A Good Place to Work

Of the many problems facing EMS, recruitment and retention can seem among the most intractable. Google the term paramedic shortage, and you'll get more results than you can stand to read. There are no easy answers to this situation, but there are agencies out there that have had success in finding and keeping people. What are they doing right, and what can we learn from them? Here we examine some success stories featuring solutions to personnel paucities that are worth replicating.

DON'T FENCE ME IN
Putnam County, FL, isn't on the beach and doesn't have a big city. The county seat, Palatka, barely has 10,000 people. But Putnam County EMS, a paid third service that split from the city fire department 15 years ago, has a waiting list of providers wanting to join.

"We have a lot of good people, and our people keep people here," says Chief Mike Patterson. "You get a bunch of folks with bad attitudes who hate their jobs and their lives, and people aren't going to hang around."

Times weren't always so plentiful or so pleasant. In the early part of the decade, as the service felt the same personnel squeeze as so many others, many employees didn't have shiny, happy outlooks to their jobs. Mandatory overtime, the consequence of a lack of people power, left many unhappy.

"There's nothing more miserable than people being forced to work who want to go home," recalls Patterson.

The first step toward a turnaround came through a campaign of personal outreach to newly minted paramedic students. The department printed recruitment flyers and distributed them to students at state test sites in packets that also included a congratulations letter, a new paramedic patch, county demographic information and a job application. This put Putnam County EMS fresh in the minds of enthusiastic new job-seekers, and distributing the packets face-to-face lent a personal connection that other kinds of recruiting--for instance, mailing information--might not. What's more, there was an unanticipated secondary benefit: Many of those not interested in the packets passed them on to others who were.

"We got quite a few people just on referrals," says Patterson. "I even got some experienced paramedics out of it."

The department has employed the same approach at tech schools around the region. These have become valuable pipelines of students. Putnam County is centrally located, with Jacksonville and its suburbs to the north, St. Augustine to the east and Gainesville to the west. These are all growing areas, and the service facilitates courting their populations by not requiring county residency. As a result, it employs providers from all over North Florida.

As well, those providers aren't required to get their fire certifications (though doing so gets them extra money). The broad idea, in both cases, is flexibility--if you're short on people, you can't be hidebound with requirements that aren't really essential to delivering service.

"You can't paint yourself in a corner with your demands," says Patterson. "If your requirements are unrealistic, you're not going to meet them."

Like an increasing number of services, Putnam County EMS offers opportunities for educational assistance in exchange for a commitment to service. The Florida Association for Rural EMS (FAREMS), of which Patterson is president, also offers grant aid for those willing to work rurally. Putnam also reaches prospective young providers by sponsoring an Explorer post that has yielded current employees.

Workforce studies suggest that career ladders are important to workers. Recognizing that, Patterson doubled the number of officers in his department, from six to 12. They all ride the ambulances, preventing the department from being top-heavy, but the positions represent a road for advancement--the opportunity to "get somewhere" with the service.

When possible, people's talents and interests are incorporated into their jobs. Beyond a direct benefit to the department, this helps keep them passionate about their work.

"I have one guy who's an IT master--he's just gotten us onto electronic run reports," says Patterson. "I have another who's a professional photographer, and he documents the history of the service. Another is mechanically inclined, and we got him certified to do our stretcher maintenance. We've been able to tap into all that talent in the officer corps--they all have projects they work on. And it saves the service a pile of money, because we have all that talent in house."

CREATE A COMMUNITY
Americans fleeing the big cities for the suburbs often take their fire and EMS protection for granted. In the San Antonio suburb of Windcrest (population 5,111), relocating Texans are often surprised to find their first-responding fire service is all volunteer. This makes it an anomaly in Bexar County, which has seen every other volunteer department forced to add paid help.

Yet the Windcrest Volunteer Fire Department has never had fewer than 30 volunteers.

"It's just a matter of always thinking about recruitment and retention in everything you do, even the way you relate to members," says longtime chief Tom Winn, who retired at the end of 2007. "If a guy wants to talk about the last run, you talk about the last run. If someone wants to talk about hog hunting, you talk about hog hunting. You become a friend with your volunteers. I was never called Chief; everybody just called me Tom. It's like with paid departments: You become a brotherhood, and it makes it comfortable to come around."

Windcrest has embraced the comfort concept to an unusual degree: A few years ago, as the service prepared to build a dormitory for its volunteers, a house adjacent to its station came up for sale. It was cheaper to buy the house than build the dorm, so the city helped the department buy and remodel it. They turned the garage into a gym, put a pool table on the patio and added a plasma-screen TV and comfy leather recliners. Then they opened it up to members.

The house now has seven full-time (single) active-member residents, including the city fire marshal, who are always quickly available to answer calls. Besides enhancing the "family" feel, this has also helped cut response times--in one early January call, Windcrest had seven providers, roused at 2:30 a.m., out the door in around two minutes.

Beyond the house, families and friends are always encouraged to come around. Quarterly socials help breed closeness. Unlike Putnam County, Windcrest does generally require its members to live in its response area, but that contributes to a sense of neighborhood and community.

That's reinforced through an annual picnic that raises enough funds to cover the department's equipment needs. Major contributors are recognized through the Windcrest Gold Program, which awards them logo gear to wear to the picnic and around town, promoting the department. They are also thanked with wine and cheese receptions at the station when new pieces of apparatus are purchased. The Gold Program started in 1992 with a couple dozen donors, and has now grown to almost 500. That's a lot of mentions of the Windcrest VFD.

Another step the department took was posting "Served By" signs at town and neighborhood entrances. These inform residents who provides their fire service and EMS first response, tells them they're volunteers, and again works to keep the name familiar. A contact number on each sign makes it easy for the curious to sign up or learn more.

"We got six members off the signs in the first 3--4 months," says Winn. People told us, 'I never knew who my fire department was out here.' They're real surprised to find out we're all volunteer."

Windcrest also fields, among its apparatus, a medically equipped PT Cruiser made available as a take-home quick-response vehicle. This has lights and striping, which makes it a good advertising tool, and also helps cut response times.

Winn discusses these measures and more in an article, It's the Little Things (Success in a Volunteer Fire Department), that appears on the city's fire website (follow the links from www.ci.windcrest.tx.us). A final tip included in that piece is that organizations with newsletters (churches, businesses, civic groups, homeowners' associations, etc.) universally love to have fire and EMS providers contribute to them.

"Then, if you run a little article about something simple like fire prevention, these groups will often ask you to come speak," Winn says. "It's a good way to keep your name before the public, and make sure they understand that you're volunteer and can use their support."

'THIS IS HOME'
In some places, EMS recuitment and retention problems are so bad that state governments have stepped in with programs to assist local services. One of the most developed of these is Virginia's. The state's Office of EMS manages a workforce retention project that provides tools and training to help agencies keep what they have. Chief among these resources is a series of workbooks, Keeping the Best!, offered free to state departments. Available online (www.vdh.state.va.us/oems), they're part of a retention "tool kit" that also includes workforce study findings and worksheets for managing data.

Facing a number of personnel approaching retirement age, the James City County Fire Department agreed last year to serve as a test case for implementing the principles of the fourth workbook, How to Retain ALS Providers: Workforce Utilization Strategies & Applying EMS Retention Principles. The book provides a framework for defining current and desired future ALS workforces, and for developing a plan to get from the former to the latter.

"We have people who live up to 90 minutes away who work for us," explains JCCFD EMS Chief Bob Ryalls. "We want to maintain that, but if the jurisdictions where they live, which are predominantly volunteer, should establish career programs, they might go to them, because they're closer to home. So if that's the case, what can we do to keep them with us?"

Through working closely with workbook producer Renaissance Resources, JCCFD leaders identified several areas for emphasis. Generally, these were internal communications, officer development/advancement opportunities, and simply treating folks the right way and maintaining that important family atmosphere.

On the first point, Ryalls says, rank-and-file employees can't feel segregated from "ivory tower" leadership. Lines of contact have to be open and comfortable to use.

"Historically, people think the guys in administration are in the imperial palace--they make decisions and pass them down and don't really understand the ramifications," Ryalls says. "Well, we've been there, done that and do understand it, but we haven't communicated that well. We need to do better communicating why we make changes and why those changes are beneficial to the organization."

To this end, the department is beefing up its website and internal Intranet, by which employees are notified of news and events. It has also resurrected a department newsletter.

The career ladder is important here as well. In an effort to improve its people's prospects for promotions, JCCFD established an officer development program that drew around three dozen employees when it debuted last fall. It is expected to continue quarterly.

Somewhat relatedly, leaders are weighing creating a medic-only position (currently, all personnel are dual-trained). This would allow them to court ALS providers from surrounding transport-only agencies. When the idea was floated at the state EMS symposium last fall, more than 20 people expressed interest.

"A lot of medics out there may not want to do fire," notes Ryalls, "but would love to get into a system like ours, where they're running emergency calls."

JCCFD is also applying to become a state-sanctioned EMT-I trainer. In Virginia, the workbook notes, the total number of EMT-I certifications is now more than half the number of paramedics. If there are fewer paramedics in the future, authors conclude, EMT-Is will be important to keeping prehospital care levels as high as they can be.

Finally there is, once again, that esoteric but vital family feeling. Simply put, employees are more likely to stick around if they enjoy their coworkers. "You want people to like coming to work," Ryalls says. "There's a broad range of attitudes and experiences and values that you're trying to meld into a good, cohesive group."

Primarily, this is accomplished by a clear, coherent, well-articulated vision for an organization that everyone understands and buys into. It relates to the openness of management and mechanisms for resolving internal conflicts. But secondarily, it also involves the extracurriculars: Do people get along when they're not running calls? Can they function socially and do things together?

JCCFD has seen a resurgence of this kind of off-duty fraternization. Some members are working to put together a flag football team with some police colleagues. There's been talk of a bowling league. In the past there's been softball and volleyball.

The bottom line to all this is creating an organization that is, as Ryalls says, "user-friendly."

"The crews should feel like 'This is home. This is a good place to work'," he says. "We're trying to create a mentality where they're more involved, and don't look at it as just a job. Folks want to be where they feel appreciated and like they're making a true contribution to the organization and community."

CONCLUSION
With recruiting and retention, the devil's often in the details. Big things like salary and benefits are important, of course, but luring and keeping people may come down to the variety of little things you can offer--modest inducements that each make life just a little easier and more enjoyable. Offer enough of the right ones, and ultimately you'll have a darn good place to be running calls.