Progressive Discipline and the EMS Manager

You are the new director of operations for a medium-size ambulance service delivering emergency and non-emergency services. During your first monthly meeting with your field and office supervisors, you ask for a report on personnel issues. Among the expected notes of occasional tardiness and the perennial disagreements between dispatch and road crews, there is a customer service complaint filed by one of the local hospitals about a transport crew. When the chief field supervisor is queried about actions taken, she answers that since the two EMTs were known for their "bad attitudes," both were suspended for a week without pay. Momentarily startled by this extreme measure, you ask if these providers had ever received other counseling or disciplinary remediation for similar behavior in the past. As the supervisor slowly shakes her head, you ask, "Don't you use a progressive disciplinary process?" Judging by the vacant looks you get from her and the others around the table, the answer is obvious. You jot down a note to have a one-day seminar for this group on progressive discipline as soon as possible.

Introduction

EMS supervisors and managers face many personnel situations that they are less than comfortable handling. Because of the practice of promoting the best field providers into positions of authority, the majority of lower and middle-management EMS officers have not received any training or education on how to handle even the most minor issues related to an agency's most important commodity-its staff. A common, and potentially damaging, shortcoming is the inability to appropriately mete out discipline. This includes addressing infractions ranging from not wearing a complete uniform to routine absences/tardiness to medical care competencies and patient safety issues.

Discipline in EMS

The lack of proper management education regarding discipline can lead to a well-deserved reputation that it is inconsistently handed out, used as a vehicle to "settle scores," and, on the whole, is largely ineffective at changing behaviors (either that of the offender or any of his observing coworkers). Except for certain "lifers" found in any agency, most providers will let sudden extreme disciplinary actions by a supervisor provoke a decision to hand in their resignation and move on. Given the relatively small pool of EMS providers, the end result is a revolving door of EMTs and paramedics that cycle in and out of the local services whenever a new "disciplinarian" is promoted. Problems aren't solved; they are just shared with the entire system.

What Is Progressive Discipline?

Progressive discipline is a process for dealing with job-related behavior that does not meet expected and communicated performance standards. The primary purpose for progressive discipline is to assist the employee in understanding that a performance problem or opportunity for improvement exists.

The process features increasingly formal efforts to address the problem or opportunity at hand. Specifically, the progression should begin with a verbal counseling session, then move on to a written warning before exploring more explicit action such as probation, suspension or termination of employment. At every step in this continuum, including termination in the form of an exit interview, feedback should be provided to the employee so that he can address and hopefully correct a stated problem (lateness, excessive absence, etc.). The endpoint of progressive discipline is to improve employee performance.

Progressive discipline is not intended as a vehicle to punish an employee, but rather an opportunity to assist the employee in overcoming performance problems and satisfy job expectations. It is most successful when it results in helping an individual become a contributing partner to the organization. Failing that, progressive discipline enables the organization to fairly, and with adequate documentation, terminate employees who have proven themselves to be counterproductive to the core mission of the agency and unwilling to change.

Useful Information

Typical steps in a progressive discipline system may include:

1. Counsel the employee about his performance. Ascertain his understanding of job requirements and expectations. Determine whether there are any externalities contributing to the poor performance that are not immediately obvious to the supervisor (e.g., financial or family pressures). Offer to help the employee address any issues, if possible (e.g., employee assistance programs).

2. Verbally reprimand the employee for poor performance. Again offer any outside assistance as is indicated.

3. Transfer the verbal reprimand into a written warning that is placed in the employee's file. Document any suggestions of outside assistance.

4. Provide an escalating number of days in which the employee is suspended from work. Start with one day and escalate to five. Each suspension should be separately documented and a copy given to the employee and placed in his or her file.

5. Employment of an individual is terminated for failure to improve. An exit interview should be conducted and documented if possible.

Tied directly into the progressive disciplinary process is this loose algorithm of questions that was developed by the late James O. Page:

• Be sure you have all of the facts when disciplining. It is way too easy to act without them. Remember that everyone is guaranteed due process.

• Check to see if there is a standard that covers this particular situation. Is that standard understandable and has it been communicated to the employee?

• Is this a first-time or repeat offense? If it is a repeat offense, what prior actions were taken?

Other Tips

• Use employee assistance programs (EAPs) in cases where you suspect alcohol, drug or family problems.

• Always consult with your corporate counsel for anything beyond a standard verbal interaction—this can save you a legal headache in the long run.

• Adopt a continuous improvement program for your EMS agency and include enhanced personnel practices as one of your key projects. Again, this needs to be continuous and include input from key players both inside and outside of your system.

Conclusion

Most EMS managers would prefer not to think about, let alone have to implement, disciplinary actions against employees. Unfortunately, the reality is that this head-in-the-sand approach doesn't work when dealing with a personnel-rich organization like an ambulance service. Properly educating supervisory staff as to the methods and procedures to follow when addressing poor performance will, in the long run, allow your agency to correct and improve the service rendered by its employees, as well as assist you in properly identifying and removing those whose performance does not improve despite your best efforts.

Raphael M. Barishansky, MPH, MS, CPM, is director of EMS for the Connecticut Department of Public Health. A frequent contributor to and editorial advisory board member for EMS World, he can be reached at rbarishansky@gmail.com.