Laziness is a problem is every job, you need to create a culture that mitigates that.
Certainly I'm not excusing a crew waiting for an elevator for a VSA one floor up, but then again, I can't say I haven't done the same thing. (Honestly, I can't remember one way or the other) The reason is that I bring the stretcher and bags to all my VSA's so they're handy in the even of transport. As a result I may have added a delay into my care without realizing it. It's worth examining in decisions like this the circumstances that created it. Do you have a system where back-up (either FD or another unit) are coming to all arrests? In which case as a service start reinforcing the primacy of the first unit beginning Pt. care over logistics and that follow up units will take care of the stretcher, board, etc. But this is only one example, I won't get hung up.
Let's look at more common problems like not making up the cot, dirty trucks, not checking bags, IV's not primed, treatment forgone for transport only. These are issues that we can find parallels at any job and reflect a tendency of an individual to do what they think they can get away with. Fixing this can be done with supervision (extrinsic motivation) or by finding a way to make enough staff care (intrinsic motivation) that they step up AND create an expectation among their peers that they should do the same (extrinsic motivation, but via peers). Direct supervision may work well at a single work site where everyone can be watched and managed, but not in most EMS systems. A Sup may come by and everyone snaps to, but when they leave if the culture hasn't changed the behaviour wont either. You can add more supervisors, but then you dilute the quality and spread the responsibility around so much that you create another layer of worker, doing the minimum to not get heck from their boss.
We need to embrace a culture that includes safety, accountability, professionalism, pride and comraderie within our services. This is far harder to do but naturally has far better pay off than discipline and supervision. Establishing a positive culture shift will vary with the system and it's individual issues, but as my service is currently going through a culture shift I'll comment on some things I have seen that may help.
1) Vision. Know what you want your service to look like and lay it out. Share this vision. In fact build it with the input of the staff. The problem children may not be interested but you'll start identifying the existing staff that can form the nucleus.
2) Recruitment and orientation. Orientation needs to be about more than payroll and policy. This is your chance to choose the right candidates that fit the model you want to create and to get them to buy into it right away. Don't just talk at them though, make sure the staff running orientation are modeling this vision too.
3) Management. If the people at the top are not leading by example it all falls apart. This doesn't mean powerpoint. You want clean vehicles, than the Sup's better have a spotless truck too. You want crews to be proactive and help each other out, the Sup had better be jumping hot calls to lend a hand.
4) Appreciation. When crews start to shift and buy in, don't act like it was something they were supposed to do anyways. It is, but they may not see it that way. Recognize improvement and reinforce it.
5) Identify resistance. Why are some staff members not buying in? Don't keep addressing the whole staff with memo's and meetings and powerpoint. The crews that have got on board will feel unnoticed or ignored and the ones that haven't will keep tuning them out. Start sitting down with them informally and chat. Explain the plan, explain the motivation and give them a chance to vent constructively. You may not get them all on board, but you've tried and they should at least respect that they were considered. This will also ID the clear problems that will never get on board.
6) Accept input and consider adjustments. If it's to be a true shift in culture than it can't be top down. Let crews own the ideas and make them their own.
I realize this is a management approach, which is funny since I'm no where near a white shirt, but I think for the most success, as with anything the ball has to get rolling from on high.
As an individual medic you can try to shift things yourself but the reach will be limited by your exposure and your influence. As a newer medic I might be able to motivate the shift at my station to clean and respect the base but I'm not going to reach much beyond that and if there's a senior more respected guy or gal against that, I won't reach beyond my partner, if that.
