Performance Based Salary

MMiz

MMiz

I put the M in EMTLife
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It is becoming more and more popular for public school systems to base teacher compensation on performance. It used to be that if your students did well on the standardized test one received a bonus. The bonuses are long gone and NC teachers haven't received as raise in years, but this year a teacher's continued employment is based on his or her students' scores on standardized tests.

How would you feel about performance based compensation in EMS? Would it help weed out the poor providers? Would providers pursue additional education to better maintain their skills?

What do you think?
 
I am all for it. As long as the judging system is fair and accurate.

I work my butt off to do the best job I can. I take the extra classes, read journals, and try and better myself. Yet people who are horrible at patient care, and are rude and mean....they get paid more, because they have been around longer.

There is a company around me that pays a bonus for each run that you do and the paperwork is done correctly.

I think that is smart business. You shouldn't have to pay people to try harder, but that's America.
 
Reminded me of a post from Kelly Grayson.

http://ambulancedriverfiles.com/2012/07/15/occupy-ems/

"Nobody in EMS is paid what they're worth. 25% are paid far less than what they're worth, and 75% are paid far more than what they're worth."

I say we make people work for what they think they deserve.
 
Anjel1030 said:
You shouldn't have to pay people to try harder, but that's America.
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You shouldn't have to, but $$$ is what drives the economy. When everyone makes the same wage for different jobs, or quality of work, you have communism, and we can see how well that works.

I think that performance-based EMS would be great for the system. It would definitely improve pt care. The only thing I see that could go wrong is with the reporting system, as in, how is performance measured? What would be an accurate way to determine who is doing "better"?
 
I think it would be very difficult to judge accurately. I mean, how do you judge performance? By whoever has the least amount of missed IVs? Has the best ROSC rate? Wouldn't work very well.

Now, if it was based on things like results of chart audits (compliance with protocols, quality of documentation), attendance and test scores for training, feedback from patients/hospitals (number of legitimate complaints, vs compliments).

Even so, I can still see it being hard to quantitatively assess the quality of a provider.
 
We can get an additional yearly raise for good performance, patients that call in saying we did good, and other recommendations from people/departments/hospitals.
 
What about patient surveys? IV stick rates? Intubation success rates?
 
Patient satisfaction surveys yes. IVs and intubations not so much. There are just too many variables. What happens if someone only gets 3 intubations in a year? What if all of the people they attempt to tube are traumatic arrests, leading to a low success rate due to the anatomy being obliterated? What if they miss an IV on a patient who later needs a central line or cut down because no one else can get on either? Some of those variables can be corrected for, but not all of them.
 
Aidey said:
Patient satisfaction surveys yes. IVs and intubations not so much. There are just too many variables. What happens if someone only gets 3 intubations in a year? What if all of the people they attempt to tube are traumatic arrests, leading to a low success rate due to the anatomy being obliterated? What if they miss an IV on a patient who later needs a central line or cut down because no one else can get on either? Some of those variables can be corrected for, but not all of them.
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Completely agree with you.

But what if people don't fill out the surveys.

I suppose it would have to be company based so they know what works.

But definitely incentive for education.
 
The problem with patient satisfaction surveys is that you can provide proper medical care but get low survey scores because you fail to acquiesce to a patient's demand.

While I'm in favor of getting paid based on performance, it's hard to judge performance in a systematic way that doesn't involve either short changing people who simply didn't have the opportunity to perform or give it based off of things like time.
 
MMiz said:
What about patient surveys? IV stick rates? Intubation success rates?
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No. It more based off of if you have any written warnings on your record, how many times you have called off, if people have complained about you sort of deal. There is no part of it that has to do with actual patient care as far as IV sticks, Intubation, saves, births, etc.

It's not really fair to judge performance off of those. Paramedic A might have been having all younger patients with good veins for the IV sticks while Paramedic B might have been having all older patients with renal failure for the attempted IV sticks.
 
How is it any different from an AP teacher with the most academic students and involved parents vs. teachers of remedial classes? The state makes no accomodation for the fact the student missed 140 out of 180 days of school.
 
MMiz said:
How is it any different from an AP teacher with the most academic students and involved parents vs. teachers of remedial classes? The state makes no accomodation for the fact the student missed 140 out of 180 days of school.
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So because teachers are getting screwed, that means we need to screw over EMTs and paramedics by patient surveys?
 
That's not what I'm saying. There are certainly metrics that can be used to effectively assess professional performance. Surely effectiveness of implementing treatment can be part of that equation. Similarly, patient survey data may be useful.
 
MMiz said:
How is it any different from an AP teacher with the most academic students and involved parents vs. teachers of remedial classes? The state makes no accomodation for the fact the student missed 140 out of 180 days of school.
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It sucks for the teachers and there's no two ways around it. If you teach smart kids that are motivated, odds are they'll meet their achievement expectations. If you don't have those kids, well you're in trouble. That does not justify the system though, if anything it points out the biggest flaw with performance based pay.

I think the idea of paying a bonus to those that are always on time, take care of their equipment, and drive well is a good idea. I know we probably shouldn't have to pay extra for meeting expectations, but of they're not being met sometimes a better motivator than terminating everyone is needed.

As others have said, I can't imagine how'd you be able to accurately quantify patient care performance given the random distribution of patients.
 
MMiz said:
That's not what I'm saying. There are certainly metrics that can be used to effectively assess professional performance. Surely effectiveness of implementing treatment can be part of that equation. Similarly, patient survey data may be useful.
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How do you determine effective treatment without going to a strict protocol? It's like in the hospital, physicians are required to abuse antibiotics because if any thought is given to pneumonia (even if it's low on the list), antibiotics have to be given or else they're dinged.
 
I'll ask a different question... which I've asked elsewhere here...

What "bonuses" do services get for providing quality care? Apart from not receiving bad press, how can companies justify additional expense (these performance bonuses) if they can't bring in any additional money for compliance?
 
I like having a performance based pay system. It rewards the ones that do more than required and doesnt reward the slackers.

We have a few different metrics that are instantly visible to the medics and work into the yearly raise amount. If a medic is doing their reports on time with no errors it's reflected in the metric. We also take into account tardies, abscences, counselings compliments etc. FTO tracks IV, intubation, record audits etc. If there are any major issues they get passed on to OPs.

After doing evals and raises this a few months ago I didnt have anyone complain about what they recieved. The ones that were unhappy know it's in their control to fix for next year.
 
I'm not so sure it's about additional bonuses, but instead simply continuing employment or receiving an intended raise.
 
I think it's a nice concept, but it would be rather hard to get a good system down that could judge performance justly.

My company will offer bonuses each month for the employees with the highest collection rates, or lowest dry run rates, etc. All of which are pretty well out of our control. Don't get me wrong, I enjoy getting a little bonus, but it's not really a system that rewards for excellence.
 
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