Home...

• Making the community better for your employees– A place to where people want to

come

• Become part of the solution– “Decisions are made by the people

who show up!”

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Summary

• The medic shortage is here to stay• It will get worse, before it gets

better• Difficult decisions ahead

– Need innovative solutions and FULL TIME attention

• Work on your ‘4 C’s’ and become part of the local solution...

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