Developing a Proactive Hiring Process for Overload Park Fire

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					Developing a Proactive Hiring Process for Overland Park Fire Department
           in the Presence of a Growing Paramedic Shortage




                     EXECUTIVE LEADERSHIP




                          Steven R. Isaacson
                    Overland Park Fire Department
                       Overland Park, Kansas




  An applied research project submitted to the National Fire Academy
             as part of the Executive Fire Officer Program




                             January 2003
                                                                                           2




                                      ABSTRACT

       This research project was conducted to analyze the paramedic shortage witnessed

in recent hiring campaigns at Overland Park Fire Department (OPFD). The problem was

that OPFD experienced difficulty in attracting and hiring paramedics. The purpose of this

applied research project was to identify factors important to applicants, determine the

scope of the paramedic shortage and discover successful recruiting techniques.

       Historical and evaluative research methodologies were used to answer, (a) what

motivating factors have been identified for applicants to OPFD, (b) is the paramedic

shortage a local or national problem, (c) what innovations could OPFD employ to

significantly increase the number of applicants for EMS positions?

       The primary procedure employed was to review written and instructional

materials to investigate the scope of the paramedic shortage on EMS systems. A

questionnaire was utilized to determine factors important to applicants as well as the

methods they used to learn about EMS positions available. Interviews were conducted

with EMS recruiters to identify techniques and approaches implemented in successful

recruiting programs. The desired outcomes of this research were to identify factors most

important to applicants considering employment in EMS, provide insightful feedback to

the OPFD senior staff, and to improve or change Department practices that have a direct

affect on the number of applicants for future openings.

       The major results of this research were that the paramedic shortage is real and

approaching a critical status, both locally and nationally. Several EMS systems are

becoming more proactive in their paramedic recruitment, and the Fire based EMS system

is not immune to this shortage.
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       There were several recommendations made from this research. They involve

implementing active recruitment techniques, monitoring national trends of EMS

recruiting, and providing advanced training for current EMT staff. Additional research

will be required to find additional solutions to this national concern.
                                                      4


TABLE OF CONTENTS


Abstract …………………………………………………………………………             2

Table of Contents…………………………………………………………………. 4

Introduction……………………………………………………………………….. 5

Background and Significance………………………………………………..…… 6

Literature Review…………………………………………………………………        9

Procedures………….…………………………………………………………….. 16

Results…………………………………………………………………………….. 19

Discussion….……………………………………………………………………… 28

Recommendations………..………………………………………………………… 31

References……....…………………………………….……………………….….. 34

Appendix A……………………………………….……………………………… 36

Appendix B….…………………………...…..…………………….…………..… 38
                                                                                                5


                                        INTRODUCTION

        The problem is that Overland Park Fire Department (OPFD) has had difficulty in

2002 hiring paramedics to fill fifteen new positions. Overland Park Fire Department has

provided Emergency Medical Services (EMS) to the community of Overland Park,

Kansas since 1968. A fire-based EMS provider, OPFD staffed the ambulance units with

cross-role dual trained Firefighter Paramedics. In 2002 the department leadership

changed the operations plan and began to staff ambulances with single-role paramedics.

Prior to 2002, the priority of the department was fire operations, including fire

prevention, suppression and training. Developing and maintaining these three areas are

essential to the operation of every fire department. However, while the leadership at

OPFD focused on these three critical areas, the EMS concerns of the department suffered.

When, in 2002, the leadership recognized the need to shift some of its focus to EMS, it

became clear how lacking the attention had been in the past. As the decision to add

fifteen single role paramedics was made, it became necessary to step up the recruitment,

hiring and training of the EMS personnel.

        The purpose of this research project is to learn if the perceived paramedic

shortage is real, and, if it is real, to determine if the shortage is national in scope.

Additionally, the purpose of this project is to identify factors applicants consider in their

search for EMS positions, and to discover successful recruitment techniques that could be

implemented. The outcome goals are to identify factors important to applicants

considering employment, provide feedback to the department, and evaluate how those

factors could be improved or inculcated into future operations. A combination of
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historical and evaluative research was employed. The research questions investigated

were:

   1. What motivating factors have been identified for applicants to OPFD?

   2. Is the paramedic shortage a local or national problem?

   3. What innovations could OPFD employ to significantly increase the number of

        applicants for EMS positions?



                         BACKGROUND AND SIGNIFICANCE

        Established in the early 1920’s, OPFD began as a volunteer organization that

served a small farming town southwest of Kansas City, Missouri. As metropolitan

Kansas City grew, so did Overland Park. A streetcar linking downtown to the suburbs, a

post-World War II building boom and the annexation of smaller unincorporated areas all

fueled the rapid growth of Overland Park, and with it, an increasing demand for fire

services. In the 1960’s, OPFD became a combination career / volunteer department, and

in 1968, OPFD began offering ambulance service, EMS, to the community. This initial

offering of transport services developed in response to a need created by an unacceptably

high response time of a private company based out of downtown Kansas City, MO. One

of the first fire based ambulance service providers in the state of Kansas to consistently

staff with Emergency Medical Technician (EMT) level practitioners, OPFD units were

each staffed with two Firefighter / EMTs in 1972.

        Overland Park Fire Department continues to serve a thriving community. The

population of Overland Park increased by 36% in the 1980’s and by an additional 18%

increase since 1990. The current population of Overland Park, Kansas is 158,000, with
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projections of up to 175,000 by the year 2005. These projections do not include plans to

annex additional land south of the city, nor do they include the daily influx of employees

to Overland Park based Corporate Woods or the new Sprint Campus World

Headquarters. Today OPFD operates five 24-hour transport units that respond to EMS

requests in Overland Park. Overland Park Fire Department provides EMS at the

Advanced Life Support (ALS) level and staffs every ambulance single-role paramedic

crews. This fire-based ALS service began in March of 2000, however in 2002 another

significant change in the operational plan was implemented. For almost thirty years

OPFD provided dual-role firefighters who staffed the ambulances and provided transport

service in conjunction with the county-based EMS provider, Johnson County Medical

Action (Med-Act). This system required two ambulances to respond to each emergency

in the City of Overland Park. A redundant system, it was neither cost effective nor

supported by the public. Citizen feedback along with shrinking municipal budgets

prompted the development of a partnership between Med-Act and OPFD. The partnership

provides staffing for five ambulances responsible for the geographic and political city of

Overland Park, KS. Each ambulance is staffed with two paramedics; one from Med-Act

and one from OPFD.

       The birth of this partnership required OPFD to hire fifteen single-role paramedics.

The hiring process, which was not the typical scenario for OPFD, began in November of

2001 and was completed in July of 2002. Previously, OPFD interviewed ten to fifteen

applicants for every open position. Once the applications were received, a large number

of applicants would test and compete for the position. This was not the case for the

fifteen paramedic positions. Overland Park Fire Department experienced a marked
                                                                                             8


decrease in the number of applicants. The decrease was even more dramatic considering

those who failed to follow through with testing, even after written confirmation. This

resulted in a shallow pool from which to select recruits. For this reason, the process to

hire fifteen paramedics was repeated three times between November of 2001 and July of

2002. Each attempt net a gain of only five qualified recruits. A commitment was made at

the outset of each process to fill the positions only with qualified candidates. Overland

Park Fire Department was not willing to fill positions with under qualified or candidates

that did not pass all segments of the testing process

       As stated by Peters (1990), “People in government are always counting something

or churning out some statistical report. But most of this counting is focused on inputs:

how much is spent, how many people are served, what service each person received.

Very seldom does it focus on outcomes, on results” (p. 349). He further points out that,

“What gets measured gets done. Measurement is the heart of any improvement process.

If something cannot be measured, it cannot be improved” (p. 349). Following this

wisdom, OPFD must find a way to quantify each step of the recruitment process in order

to meet the high standard of quality applicants.

       This research project was completed in accordance with the applied research

requirements of the National Fire Academy’s Executive Fire Officer Program (EFO).

The problem addressed by this research project related to Module 4: Managing Multiple

Roles, specifically dealing with how OPFD as an organization changed the way it

previously viewed its role and responsibility as a Fire Department; specifically, that all

employees should be fire fighters. Module 4 of the Strategic Management of Change

Course is titled, Leading Change using the Change Management Model, Objective 7,
                                                                                             9


deals with the identification of organizational conditions that require change to meet the

mission, standards values and norms of the organization. In the course of completing this

project, this author referred to the Management of Multiple Roles information presented

in the EFO course entitled Executive Leadership.



                                LITERATURE REVIEW

       An analysis of writings on the subject of recruitment and the paramedic shortage

was conducted through a search of journals, books and Executive Fire Office Program

applied research papers cataloged at the library of the National Emergency Training

Center in Emmitsburg, Maryland. Additional research was conducted through resources

available at both the Johnson County Community College library in Overland Park,

Kansas and web sites on the Internet.

Research Question 1

       What motivating factors have been identified for applicants to OPFD? The

Occupational Outlook Handbook, a handbook prepared by the Bureau of Labor Statistics

(BLS), identifies the trend of a lower increase in firefighter position throughout the

country over the next eight years through 2010. The handbook goes on to state that the

number of qualified applicants in most areas exceeds the number of job openings within

fire departments. Fire Departments are in direct competition with other public safety

providers for the funding to expand. However, a significant variant is that firefighters

with paramedic training and certification will experience greater opportunities for

employment. This document of the Federal government forecasts the growing need for

paramedics.
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       In an attempt to identify specific areas of concern or priority for the applicant, a

survey was sent to every applicant to the OPFD over the past calendar year beginning in

November of 2001. The findings are described in the results section of this paper, with

the detailed results presented in Appendix B. The purpose of the survey was to identify

motivating factors for applicants to OPFD. The literature did not specifically identify

these factors.

Research Question 2

       Is the paramedic shortage a local or national problem? A review of current

literature in professional journals and newspaper articles paints the picture of a

nationwide paramedic shortage. From coast to coast, the shortage is effecting both fire-

based and traditional EMS delivery systems. It is difficult to identify through a literature

review specifically why an applicant to the OPFD would fail to arrive for their testing or

complete the application process. For this reason, the author looked to other organizations

for documentation that would shed light on the state of the paramedic pool of applicants.

       Jack Hafenbrack, a reporter for the “Charleston Daily Mail” of Charleston, West

Virginia, published comments from a state panel commissioned to research the paramedic

shortage in the Charleston Fire Department. “We need to understand how critical this

(shortage) is, they don’t have enough paramedics.” The problem in Charleston became so

critical that EMS vehicles were lettered to more accurately represent the certification of

the ambulance crew on-board. Previously, the ambulances were identified as

“Paramedic,” but were changed to the generic “Emergency Medical Services” allowing

non-ALS trained firefighters to staff the ambulances. Hafenbrack went on to identify one

reason for this shortage. The firefighter who goes on to complete the 2-year training to be
                                                                                             11


certified as a paramedic receives an $1,800.00 per year increase in salary. This amount is

not enough to entice most firefighters, “because there is not enough reward for the

hassle.” To further demotivate the educational investment, the paramedic incentive pay

is removed from the paramedics when they are promoted to Captain.

       This is also the case at OPFD. When a paramedic firefighter is promoted above

the rank of Lieutenant, the 8% paramedic incentive pay is taken away. Overland Park

Fire Department follows a similar pay system to the Charleston Fire Department. The

state panel looking into the Charleston Fire Department situation did provide suggestions

for the city to consider. First, the panel recommended that the paramedic that is actually

riding the ambulance be given additional compensation for the hours worked on the

transport unit. Second, they recommended that future fire department applicants that are

paramedics should be given higher priority than one-dimensional firefighters.

       This is not just a fire department problem in rural areas. The Honolulu Star

Bulletin reported (Antone, 2001) a sharp increase in overtime for the paramedic staff.

An average daily overtime reported for the sixteen ambulances was 800 hours during the

summer of 2001. This article went on to report that, the financial implications aside, the

Medical Directors are concerned about the potential for fatigue caused accidents or

actions that could be detrimental to patient care.

       In his article, The Expansion of EMS, author Gordon Sachs reported, “In all, 21st

century EMS will be an expanding field. Occupationally, it will become the public safety

field of choice and will be considered a healthcare profession by the medical

community”. The article identifies the increasing need to expand into the field of home

health care and to develop fire stations into neighborhood health and safety centers.
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Expansion such as that described in Sachs article will intensify need for paramedics.

(Sachs, 2000)

       In the March 2000 issue of JEMS a comprehensive listing of how the workforce

has changed since 1993 was presented. The article identified that “the biggest change in

the EMS workforce is in the category of paramedics. In 1993, 8% (52,439) of the

certified personnel in EMS were paramedics. Paramedics in 2000 represent 15%

(127,918) of the workforce. A 144% increase over the 1993 statistics.

Research Question 3

        What innovations could OPFD employ to significantly increase the number of

applicants for EMS positions? To identify critical system components several sources

were reviewed. Evaluation of an EMS system is only possible if measurable goals and

objectives define the desired results. An effective general planning process involves

several activities including system descriptive studies, alternate approaches, program

development and implementation, and evaluation of the process. With this in mind, the

author reviewed private sector recruitment principles in light of public sector

organizational hiring practices. In his book The Difficult Hire, author Dennis Doverspike

illustrates seven recruitment and selection principles for the hard to fill position. This

would certainly apply to the single-role paramedic position at OPFD.

       The first principle states that the hiring team is the most important factor to filling

the open positions. The signaling theory states that experiences during the initial stages of

recruitment and selection are taken as representative of the norms of the organization. Job

candidates prefer recruiters who are warm, enthusiastic, credible and professional. In
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addition, a recruiter who is able to discuss how the needs and qualifications of the

candidate relate to the job and the organization impresses job candidates.

        The second principle Doverspike presents implores the hiring team to maintain

control throughout the recruiting process. Control over your attitude, the job candidate's

perceptions, and the flow of information. If not, there is a high likelihood that good

people will be lost and the wrong people selected.

        The third principle presented in his book is to put the company and job on a

pedestal. One of the biggest problems in trying to hire for hard to fill positions is resisting

the insidious invasion of the attitude that the company is desperate and that as a result

will take anyone who applies. Even if there is a touch of reality in the attitude, projecting

such an attitude is lethal to the recruiting process. It is the wrong attitude for the

employer to take and it sends the wrong message to every candidate who applies. In

addition, it multiplies the very problem that needs to be solved; by creating an

environment of hard to fill positions.

        “Perceptions are everything and you can change perceptions.” The previous

principle establishes that the department must create a positive perception. Perceptions

are everything, and these perceptions will drive the decision making process for

candidates. Candidates enter the hiring process with some preconceived notions about the

department. The perceptions they carry with them are positive, negative or indifferent.

The opportunity is there for the perception of the candidate to be molded throughout the

recruiting process if members of the hiring team conduct themselves properly. The

author makes the point that all the words and actions of those on the hiring team shape
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the perception of the candidate, because to the candidate, the members of this team are

the department.

        The next principle presented is to control the negative. Even in the best

departments, negatives exist. The goal is to control the negatives, so that they do not

define the department. The best way to do this is to concentrate on the positives and

create a climate of achievement. A candidate who is hard at work trying to earn a job will

have less time to dwell on the negatives. Another way to deal with negatives is to turn

them into positives. In order to become a firefighter, a job candidate must endure rigorous

physical testing including dummy drags through darkened halls and climbing aerial

ladders. Some may view this as a negative. However, because of past experiences, the

media and recent national events, most firefighting candidates view this as a positive.

        The department must fulfill the individual’s needs. One factor that affects choice

is a person's past behaviors and choices. Not only does a person's past behaviors and

choices affect job choice, it also affects how productive a person will be on a job and how

well the individual will fit with the department. Thus, it is critical during the screening

process, that the recruiter accurately identifies the qualifications of the job candidate, to

the best of their ability. At stake is the degree of fit to the job and the department.

        Finally, develop and maintain high standards. An important principle in attracting

the difficult hire is to create the perception that the job is valued and important and that

the person who earns the right to fill the job is important and will be valued. It is critical

to remember, then, that just because a position is hard to fill does not mean that the team -

should adopt an attitude that anyone can do the job. The job will actually be easier to fill

if the department sets, maintains and publicizes high standards.
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       Continuing the review of current human resources guides is a book written by

Richard Fern in 2000 titled 101 Hiring Mistakes Employers Make. The author makes

several key points that could be applicable to the fire service and other public sector

organizations. The first point Fern presents is starting from scratch. The concept is to

review the applicant base when future hiring is posted. It has been the history of OPFD to

begin the process new each time, even if the last process was completed less than six

months ago. Fern urges the hiring team to use the old list of applicants as a resource pool.

       The second point Fern presents is not having a complete plan. When it comes to

key employees, such as paramedics, a complete plan for replacements should be in place.

An updated job description is an important first step but doesn't constitute a complete

plan. Encourage hiring managers or the hiring team to review resumes even when not

looking for a new hire. Additionally, Fern recommends that the department stay in touch

with prospective applicants even when nothing specific is open.

       Point number three, according to Fern is to being reactive instead of proactive.

Hiring the best candidates requires a pro-active rather than a reactive approach to

staffing. Again, the key reason is the pressure of time. A proactive approach requires time

before vacancy occurs, but lessens the time-to-hire after a vacancy occurs.

       Another point presented in his book is sourcing only those candidates “looking”

for a job. Fern recommends the recruitment of "passive" candidates who require a

different recruiting strategy. The hiring team should always be on the lookout for quality

individuals. Let people know your company is a great place to work. (Fern 2000)
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                                    PROCEDURES



Definition of Terms

   Partnership. The functional merger of two free standing Emergency Medical Services

providers to cooperatively staff, respond and train a team of paramedics purposed to

deliver emergency services to the community of Overland Park, Kansas (OPFD / Johnson

County Medical Action Deployment Plan, 2002).

   Emergency Medical Technician (EMT). Assess and provide treatment for patients of

an emergency under physician-approved protocol. Monitor peripheral intravenous lines

delivering fluid during interfacility transfer. Airway maintenance to include

oropharyngeal and nasopharyngeal airways, suctioning and oxygen administration. When

authorized by medical protocol. Assist the patient in the administration of the following

medications prescribed for the patient: Auto-injectable epinephrine, sublingual

nitroglycerin and inhalers for asthma and emphysema. (Kansas Statute 65-6121)

   Emergency Medical Technician-Intermediate (EMT-I). Perform any of the activities

identified in the K.S.A. 65-6121, and the additional amendment. Under direct voice,

radio or telephone monitored by a physician or designee the EMT-I may; perform veni-

puncture for IV fluids or blood sampling, endotracheal intubation and the administration

of nebulized albuterol (Kansas Statute 65-6120)

   Mobile Intensive Care Technicians (MICT). Perform all the authorized activities

identified in K.S.A. 65-6121 in addition to these items the MICT may perform cardiac

defibrillation, under direct physician control or authority may administer such
                                                                                           17


medications or procedures as may be deemed necessary by a physician. (Kansas Statute

65-6119)

  Paramedic. The state of Kansas identifies a Paramedic as an MICT. They are

interchangeable and for this paper an MICT will be described as a Paramedic.

Research Methodology

       This research project employs historical and evaluative research methodologies to

examine the impact of a perceived shortage of paramedics and determine potential

recruitment options are available and utilized to help improve hiring outcomes. The

desired outcome of this research was to review current literature on the paramedic

shortage to provide supporting documentation that this experience was a not just an

OPFD phenomenon but rather a systemic problem for MS providers throughout the

country.

       A survey of recent applicants for a position with OPFD was completed in an

effort to identify factors that influenced their decision to apply for a position with OPFD.

The survey requested feedback from applicants regarding factors that motivated them to

apply to OPFD. The survey also asked how they became aware of the opening and what

knowledge they had of OPFD prior to the application process. The author also attempted

to gain insight from those individuals who applied for the opening but failed to follow-

through with the application process.

       Ninety-five total surveys were mailed through the United States mail system. The

survey was sent to the addresses provided by individuals on their employment

application. The sample was selected by isolating the applicants for paramedic positions

at OPFD. Every person who applied for a paramedic position with OPFD over the eight-
                                                                                               18


month period from November 2001 to August 2002 was mailed a survey. From the

original mailing of ninety-five surveys, seventeen (16.15%) individuals returned the

completed survey. A copy of the survey is included as Appendix A.

       Telephone interviews were conducted with representatives from two departments

of similar size in an effort to gain insight into their recruiting history and practice. The

interviews were also an effort to determine available methodologies for EMS system

recruiting and prepare a recommendation to be adopted by OPFD. The interviews took

place in the month of December 2002. Each interviewee was selected because of their

involvement with paramedic recruiting and experience with the success or failure of their

recruitment plan. Both organizations had the reputation of having an aggressive recruiting

process for paramedics in 2002.

       During each of the interviews, this basic set of questions was asked:

           1. How many paramedics did your service hire this past year?

           2. What was the ratio of applications per position available?

           3.   Does your organization have a position designated “Recruiting Officer”?

           4. Comments and or recommendations.

       Each interview lasted approximately twenty-five minutes. Background

information on the researcher and the affiliated departments were provided as well as

details regarding how they were chosen for the interview. Following the discussion on

the three main questions, open discussion on the paramedic recruitment topic continued

in a more freeform nature. Both interviewees were pleasant, open and willing to discuss

successes and failures.
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        A search was conducted at the Johnson County Community College Learning

Resource Center to find relevant information from the private sector human resource

literature and texts that would be relevant to the public sector, specifically OPFD. Trade

journals were reviewed to gather information on current trends and insider positions on

those trends identified. Finally, internal documentation of previous hiring statistics was

gleaned through the human resources department of OPFD.

Assumption and Limitations

        The applicable resource materials limited the researcher. Fire based EMS is

closely aligned with the healthcare industry as a pre-hospital Allied Health Care Provider.

The researcher assumed that general business recruitment guidelines could be adapted to

the fire service. Fire based EMS providers have been slow in develop and practice

aggressive recruitment strategies for the attraction of paramedics. The lack of significant

documentation in the fire industry journals suggests that the need for targeted recruitment

in the fire-based EMS systems has emerged relatively recently.

        The survey piece of this project yielded limited results to the researcher. A 12%

return rate was experienced on the survey, which limited its effectiveness in providing

clear direction.



                                          RESULTS


Answers to Research Questions

Research Question #1.

        1.         What motivating factors have been identified for applicants to OPFD?
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       A survey of recent applicants to OPFD was conducted in an effort to answer

research question number one. Following recommended guidelines set forth in the

research guide, provided by the National Fire Academy in the Executive Development

Student Manual, the survey was mailed to all applicants to OPFD during the period from

November 2001 to August 2002. The survey was written, after which a test draft was

completed and distributed to several office staff members for feedback and identification

of misleading or ambiguous questions. Following input from the OPFD staff, the

questionnaire was modified and mailed to all recent applicants. (Appendix A). The

survey was sent in number ten business envelopes from this researcher and included a

paragraph that briefly explained the survey and thanked them in advance for their time

and input. A self-addressed stamped envelope was included to simplify the return

process. A total of 147 surveys were disseminated with seventeen completed and returned

for a return rate of 12%. The results of the survey were tabulated and presented at an

OPFD Senior Staff meeting. (Appendix B).

       The first question asked applicants to identify those factors that are most

important to them in considering applying for a position with a fire department. The

respondents were directed to rank their responses in order of importance to them. The

factor that received the highest score was, “Reputation of the Department, locally and

nationally.” The factors that ranked second and third highest were separated by only one

point with the second being “Call volume,” and the third being “Pay scale/ benefits.”

       Next the respondents were asked to reveal how they became aware of the

opening. The number one response to this question was, “Friend/ acquaintance.” The

score assigned to this response is even higher when two comments from the “Other”
                                                                                         21


category are considered. Those comments were “Brother lives in OP,” and “BC, Mike

Casey.” The scores were evenly distributed among “Newspaper advertisement” and

“Mailing,” although the Internet was noted on two write in comments.

       The next question on the survey queried respondents regarding any knowledge

they had about OPFD prior to applying for the posted opening. The majority either left

this section blank, or wrote in “None.” However, those who did respond with a specific

comment noted, among other factors, the Firefighter Combat Challenge and the national

reputation of the department.

       Those who selected a testing date, but did not continue with the application

process were asked to comment on what influenced their decision. Most left this portion

of the survey blank. Two responded that they had accepted another position prior to the

testing date and three wrote in comments regarding miscommunication and confusion.

       A number of respondents provided comments when asked what they liked about

the application process. Comments such as “the people,” “the encouragement they

received during the testing process,” and the “organization” and “efficiency” of the

process were comments provided. Several respondents provided suggestions for ways to

improve the process. Among others, comments included “online PDF” and “interview

was too short.” Interestingly, one applicant suggested there be separate test dates to

minimize the need for applicants to take vacation time from their current positions, while

another commented on how they appreciated back to back days to minimize the

disruption to their working schedule.

       When asked how OPFD could more effectively communicate opening to potential

employees in the future, many responded that they felt the department already
                                                                                               22


communicated openings effectively. Those respondents, who did have suggestions,

recommended increased exposure via the Internet and newspaper/ journal advertisements.

Research Question #2.

   2. Is the paramedic shortage a local or national problem?

        Review of applicants’ records over the most recent hiring processes revealed a

trend developing in the decreased numbers of applications and subsequent follow-

through. Figure 1 displays the numbers of applicants for paramedic positions with OPFD

in 2002 and how they compare to the number of open positions and number of applicants

that tested for positions and were subsequently hired.



Date of Process   # Available Positions    # Applicants        # Tested           # Hired

  Nov. 2002                  2                   13                8                 2

   July 2002                 5                   25               13                 5

 March 2002                 10                   42               21                 5

  Nov. 2001                 15                   67               30                 5



Figure 1. Paramedic applicant data for OPFD 2002

       In an effort to determine if this trend is local or a national issue, interviews were

conducted with EMS departments that had been proactive in their recruitment activities.

The author identified two departments, both of whom actively recruit paramedics. One

department is a fire-based EMS provider and the other is a hospital-based EMS provider.

Both organizations were approached because of their overt recruitment efforts at large

national EMS conferences held during the summer of 2002. Interviews were done with
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the lead recruitment individual for each service. The interviews began with a set of pre-

written questions to guide the interview and focus the questions on the targeted research

query.

         The first interview was with New Hanover EMS in Wilmington, North Carolina.

This aggressive hospital based EMS system sent a recruiting team to a large national

conference in 2002. Erin Walter is the Human Resources representative from the hospital

assigned to EMS charged with the mission of building a strong recruit base. The

following are questions and answers completed in a phone interview with Ms. Walters.

First, Ms. Walters was asked, “How many paramedics did your organization hire in

2002?” To this she replied, “Less than ten.” They are an organization that enjoys a low

turnover rate. Their goal is to not only to hire a paramedic to fill a position but to hire an

individual to become a long-term member of the New Hanover family. New Hanover

Regional will identify a quality employee and assist them in the transition from an EMT

provider to EMT-I and even continue the training to the paramedic level. It is better,

according to Ms. Walter, for the organization to train and develop the commitment than it

is to hire from the outside and have a paramedic move on in the future to another

provider. New Hanover enjoys the unique opportunity to draw from a large population

base within a 300-mile radius, bring in under trained recruits and provide advance

training in their facility.

         The second question asked was, “What is the ratio of applications to available

positions?” Ms. Walter shared that a paramedic opening will see a ratio of five applicants

for each position and an EMT opening will have a sixteen to one ratio. The researcher

inquired, “Recruitment: Are the national trade shows effective recruitment tools?” The
                                                                                             24


answer was a qualified, “Yes.” It is the goal of New Hanover Regional Medical Center

to get their name out to the medical community. They are concerned, first, with the

reputation of their Health Care System. At each trade show, they recruit for the system,

not just for a specific position opening. Their ultimate goal has less to do with volume of

applicants and more to do with those who will provide the right fit long term. The

hospital CEO is committed to providing a strong presence at national conventions to

highlight the presence of New Hanover Regional and its mission. This is consistent with

their stated goal of presenting the New Hanover Regional system as a medical

community.

       Third, Ms. Walter was asked, “Does your organization have a specific position for

recruitment?” She replied in the affirmative. Ms. Walters is officially an employee of

New Hanover’s Human Resources Department and is temporarily assigned to the EMS

Division. Her focus has been to develop a base of interest in all aspects of EMS. The

focus most recently has been to fill the EMT level positions assigned to their Patient Care

Transport Division and selected openings for paramedics in the VitaLink Critical Care

Transport Division.

       Finally, Ms. Walters was asked to provide any other comments and/or

recommendations. She communicated that New Hanover Regional has had limited

difficulty in the past years hiring paramedic staff. However, there is a definite trend of

decreasing applications as well as a decrease in quality of the applicants. The Medical

Center plans to expand their notification base as a result of this trend. They will

advertise in the southeast major metropolitan newspapers to include Virginia, North and

South Carolina major cities. The last several hiring processes revealed a high number of
                                                                                            25


repeat applicants. It is their desire to expand the list of potential candidates for open

positions.

       The second interview was a fire based EMS provider from the western region of

the United States, Grand Junction Fire Department. This department is located on

Interstate 70 west of the Rocky Mountains in western Colorado. The department covers

a ninety-three square mile geographic area with a population base of approximately

68,000 residents. Nikki Jost was the contact person from Grand Junction that was

interviewed for this project. Ms. Jost is a Personnel Analyst from the City of Grand

Junction’s Personnel Department. Ms. Yost was assigned to the fire department

specifically to assist with tracking the paramedic shortage and providing a framework

for the city to affect an effective hiring process. This interview was a prescheduled

telephone interview completed in December 2002.

       First question to Ms. Jost was “How many paramedics did your organization hire

in 2002?” Ms. Jost explained that Grand Junction Fire had an unusual situation in 2002.

They built a new fire station, which required fifteen firefighter paramedic positions to be

filled. They typically hire one to two positions annually. However the past two years have

seen the development of a concerning tend for Grand Junction. They lost three firefighter

/ paramedics to other departments. Two medics moved to California and one relocated to

a Front Range city near Denver. These employees left Grand Junction for the allure of

higher salaries. These are alarming occurrences for Ms. Jost, recognizing the potential to

lose additional employees when the paramedic market is already tight.

       Next, the author asked, “What is the ratio of applications to available positions?”

Ms. Jost said that the most efficient way to respond to this question was to give the
                                                                                            26


number breakdown for the most recent hiring process completed in October of 2002. The

city made the decision to allow non-paramedic firefighter-trained individuals to apply for

the openings. This decision was made with the paramedic shortage in mind; they would

use the non-paramedic applicants to fill slots not taken by paramedic level applicants. For

the fifteen positions vacant they received 266 applications. Two hundred applicants took

the written test, one hundred passed with a score of 80% or better, ten of who failed the

physical test, leaving ninety applicants to interview. Twenty-five of those were placed on

an eligibility list for hiring. Key information: of the 266 total applicants, only 25 (10.6%)

were paramedic trained. Of those twenty-five, only seven proceeded to the interviews and

were hired.

       The next question was “Does your organization have a specific position for

recruitment?” Nikki Jost is a city employee from the Human Resources office that is

assigned to the fire department. This position will be a temporary assignment as she will

be transferred or reassigned to another city department once a plan is in place to meet the

needs of the paramedic shortage.

       When asked to provide any additional comments and/or recommendations, Ms.

Jost was quick to respond. Recommendations are easy for this organization to provide,

she reported, because they feel they were caught by surprise over the past two years with

a staffing issue that has been smoldering around the country for nearly five years. Grand

Junction will be on of the first fire-based provider to identify the issue that was thought to

be a problem unique to the private provider. Traditionally, non-fire based EMS providers

could not compete with the benefits or salary packages offered by public providers, and

have consequently been fighting this battle all along. Now, fire-based EMS providers
                                                                                            27


have joined in the battle as the pool of qualified paramedic applicants shrinks. Simply

stated, Ms. Jost said, “The problem is here and must be addressed.” (N. Jost, personal

communication, December 17, 2002.)

       Hiring EMT firefighters and training to the advanced level is currently not an

option for Grand Junction. The city is lacking the educational foundation necessary to

provide the initial course of instruction for paramedics. This situation is being given

serious consideration by the entire medical community of the city of Grand Junction. It is

considered a high priority for any long range planning. Ms. Jost offered other valuable

information on job fairs. Specifically, it has been her experience that job fairs held at

local college or technical school programs do not work. They received zero applications

from those fairs. They did go on recruiting trips to the International Chiefs Conference in

Kansas City in August of 2002. From that event they mailed out 120 interest cards. These

cards are designed to provide additional information on the openings and dates for

testing. From that they received more than fifty returned applications. The number of

paramedics included in that number was not known.

       Information gathered from journal articles and the interviews with EMS providers

supports the evidence that the paramedic shortage is more then an OPFD problem. It is a

national concern that requires immediate attention.

Research Question 3.

       What innovations could OPFD employ to significantly increase the number of

applicants for EMS positions?

       All employees of OPFD must consider themselves to be recruiters. Each OPFD

employee is a walking advertisement for the department and must wear the identity and
                                                                                           28


promote OPFD to everyone they encounter. (Dovenspike, 2000). When it comes to

specific hiring scenarios, OPFD will need to learn to control the initial contact with

employees. Make the contact positive and professional. These early reactions will

impress the candidate on the likelihood of their desire to make a long-term commitment.

The initial impression candidates have of the department is for the members of the hiring

team to determine.

       A pro-active aggressive hiring team will allow for future planning of hiring

scenario’s and recruitment. (Fein 2000) The department should also be looking for

employees that are currently in the work force and perhaps not overtly searching for new

employment. There are individuals that may be interested in OPFD who simply have not

considered the option of working for the department. A proactive hiring team will not

overlook the candidate that des not currently read the classified looking for new

employment options.

       The recruitment team should be aggressively tracking market trends relating to

firefighter / paramedic positions nationwide and research the feasibility of enhancing the

recruitment package to be a competitive employer in the region. (N. Jost, personal

communication, December 17, 2002.) Overland Park Fire Department must rethink,

retool and control it’s recruitment plan to prepare for what the paramedic shortage facing

all EMS providers.



                                      DISCUSSION

   All indications lead one to believe that the need for paramedics is real not only for

OPFD but for most providers across the nation. As Gordon Sachs wrote, “In all, 21st
                                                                                          29


century EMS will be an expanding field.” (Sachs 2000) This observation has been

repeated in numerous journal articles, Federal government statistics and personal

interviews conducted during the course of this research. The growing need for qualified

paramedics has been documented in the review of literature and procedures sections of

this research project.

       The Bureau of Labor Statistics has projected that the occupation of paramedic will

increase by 31 % over the next six years (BLS, 2001). This will be the minimum growth

in most areas due to a greater increase in population and the “graying” of America.

Overland Park is a community on the verge of explosive growth as the city expands its

geographic boundaries. With an increase in square mileage come additional homes,

nursing homes and steady increase in the need for EMS.

       The critical nature of the current paramedic shortage in Charleston, WV provided

an extreme example of what could happen if the trend continues. If a OPFD cannot hire

qualified paramedics, the provider will be forced to make operational changes similar to

those facing Charleston (Hafenbrack 2002). Charleston Fire Department was forced to

remove paramedics from ambulances downgrading their response capability to the EMT

level on numerous ambulances. OPFD must learn this lesson. Ambulances could be

staffed with one paramedic and one EMT if the national trends continue. The reality of

the Charleston experience must be ever present on the minds of EMS administrators.

       To prevent this OPFD must learn from our applicants what factors motivated

them to apply. Factors such as career opportunities for advancement, call volume and pay

scales ranked high in the survey of recent applicants to the OPFD. The reputation of the

department was the highest-ranking response chosen by respondents. The leadership of
                                                                                           30


OPFD has overtly concentrated on being viewed as leader in the fire service. This

reputation has placed OPFD into a leadership role in Hazardous materials, prevention and

most recently EMS. This hard fought reputation has a direct effect on hiring as this

survey illustrates. This information allows OPFD to prioritize and continue the

advancement of this perception, defining our reputation and eventually empowering staff

to proactively recruit through a strategic and proactive hiring process.

       The survey was specifically designed to inquire of applicants two other points of

interest to OPFD. Question 2 inquired how the applicant learned of the opening at OPFD.

The intent was to gain insight and direction for subsequent hiring campaigns. That focus

was not clear in the results. Word of mouth through friends was revealed as the most

prevalent factor in the applicants awareness of position openings. Journals ranked a zero

in respondents. Overland Park Fire Department did place a notice in two national journals

for positions in 2002. Following the results of this survey, it will behoove OPFD to

reconsider this action in future small hiring processes. Question four was directed at those

applicants that had applied for positions but failed to follow through with the process.

During the 2002 processes OPFD, only half as many applicants completed the hiring

process. (Figure 1, page 22) The results from the survey only revealed two candidates

that took other positions and three other comments. Further research into this specific

area is needed. Complete survey results are provided in Appendix B.

       Change is never easy for organizations to embrace, and changing the hiring

process for OPFD will be a challenge. Previously the open position is advertised in the

newspaper and the applications flow in at the appropriate time. It will now require an

overt change of mindset for staff and management to adopt the ideas of anticipating
                                                                                             31


openings, being proactive by establishing a hiring plan before the opening occurs and

following the plan to educate current employees on recruitment (Fein,2000). The Grand

Junction experience would teach us to allow any interested paramedic to fill out an

interest card that would remain active and result in electronic and hard mail notification

of an open hiring date. These two activities could transform the hiring and recruitment of

paramedics to OPFD.

       Further research is also recommended to develop specific tools to quantify

recruitment endeavors and measure outcomes. These tools can then be effectively

implemented by the fire service for overall recruitment. It is this authors’ desire to see

OPFD on the leading edge of this wave of proactive recruitment.



                                    RECOMMENDATIONS

         Several recommendations can be made from this research. They involve current

staff training to recruit, future paramedic openings and ongoing monitoring of nationwide

trends. Additional research must be completed regarding staffing options and the

development of contingency plans in the event critical staffing challenges within the

paramedic position.

        Overland Park Fire Department must be diligent now to forecast growth potential

and develop plans to fill positions created both from that projected growth as well as

inevitable turnover. Proactive staffing, as described by Doverspike, must be a

commitment within the leadership of OPFD. Overland Park Fire Department will need to

develop recruitment teams that monitor trends, attend national conferences and propel the

department to the cutting edge of future recruitment planning.
                                                                                          32


       Educational opportunities need to be made available for those OPFD EMT staff

who wish to continue their training to the paramedic level. The Grand Junction Fire

Department situation underscores the need to give this option serious consideration.

Overland Park Fire Department is fortunate to have within its city a Community College

with an accredited paramedic program that provides an Associate of Science degree upon

completion. The two-year program can be completed while working on the current

twenty-four hour shift cycle that OPFD firefighting staff work. This option will allow

OPFD to send those employees who have proven themselves dedicated and will provide

long-term employees for OPFD that can function at the paramedic level.

        Review of the applicant survey reveals key factors that prospective employees

consider when applying for a position. Senior staff must review these surveys and

implement action plans to foster the growth of professionalism, manage the public

perception and maintain the pay scales on the leading edge of the regional fire service

EMS providers.

        One final recommendation is to review the interviews with experienced

professionals in the area of paramedic recruitment. Prepare a marketing or professional

recruitment folder that can be handed out at EMS conferences or mailed to interested

paramedics. Inside this folder, include demographic background, salary history and

potential for paramedic staff. Highlight in the packet the extraordinary working

conditions that are present at OPFD. Sell the applicant on the fact that OPFD is a

premiere service with exceptional equipment and staff. Promote the family feel that exists

among the OPFD employees. Also in this packet include a CD-ROM that show video of

the facilities, staff and geographic region. (N. Jost, personal communication, December
                                                                                       33


17, 2002) This packet will help mold the perception of prospective employees and put the

department on the pedestal as recommended by Fein. He reminds departments to develop

pride in the service and let this pride show in the faces of the staff. (Fein, 2000)
                                                                                            34




                                        REFERENCES

   Antone, R. (2001, July). Ambulance crews piling up overtime. [Electronic version]

Honolulu Star Bulletin. http://www.starbulletin.com/2001/07/11/news/story1.html

Accessed December 5, 2002.

   Bureau of Labor Statistics. (2001). Occupational outlook handbook. Online. Available

at http://www.bls.gov/news.release/ooh.nr0.htm Accessed December 17, 2002.

   Cook, Mary (1992). The AMA handbook for employee recruitment and retention

[Electronic version] (pp. 124-125). New York, NY: 1992

   Doverspike, Dennis (2000). The difficult hire, seven recruitment and selection

principals for hard to fill positions [Electronic version] (pp.25-30). Manassas Park, VA:

Impact Publications, 2000.

   Emergency Medical Services Act, 4 Kan. Stat. Ann. §§ 65-6119 – 6120 – 6121 (1988

& Supp. 2002)

   Fein, Richard (2000). 101 hiring mistakes employers make, and how to avoid them

[Electronic version] (pp. 3-56). Manassas Park, VA: Impact Publications, c2000

   Fix, S. (2000, March). Wanted: skilled EMS personnel. Emergency Medical

Services, 29(3), 39-40

   Hafenbrack, J. (2002, October). Shortage of paramedics threatens emergency rating.

[Electronic version] Charleston Daily Mail http://library.cnpapers.com/cgi-bin/search/

accessed December 5, 2002.

   Heightman, A.J. (2000, March). EMS Workforce. JEMS, 25(3), 108-112.
                                                                                      35


   Meijer, M. (2000, January). Prehospital care in the new millennium. Emergency

Medical Services, 29(1), 77.

   Peters, T. (1990). The path to fire service excellence. Fire Engineering, 27-32.

   Sachs, G. (2000, January). The expansion of EMS. Emergency Medical Services,

29(1), 66-67.
                                                                                       36


                                      Appendix A

                  Overland Park Fire Department Applicant Survey
                                     Fall, 2002

Thank you for the interest you demonstrated in the Overland Park Fire Department with
your recent application for employment. OPFD continuously works to improve all
aspects of the Department, including the application and hiring process. Toward that end,
please take a moment to complete this short survey and return it in the enclosed envelope.
Your input is extremely important to us. Thank you for your time.

What factors are important to you when you consider applying for a position with a
Fire Department? (Please rank those factors that are important to you, “1” through
“9”, with “1” being the most important.)

       _____ Call volume

       _____ Geographic location

       _____ Opportunities for advancement

       ____    Opportunity to practice firefighting and paramedic skills

       _____ Pay scale/ benefits

       _____ Reputation of the Department, locally and nationally

       _____ Size of the Department

       _____ Union vs nonunion status of the Department

       _____ Other ______________________________________


How were you made aware of the opening for the Firefighter of Paramedic with
OPFD?

       _____ Journal advertisement

       _____ Newspaper advertisement

       _____ Mailing

       _____ Friend/ acquaintance

       _____ Other ________________________________________
                                                                                     37




What, if any, prior knowledge did you have of the OPFD prior to applying for this
opening?



If you selected a testing date, but did not continue with the application process, what
influenced you to make this decision?

       _____ Personal or family illness

       _____ Accepted another position prior to the testing date

       _____ Inability to travel of OP on the testing date due to:

              ______________________________________________

       _____ Other _________________________________________


If you completed the application process, what did you like about the process?



What suggestions do you have to improve the application process at OPFD?



How could OPFD more effectively communicate openings to potential employees?



What suggestions do you have for OPFD to make more attractive future openings
for Firefighters and/or Paramedics?



Additional comments:
                                                                                       38


                                        Appendix B

             Overland Park Fire Department Applicant Survey Results
                                   Fall, 2002

Of the 95 surveys disseminated, 17 were returned and processed. A 16% (16.15%)
return rate.
(Comments included sic)

Thank you for the interest you demonstrated in the Overland Park Fire Department with
your recent application for employment. OPFD continuously works to improve all
aspects of the Department, including the application and hiring process. Toward that end,
please take a moment to complete this short survey and return it in the enclosed envelope.
Your input is extremely important to us. Thank you for your time.

What factors are important to you when you consider applying for a position with a
Fire Department? (Please rank those factors that are important to you, “1” through
“9”, with “1” being the most important.)

        92     Call volume (FYI--7 of the 17, or 41%, respondents ranked this factor in
               the top three.)

       62      Geographic location

       77      Opportunities for advancement

       84      Opportunity to practice firefighting and paramedic skills

       91    Pay scale/ benefits (FYI--7 of the 17, or 41%, respondents ranked this
             factor in the top three.)

      106    Reputation of the Department, locally and nationally (FYI--11 of the 17, or
             65%, respondents ranked this factor in the top three.)

       75      Size of the Department

       38      Union vs nonunion status of the Department

        3      Other Length of testing period (1)
                     Reputation of Department/ References (1) (FYI -- the only other
                     factor this individual marked on the survey was “Reputation of the
                     Department)
                     Equipment Standards (1)
                                                                                      39


How were you made aware of the opening for the Firefighter of Paramedic with
OPFD?

      0      Journal advertisement

      3      Newspaper advertisement

      3      Mailing

      6      Friend/ acquaintance

      6      Other Perfect Firefighter     1
                   Brother lives in OP     1
                   Internet                2
                   Firefighters.com        1
                   BC, Mike Casey          1


What, if any, prior knowledge did you have of the OPFD prior to applying for this
opening?

      Not much

      Some, pay scale; Advancement

       Seen the Firefighter challenge team on TV, other than that no prior knowledge
      of the Department

      None

      Size, location, pay scale, volume of calls, Chiefs names, history, where your
      budget comes from, how it is approved.

      Dad is a Firefighter in Springfield, MO and he told me that Overland Park
      would be a good place to work.

      Very familiar with most aspects of dept. Work for another JoCo dept.

      None

      Just a good national reputation and the FF combat challenge

      Just what I could obtain from the website

      None
                                                                                       40


       Just hearing about combat challenge

       Great Department and great training facilities


If you selected a testing date, but did not continue with the application process, what
influenced you to make this decision?

       0       Personal or family illness

       2       Accepted another position prior to the testing date

       0       Inability to travel of OP on the testing date due to:

       3       Other You never ask me too.
                     Was not allowed to test, EMT results not in, I am a Western MO
                     fire Academy grad and I work ER??
                     I didn’t get any info when testing was


If you completed the application process, what did you like about the process?

       Very fast and efficient

       I liked the monitoring vitals during physical and encouragement from staff.

       The people were very encouraging, the facility very impressive

       It was fair and the speed was good. It didn’t take a long time to find out if you
       passed something or not

       Physically agility test. Written test.

       It was easy

       Choice of days to take each phase. Easy to work around my schedule. Quick
       email response.

       The process was very fast from written test through oral boards to offer.

       Same as all others I have attended

       The people.

       2 test days. Very organized
                                                                                       41


What suggestions do you have to improve the application process at OPFD?

      Online PDF, so it can be presented well, typewriters are becoming dinosaurs.

      More leeway – especially if the training officer could acknowledge my skills.

      Nothing – I liked the speedy notification and speedy process.

      Pick the right applicant next time.

      The interview is very short. Didn’t get a lot of time to sell myself.

      Separate test dates. Two different dates for written to allow everyone a chance
      to come without taken vacation days off.

      Send the testing info to me next time.

      Give all applicants a chance, not just the few that are related to department
      members

      None


How could OPFD more effectively communicate openings to potential employees?

      Advanced postings for open positions, not eligibility lists.

      Same – ads, emails, internet

      I have no valuable input, I’ve not found any sources that list FF job openings
      other than word of mouth or newspapers.

      Nothing – you took all the right routes

      Advertise

      I think it is already done very well

      TV, Internet

      Ads in paper
                                                                                       42


What suggestions do you have for OPFD to make more attractive future openings
for Firefighters and/or Paramedics?

      Fast testing period. Keep tests close together to cut down on travel time and
      cost for candidates.

      From seeing the facilities, talking with others about OPFD An employment
      opportunity at OPFD is all the attraction for a serious applicant that is needed

      None

      If you were not attractive in the first place I would not of applied.

      None

      Don’t know

      Be the dept you are. Everything that I have learned about your dept I found
      that OPFD is an excellent and I hope I could have a future there.

      Keep things the same


Additional comments:

      Overall, I had a great experience. Good people,

      I’m really disappointed at myself for not meeting OPFD standards. I should
      have been more physically/ mentally prepared. I’m also disappointed OPFD
      missed out by failure to hire the best hand ever to apply there. Hopefully, we
      can five each other another chance sometime. Thank you.

      Many people believed that you had pre-selected the individuals you wanted for
      the jobs. The 3 question interview process made me feel that was apparently the
      case. With the knowledge I learned later made some of it true. Don’t waste my
      time if I was never a real candit. Hire the top 10 candits before you begin a new
      process.

      Thank you for the opportunity to try-out for your dept.

      I was rather pissed to find out that the 5 people choosen where picked before
      the process took place. I wouldn’t have driven 3 hours and paid for 2 nights in
      a hotel had I known the applicants were picked before the process. To bad one
      didn’t pass the tests…

				
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