From the Officer`s Desk: Maintaining High Performance

There are many factors that can contribute to underperformance. They include poor operational infrastructure, poor employee retention, lack of personnel development, minimal promotional opportunities, lack of leadership development, competitive threats, and market disruptions.

Leaders must be on the lookout for symptoms that indicate underperformance and determine and address their root causes. Unfortunately, there are no alarm bells to signal when things are going awry. Instead EMS officers must develop plans to assess their work functions and detect it themselves.

To do this, focus on key activities and what goes into them. There are six key organizational activities to consider:

• Leadership;
• People (internal and external stakeholders);
• Strategic plan;
• Continuous quality improvement;
• Culture;
• Community.

Leadership

EMS officers must never lose sight of the primary focus of supporting their employees by coaching, mentoring, and setting an example of a servant leader. They cannot simply delegate but must roll up their sleeves and work side-by-side with their team in the trenches. Identifying underperformance requires familiarity with the many intricacies of EMS service delivery: operational activities, staffing, logistics, training, dispatch, and so on.

In addition officers must look for external factors that can cause the organization to underperform. Among these is the political landscape and whatever body has final authority over capital purchases, memoranda of understanding, service contracts, and other business activities. Monitoring the political landscape also includes competition, market disruptions, and other external forces.

Key questions for organizational leaders include:

• Does the service being delivered to customers align with the organization’s mission, vision, values, and purpose?
• Are there metrics in place to measure performance?
• Am I engaging with my team on a regular basis?
• Have we set strategic objectives?
• Do I seek input from internal and external stakeholders as we seek to improve performance?
• What is my contribution to a positive working culture?

Officers losing sight of their duties and expectations may result in lack of oversight, deviation from mission, and ultimately underperformance. If it is determined an organization is underperforming, it is the officer’s responsibility to bring their teams together and begin developing a strategy to turn things around.

People

Don’t just blame employees for underperformance. It’s more commonly caused by some failure in systems, processes, or activities already in place. Prior to taking any corrective action upon any individual, an officer must:

• Gain the confidence of employees and listen to what they have to say;
• Don’t make immediate changes unless actions are detrimental to customers or employees;
• Give employees every opportunity to improve their performance by providing the training and tools they need to succeed;
• Provide effective communication to team members;
• Seek input from internal and external stakeholders during the planning and development of strategic goals.

If an employee is struggling, it’s important to have a conversation, ask them how they think they are performing, and share your observations of their performance. Ask them what you can do to help get them back to the expected performance level. These are difficult conversations; however, if you make it nonconfrontational and from a place of partnership, it will be easier to help the employee back on track. Teams members who do not feel valued, respected, and included as part of the team may begin to lose focus.

Strategic Plan

An organization without a strategic plan is like a ship or plane without navigational equipment. The EMS officer can use the SWOT assessment (for strengths, weaknesses, opportunities, and threats) when developing strategic goals and objectives. Tailor plans to capitalize on strengths, mitigate weaknesses, take advantage of opportunities, and defend against threats. Include both internal and external stakeholders in strategy sessions.

One of the biggest pitfalls in this area is execution. An organization can have a great strategy in place and execute it poorly, creating performance gaps. Once a plan has been developed and implemented, monitor things on a regular basis.

Continuous Quality Improvement

The delivery of quality outcomes must be part of any organization’s culture, and that requires the use of quality methodology tools to measure and analyze activities. EMS officers can use a variety of tools to make improvements. For instance, the 80/20 rule, also known as the Pareto principle, states that 80% of outputs come from 20% of causes (the “vital few”). Addressing that 20% of the causes can reduce 80% of the consequences. Alternatively, Lean Six Sigma methodology focuses on eliminating waste and reducing variation in business activities by using the acronym DMAIC, for defining the problem; measuring current activities; analyzing the data and determining root causes; improving the process; and controlling the outcome.

Regardless of which methodology is used, quality improvement must be part of the organization’s daily business. QI tools and methodologies will help identify underperformance and rectify is causes. You can’t improve what you’re not measuring!

Culture

Peter Drucker, a pioneer of modern management, famously said, “Culture eats strategy for breakfast.” Leaders may have the best strategies in place, but if the organization has a negative working culture, there is a high probability it will underperform. To promote a “just culture” environment, focus on improving systems, processes, policies, and other business activities. Change starts at the top and must include stakeholders.

Community

Departments must find ways to not only serve patients during emergencies but their overall community during nonemergency events. For example, as it pertains to the recent pandemic, an agency could provide testing and vaccines to community members. Communities can always be better prepared for catastrophic events such as hurricanes and wildfires, but lives can also be improved in smaller ways by services such as checking child safety car seats, collecting expired medications, and providing community paramedicine.

Organizations may meet customer expectations during emergency transports, but some communities may anticipate more. Citizens may compare their local public safety department to other agencies and communities. Think beyond emergency responses to demonstrate you’re working hard to keep citizens safe even during times that don’t require an emergency response.

Maintaining Performance

Achieving and maintaining high performance is everyone’s responsibility within the organization, but it must be driven by those at the top. As EMS officers, it is our responsibility to prevent underperformance from affecting the areas we oversee. Six key activities—leadership, people, development of a strategic plan, continuous improvement, culture, and community—are fundamental to achieving a high-performance organization.

Orlando J. Dominguez, Jr., MBA, RPM, is assistant chief of EMS for Brevard County Fire Rescue in Rockledge, Fla. He has more than 30 years of EMS experience and has served as a firefighter-paramedic, flight paramedic, field training officer, EMS educator, and division chief. He has authored two books, including EMS Supervisor: Principles and Practice, and is a certified Lean Six Sigma Green Belt. Follow him at @ems_officer.