Cultivating Stakeholder Relationships Part 2: Community Stakeholders

Matt Zavadsky is a featured speaker at EMS World Expo scheduled for October 29–November 2 in New Orleans, LA. For more information, visit EMSWorldExpo.com.

In our last installment we discussed the new roles EMS—or more appropriately “UMS” (unscheduled medical services—more on that later)—agencies need to undertake with healthcare stakeholders in today’s environment.

While healthcare partners are crucial, successful EMS agencies need to cultivate excellent relationships with several other significant stakeholder groups. In this second part of our three part series, we will look at ways to develop relationships with employees and government leaders. These stakeholders need to be fully engaged in order to have any hope of future success for our industry and your agency.

Employees

Our employees are much more than our most valuable asset on the income statement—they are the ambassadors upon which we stake our reputation and foundation for success. Every interaction they have with fellow employees, patients, hospital staff members, co-responders or the public is a “moment of truth.” How they interact and represent your agency can make or break you. If one employee is rude, or even less than enthusiastic with one member of a co-response agency, word sparks like wildfire that your entire agency is a bunch of prima-donnas who belittle other agencies. The same is true of hospital staff. Conversely, if our staff is kind, compassionate and empathetic, the interaction with these groups will convey the message that “we care about you.”

Creating a culture of caring starts at the top, and it needs to inhabit every aspect of your agency. It can’t be just lip service either; you need to walk the walk. If employees are shown empathy, they’re more able and better prepared to show empathy to others. In practical terms, this means doing the right thing for employees, which occasionally may go against doing things right.

For example, suppose you have a tenured employee who develops cancer and gets very weak the day after chemotherapy treatment. Human resources rules may state that an employee who is too weak to work due to a non-work related illness cannot be placed on “light duty.” But you know the employee’s life revolves around his work—and without work, he’s subject to depression and perhaps a worsening medical condition.

So, you do “the right thing” and allow the employee to work in a light-duty capacity for a few shifts every month to keep him connected and positive. Even though it’s not 100% compliant with your policy, it’s the right thing to do for the employee. That employee, and everyone who knows and cares about him, sees what you’re doing and it makes them feel better about you and the agency. All the employees learn from that demonstration of caring, and in return are better equipped to show that same compassion for others.

At MedStar, we call this Job No. 1—taking care of our internal and external stakeholders. It’s something everyone puts into practice as a guiding principle every day.

Another important aspect of employee relations is engaging your employees and sharing your vision with them about the future of our industry. Having a clear vision for where your agency is headed, especially in light of the numerous changes in the healthcare system, will help them understand how our profession’s role needs to change. Things like the importance of customer service to new payers, such as hospitals and ACOs, because it may have an impact on their reimbursement rate from Medicare, or the reasons behind working on innovative programs to reduce readmissions and navigate patients to alternate destinations for minor medical or trauma issues, can help ensure employees understand the need for changes in delivery models.

Once employees understand the reasons we cannot do business as usual and survive, they will be better engaged and equipped to be the ambassadors we need in order to be successful with our other stakeholders.

Government Leaders

From my experience, there are two key things government officials look for from EMS agencies: reduce our impact on their budget and keep investigative reporters out of their office.

These are very tumultuous times to be a leader in government. Elected and appointed officials are facing incredible budget pressures to balance needed services with available revenue. In some unprecedented cases, difficult decisions are being made to reduce service levels in order to balance budgets. The best thing we can do to cultivate relationships with these stakeholders is to be reasonable. Now is not the time to push for potentially unnecessary budget increases. In fact, we should be doing all we can to reduce our reliance on government funding, either for operating or for capital. In many cases this will require either proposing alternate methods for delivering current service levels, or finding other funding streams. The ability to do this will make you a super hero.

In our system, our largest city was providing a subsidy for our services. Knowing our largest city was facing insurmountable budget shortfalls a few years ago, we approached the city and suggested it eliminate our subsidy. We told city leaders we would make up the difference in the ambulance rate. It helped the city with its budget issues and made us a subsidy-free system (which, by the way, has numerous other benefits).

Contrast this with another scenario, where a city in our service area was approached by its local volunteer fire department to convert to a paid department. City officials looked at the types of calls the fire department was responding to and realized it was about 85% medical. As an alternate option to evolving to a paid department, the city asked us to provide a proposal for medical first response services, which was seen as a more cost-effective solution with a specific focus on the healthcare needs in the community. The moral of that story is be careful what you ask for and when you ask for it.

Government leaders don’t generally like surprises—good or bad. But when things are good, share that news early and often. Even allow government officials to take some of the credit by letting them release good news. Obviously, we do all we can to prevent the bad, but if (and arguably when) something goes awry, work with your government stakeholders to help ensure a local news crew—or worse, 60 Minutes— doesn’t show up outside their door with a camera and microphone asking, “What’s your stance on the ambulance crew that flipped the coin to see who was going to respond to the elderly fall victim?” or “Is the city planning to fight the $4.2 million Medicare fine for fraudulent ambulance billing?” Or, at the very least, if this does happen, the official has a well-crafted statement for the media. Take the hit, if necessary, admit when a mistake was made and describe what you’re doing to correct it. (We’ll cover much more on crisis communications in future columns.)

A word about lobbying and effecting change legislatively: Lobbyists get a bum rap as a whole, but in my experience legislators appreciate lobbyists who truly invest time into educating elected officials or their staff members. Arguably, some lobbyists simply act as hired guns, but the ones worth their salt develop reputations as educators and problem solvers. Many organizations and associations seem to spend a lot of time lobbying for initiatives that are either too self-serving or not forward-looking. The best way to make inroads with elected officials is to bring them solutions to issues faced by their constituents, or the government, such as the elimination of Medicaid payments for ineffective ambulance service delivery models fraught with fraud and abuse, e.g., repetitive dialysis patients, in favor of a new one that saves the system money—patient navigation, treat and release, and call center triage. In Minnesota, Gary Wingrove, O.J. Doyle and Buck McAlpin did an incredible job this year educating their legislators about the clinical and fiscal benefits of community paramedicine, and the state legislature passed legislation enabling that service to be paid by Medicaid.

You, too, can make innovative changes with the right mix of data, innovation and education.

Stay tuned for the final installment of our three part series—a column devoted entirely to building relationships with the media.

Matt Zavadsky, MHA, is director of public affairs for MedStar EMS, the public utility model system in Fort Worth and 14 surrounding cities in North Texas. He holds a master’s degree in Health Service Administration and has 30 years’ experience in EMS, including volunteer, fire-based, public and private-sector EMS agencies. He is a former paramedic and has managed private sector ambulance services in four states, as well as serving as a regulator. Matt is a frequent speaker at national conferences and has done consulting on numerous EMS issues, specializing in high-performance system operations, public/media relations, public policy, employee recruitment and retention, data analysis, costing strategies and EMS research. He has served as chair of the American Ambulance Association's Industry Image Committee and as a member of its Professional Standards, Strategic Development and Management Training Institute Committees. He is adjunct faculty for the University of Central Florida’s College of Health and Public Affairs, teaching courses in healthcare Economics and policy, healthcare finance, ethics, managed care and U.S. healthcare systems.