How can incentives lead to better care?

[medicdan]

Me again, on my policy kick.

I'm one of those people who thinks that almost anything can be done for the right incentives, or bribes. Those bribes could be a bonus (money) for doing good things, a demerit or (penalty) for doing bad, a slap on the hand, a cupcake, and so so much more.

We talk here (as so many bloggers and podcasters) about what needs to be done to change EMS (education, pay and protocol development come to mind immediately). My question to you is... HOW can you make it happen? If you were in charge, how would you change things for the better?

What incentives do you think would convince your employer (local ambulance provider, hospital, SAR group, educational institution, etc.) to improve standards of care, employee treatment, equipment, education, etc? What could your local OEMS do to encourage QA/CQI? Your union to provide better hours?

I want to hear you dream... let me know what you'd like to see, and how you would make it happen (encourage with incentives), if you had the keys to the kingdom.

 

[TatuICU]

Me again, on my policy kick.

I'm one of those people who thinks that almost anything can be done for the right incentives, or bribes. Those bribes could be a bonus (money) for doing good things, a demerit or (penalty) for doing bad, a slap on the hand, a cupcake, and so so much more.

We talk here (as so many bloggers and podcasters) about what needs to be done to change EMS (education, pay and protocol development come to mind immediately). My question to you is... HOW can you make it happen? If you were in charge, how would you change things for the better?

What incentives do you think would convince your employer (local ambulance provider, hospital, SAR group, educational institution, etc.) to improve standards of care, employee treatment, equipment, education, etc? What could your local OEMS do to encourage QA/CQI? Your union to provide better hours?

I want to hear you dream... let me know what you'd like to see, and how you would make it happen (encourage with incentives), if you had the keys to the kingdom.

Demerits don't work, they just tie the group together and make them further hate their bosses worse.

LDT's with incentive pay. Incentive pay to cover shifts (extra 10-15 per hour), paid vacation, paid sick days, 401K with any sort of match, even 1% would be something, healthcare, etc. Just stuff that other jobs get that most EMTs around here don't.

 

[Veneficus]

Me again, on my policy kick.

I'm one of those people who thinks that almost anything can be done for the right incentives, or bribes. Those bribes could be a bonus (money) for doing good things, a demerit or (penalty) for doing bad, a slap on the hand, a cupcake, and so so much more.

We talk here (as so many bloggers and podcasters) about what needs to be done to change EMS (education, pay and protocol development come to mind immediately). My question to you is... HOW can you make it happen? If you were in charge, how would you change things for the better?

What incentives do you think would convince your employer (local ambulance provider, hospital, SAR group, educational institution, etc.) to improve standards of care, employee treatment, equipment, education, etc? What could your local OEMS do to encourage QA/CQI? Your union to provide better hours?

I want to hear you dream... let me know what you'd like to see, and how you would make it happen (encourage with incentives), if you had the keys to the kingdom.

I actually posted a 10 year plan several months back in order to make the conversion.

While it is certainly not perfect I think it is a good place to start,

But in an ideal world or not, I do not think it is realistic to raise pay/benefits before raising standards. Providers are going to have to front the cash to invest in their own future.

The fire service has already been successful with an over time approach. I don't see why EMS would try to reinvent the wheel.

 

[Doczilla]

I worked for a county third service EMS before I joined the army, it was great. I think most of the gripes come from the private sector. There's nothing you can do about that on a large scale. For-profit organizations will always pass the savings onto themselves. Furthermore, some employees remain impossible to satisfy.

 

[medicdan]

Thanks all. More specifically, i'm interested in incentives the government or payors can bring on to providers, to bring about the ends we would like to see. What do you think Medicare would have to say to your employer to improve education standards?

Vene, I'll pull up your 10-year plan, sorry for missing it.

@TatuICU, what is LDT? Long distance transports?

@Doczilla: what changes would you suggest for all providers, private, fire and third service?

 

[TatuICU]

@TatuICU, what is LDT? Long distance transports?

Yes, oftentimes 911 crews are up running emergencies all day and then get that dreaded 0200 5 hour transfer

Had several employees quit on the spot when they were called to do it after having had no rest. Don't blame them a bit. To combat this, another local service started giving out pagers and when a LDT comes in they page people and see who wants to go for a flat fee. Now LDTs for them have turned from something that people loathed into something that only employees with the best records, service times, and attendance records GET to do. And it keeps our emergency crews a little fresher.

I'm all for neat little things all people enjoy, but when it comes down to it you go to work to make money. Money or PTO is the best incentive. Money talks, bullsh!t walks.....

 

[medicdan]

Yes, oftentimes 911 crews are up running emergencies all day and then get that dreaded 0200 5 hour transfer

Had several employees quit on the spot when they were called to do it after having had no rest. Don't blame them a bit. To combat this, another local service started giving out pagers and when a LDT comes in they page people and see who wants to go for a flat fee. Now LDTs for them have turned from something that people loathed into something that only employees with the best records, service times, and attendance records GET to do. And it keeps our emergency crews a little fresher.

I'm all for neat little things all people enjoy, but when it comes down to it you go to work to make money. Money or PTO is the best incentive. Money talks, bullsh!t walks.....

Thanks, that's very interesting...

 

[Veneficus]

I think it is important to note that in many nonhealthcare industries, the common wisdom is that money alone will not stop an employee from becoming disgruntled nor reverse one that has.

In EMS, whether private, 3rd service, or fire based, what motivates various individuals will be different.

I think you have to tailor individual incentives to wants.

For example. If you have an employee who likes to go to conferences, desirable care or behavior may not be a cash payout, but picking up all or part of a conference tab.

Even lower cost occasonal appreciations work well. Gift cards. etc.

 

[abckidsmom]

I believe that because EMS is such a relatively independent thing, we're out there doing what we feel like doing with extremely limited supervision in the field with just our own brain for guidance that change starts from the medic in the box.

In my limited experience of never having the keys to the kingdom, I do what I can to get into the heads of coworkers and challenge them in their own ways to do better. To provide better customer service, better teaching, better documentation, better care. If we cover these basics, and exceed expectations on them with each interaction with patients, and if every medic was doing this, gradually the profession would come to be recognized as such.

Nursing did this. They were the maids of the hospitals, and gradually added to their professionalism, put their feet down and demanded the respect they deserved. About 20 years after that, they started getting it.

The trouble is that critical mass can be reached, and quickly. There is only so much that people can do with limited energy, resources and recognition.

Something as simple as personal communication from my supervisor when they recognize I did a good job would be great. A bonus or gift card when I have 100% compliance with the QA issue of the month. A raise every now and again.

When the system has people working towards excellence on every ambulance, then we can start raising the bar on the governance of the systems. You have to start at the bottom.

 

[Veneficus]

I believe that because EMS is such a relatively independent thing, we're out there doing what we feel like doing with extremely limited supervision in the field with just our own brain for guidance that change starts from the medic in the box.

Something as simple as personal communication from my supervisor when they recognize I did a good job would be great. A bonus or gift card when I have 100% compliance with the QA issue of the month. A raise every now and again..

I think these are very good points.

Because of the relative independant nature of EMS, people do not get enough positive feedback from FTOs, supervisors, etc.

In many cases, the only interaction with supervisory or admin is overwhlemingly negative.

Another big morale killer is management not communicating with the rank and file, it leads to distrust and many rhumors. All of which are damaging to an organization.

While there must be a certain level of motivation, as discovered and demonstrated in both military and paramilitary organizations, and I think importable to EMS, leadership needs to be aware and take an active role in keeping it high.

It is my opinion only then will individual will and motivation remain postiive.

 

[mycrofft]

Robert Townsend noted that rewards for good work are almost invariably those you have to uses away from work.
Napoleon is quoted as saying soldiers will go to great lengths for a "bit of colored ribbon".

 

[Meursault]

I thought about some sort of system-level P4P for 911 providers where they'd be rewarded for finding ways to avoid EDs with funding to do more of the same or advantages in grant applications. That would be balanced on a knife edge between politically infeasible and easily gamed, though.

It seems to me that a lot of the changes that will make EMS better need to happen outside of EMS: stronger out-of-hospital support for the elderly, more continuity and more direct entry into the mental health system, a change in the way we think about standards of care, death panels, etc. The changes that need to happen within EMS either need to be done quickly and painfully (raising educational standards and creating barriers to entry a la Vene's 10-year plan) or need to come from within (employee investment, a sense of unifying as a profession, and rethinking protocols). It doesn't seem like any of the latter are amenable to fixing with carrots dangled by CMS.

Another big morale killer is management not communicating with the rank and file, it leads to distrust and many rhumors. All of which are damaging to an organization.

I think I'd go back to the bottom of the pay scale in exchange for open and honest business and quality information from management. In most private companies that I know of, the employees seem to have no stake in the company, and it's devastated morale.

 

[mycrofft]

I'd say make it civil service, unionized and with the Civil Service Commission backing the employees, but the way the top political people are throwing line worker civil servants (the ones who actually do the work) to the wolves under the bus, even that is no longer a viable model.

"Industrial psychology" reminds us time and again that, once a living wage and benefits are achieved, the main effect of enhanced rewards is the initial impact and is soon forgotten/taken for granted.

As has been said above, rewards much be tailored to what employees find desirable and important. If you can tailor what they find important (such as, by pitting one division or team against another in some sort of competition, thereby fulfilling the need for status for the winner), then you can tailor what you have to deliver.

Sears, Roebuck used to compensate their employees (ALL their permanent employees) with stock shares. Sear was known for excellent quality and good service. Management changed, they stopped the practice, and even before the Internet their service and quality (and their image) changed for the worse.

PS: My guru, Robert Townsend, said one of the best things to do to invigorate your company is look around, ask around, and fire the biggest dunderheads. That means two things, if done properly: 1. I kept you so I value you and you are meeting or exceeding standards. 2. Don't be a dunderhead. So, link rewards, both positive and adverse, to personal and company performance, invest in your people, and don't be greedy at the top.

PPS: Not an ad, but get this book. It is getting farther and farther out of date in its popular references, but the basic observations of corporate mindset are spot on. The guy has creds, too.
http://www.amazon.com/Up-Organization-Robert-Townsend/dp/0449205053