Research Project of Employee Retention

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					          Ohio EMS
Recruitment & Retention Project


         Sponsored by the Division of EMS,
         Ohio Department of Public Safety
             with grant support from the
          Ohio Department of Health and
   the Health Resources & Services Administration

                                                    8/11/2011
         “All communities should have
         comparable levels of EMS
         preparedness and response. Whether
         provided by volunteer or career
         services, by governmental agencies or
         the private sector, this is a basic
         health need.”

          - National Rural Health Association

Ohio EMS Recruitment & Retention Project   January 18, 2007 2
          Surveys of state EMS directors in
          2000 and 2004 indicated that the
          greatest need for rural services is the
          adequate recruitment and retention of
          personnel

          - Rural and Frontier EMS Agenda for
          the Future.



Ohio EMS Recruitment & Retention Project   January 18, 2007 3
             Recruitment & Retention
              Recruitment                       Retention



              Recruitment                  Retention
              Finding,                     Keeping     Good
              Training,                    People
              Integrating
              New People




Ohio EMS Recruitment & Retention Project                      January 18, 2007 4
          Recruitment and Retention
          Project Goals
          1.    Examine what is known about current
                Ohio EMS personnel and agencies.
          2.    Identify issues that impact recruitment
                and retention (R&R) of EMS providers in
                Ohio.
          3.    Review research and state EMS programs
                for existing R&R strategies.
          4.    Develop recommendations and guidelines
                to assist local EMS agencies develop
                and/or improve their R&R efforts.

Ohio EMS Recruitment & Retention Project        January 18, 2007 5
          Data Collection
          1.    Literature search of EMS and volunteer
                recruitment and retention efforts.
          2.    Demographic research of Ohio and
                Ohio’s EMS population.
          3.    Five regional focus groups throughout
                Ohio.
          4.    Mail survey sent to a random sample of
                Ohio EMS providers.


Ohio EMS Recruitment & Retention Project        January 18, 2007 6
         Focus Group Discussion
             Present regional Ohio EMS provider and agency
              data.
             Discuss personal motivations and experience of
              being an EMS provider in Ohio.
             Examine why EMS providers leave field.
             Discuss agency strategies and rate their
              effectiveness.
             Discuss strategies for Ohio Div. Of EMS to assist
              local agencies with R&R.

Ohio EMS Recruitment & Retention Project               January 18, 2007 7
             Common Retention Barriers over
                the Volunteer Life Cycle
         0                                    Poor job match
                  Invest/Train
         1                                    Inadequate orientation
         2         Active                     Time conflicts
         3
                   Involvement                Interpersonal conflicts
                                              Burnout
         4         Mastery/
                   Leadership
                                              Commitment
         5                                    Competency
     Years
Ohio EMS Recruitment & Retention Project                        January 18, 2007 8
          Breakdown by Region and
          Geographic Classification
             Homeland Security Planning (HSP)
              Regions (8)
             Community Environment Setting (CES)
              Classification – Appalachian, Rural,
              Suburban, Rural



Ohio EMS Recruitment & Retention Project      January 18, 2007 9
         Northwest
                                                                               Trauma/EMS by Homeland                                                                                         Northeast
                                                                                                                                                                                Ashtabula

 Williams              Fulton
                                             Lucas       5
                                                             H
                                                                 H             Security Planning Regions Lake
                                                                     H                                                                                                                             LEGEND
                                   H                                       Ottawa
                                                                                                                                            H     7                                           Counties in Red
                                                        Wood
                               Henry                                                                                                               H          Geauga            Trumbull      have NO hospital
                                                                      Sandusky                    Erie                        H         H Cuyahoga H
         Defiance                                                                                                                                                                             H = Helicopter
                                                                                       H                                  Lorain                            Portage
                 H                                                                                           Huron                                                                                 = No 9-1-1 service
 Paulding                                                             Seneca                                                            Medina   Summit

                                                                                                                                                     3
                                                   Hancock                                                                         H                                         Mahoning
                      Putnam
                                                                                                                                                                                             NE Central
                                     H                               Wyandot                        Richland       Ashland
  Van Wert                            H                                              Crawford                                                                 Stark                     H
                                                    H
                                                                                                                                                                        Columbiana             = Accredited Training
                               2                                                                                                                            3 H                                Institute(s)
                                   Allen                                        Central                                            Wayne
                                                Hardin
 Mercer                                                                                                                                                                                        = Trauma Center(s)
                                                                      Marion                   Morrow
                        Auglaize                                                                                                                                Carroll                        The number next to
                                                                                                                                   Holmes        Tuscarawas
                                           Logan                                                                                                                                Jefferson      the icon indicates the
                       Shelby                                     Union                                                        Coshocton            H                                          number of trauma
                                                                               Delaware                        Knox                                               Harrison                     centers in that county
   Darke                                                                                                                                   H
                                       Champaign
                     Miami
                                                                      H                                  Licking                                 Guernsey                              Southeast
                                            H
                                                                                                                                                                      Belmont
 SW Central                                                                         Franklin
                                                                                        4
                                            Clark
                                                                                Franklin                                           Muskingum
                           H                                                                       Fairfield
                                                                 Madison
Preble                 3           Greene                                       Pickaway                              Perry                                     Monroe
                 Montgomery                                  Fayette                                                                   Morgan     Noble
                                                                                                                                                                                    EMT Density per 1000
                                                                                                          Hocking                          H                                        Ohioans (per 10 Sq Mi)
     Butler           Warren                 Clinton                                                                                              Washington
             4          H                                                                                                  Athens                                                  Northwest: 4.0 (7.1)
                                                                            Ross
             H                                                                                                                                                                     SW Central 3.7 (11.8)
     Hamilton                                           Highland                                         Vinton
 H       3                                                                                                                                                                         Southwest: 3.2 (14.3)
                                                                            Pike                                              Meigs
                       Clermont                                                                          H                                                                         Central: 3.4 (9.2)
                                       Brown                 Adams                                 Jackson
                                                                            Scioto                                                                                                 South: 3.8 (3.4)
     Southwest                                                                                                   Gallia
                                                                                                                                                                                   Northeast: 3.1 (28.8)
                                                                                                                           South                                                   NE Central: 3.1 (11.2)
                                                                                                     Lawrence

         Ohio EMS Recruitment & Retention Project                                                                                                                                 Southeast: 4.8
                                                                                                                                                                                                 10
                                                                                                                                                                                January 18, 2007 (4.1)
          EMT Density
          (Mileage X Population)




Ohio EMS Recruitment & Retention Project   January 18, 2007 11
         Northwest
                                                             H                  Community Environment                                                     Lake
                                                                                                                                                                              Ashtabula     Northeast
                                             Lucas       5       H
 Williams              Fulton
                                   H
                                                                     H          Setting Classification
                                                                           Ottawa
                                                                                                                                                                                                 LEGEND
                                                                                                                                          H     7                                           Counties in Red
                                                        Wood                                                                                                  Geauga
                               Henry
                                                                      Sandusky
                                                                                                                                                 H                            Trumbull      have NO hospital
         Defiance                                                                               Erie                        H         H Cuyahoga H
                                                                                                                                                                                            H = Helicopter
                                                                                      H                                 Lorain                              Portage
                                                                                                                                                             7
                 H                                                                                         Huron                                                                                 = No 9-1-1 service
 Paulding                                                             Seneca                                                          Medina   Summit

                                                                                                                                                   3
                                                   Hancock                                                                       H                                          Mahoning
                      Putnam
                                                                                                                                                                                            NE Central
                                     H                               Wyandot                      Richland       Ashland
  Van Wert                            H                                             Crawford                                                                Stark                      H
                                                    H
                                                                                                                                                                      Columbiana
                               2                                                                                                                          3 H
                                   Allen                                                                                         Wayne
                                                Hardin
 Mercer                                                                                                                                                                                           = Trauma Center(s)
                                                                      Marion                 Morrow
                        Auglaize                                                                                                                              Carroll                             The number next to
                                                                                                                                 Holmes        Tuscarawas
                                                                                                                                                                                                  the icon indicates the
                                           Logan                                                                                                                              Jefferson
                                                                                                                                                                                                  number of trauma
                       Shelby                                     Union        Delaware                      Knox            Coshocton            H                                               centers in that county
                                                                                                                                                                 Harrison
   Darke                                                                                                                                 H
                                       Champaign
                     Miami
                                                                      H                                Licking                                 Guernsey                              Southeast
                                            H                                     Central                                                                           Belmont
 SW Central                                                                       Franklin
                                                                                       4
                                            Clark
                                                                                Franklin                                         Muskingum
                           H                                                                     Fairfield
                                                                 Madison
Preble                 3           Greene                                       Pickaway                            Perry                                     Monroe
                 Montgomery                                  Fayette                                                                 Morgan     Noble

                                                                                                        Hocking                          H                                                 Rural
     Butler           Warren                 Clinton                                                                                            Washington
             4          H                                                                                                Athens                                                            Appalachian
                                                                           Ross
             H
     Hamilton                                           Highland                                       Vinton                                                                              Metro
 H       3
                                                                           Pike                                             Meigs
                                                                                                                                                                                           Suburban
                       Clermont                                                                        H
                                       Brown                 Adams                               Jackson
                                                                           Scioto
     Southwest                                                                                                 Gallia

                                                                                                                         South
                                                                                                   Lawrence

         Ohio EMS Recruitment & Retention Project                                                                                                                             January 18, 2007 12
            Twenty percent
            (2,233,979) of Ohioans
            live in rural areas.


Ohio EMS Recruitment & Retention Project   January 18, 2007 13
                               Median Age by County




Ohio EMS Recruitment & Retention Project              January 18, 2007 14
          Ohio Population Change by Age




Ohio EMS Recruitment & Retention Project   January 18, 2007 15
          Ohio EMTs by Age Group




Ohio EMS Recruitment & Retention Project   January 18, 2007 16
          Ohio EMS Providers by Level
          Of Certification




Ohio EMS Recruitment & Retention Project   January 18, 2007 17
          EMTs and Agencies by Community
          Environment Setting (CES)
          Classification




Ohio EMS Recruitment & Retention Project   January 18, 2007 18
          Percent EMT-B and Paramedic
          of All Ohio EMTs




Ohio EMS Recruitment & Retention Project   January 18, 2007 19
   Transport
   Times




Ohio EMS Recruitment & Retention Project   January 18, 2007 20
          Ohio EMS Agencies by
          Member/Employee Pay Status




Ohio EMS Recruitment & Retention Project   January 18, 2007 21
          Employee Pay Status by Region




Ohio EMS Recruitment & Retention Project   January 18, 2007 22
           Paid Vs. Volunteer Agency




Ohio EMS Recruitment & Retention Project   January 18, 2007 23
          Percent EMT-B & Volunteer




Ohio EMS Recruitment & Retention Project   January 18, 2007 24
          Fewer Financial Resources




Ohio EMS Recruitment & Retention Project   January 18, 2007 25
             Lower Run Volume with Fixed
             Operating Costs




Ohio EMS Recruitment & Retention Project   January 18, 2007 26
             Run Volume by Region




Ohio EMS Recruitment & Retention Project   January 18, 2007 27
          Ohio EMS Resources by HSP Region




Ohio EMS Recruitment & Retention Project   January 18, 2007 28
          Accredited Training Facilities




Ohio EMS Recruitment & Retention Project   January 18, 2007 29
              Rural & Appalachian Challenges
             Low run volumes with high fixed operating costs
             Poor geographic boundaries with little or no system of
              organization among many agencies
             Remote areas with longer response and transport times
             Organizational instability with high turnover and lack of
              continuity in leadership
             Lack of trauma and/or specialized care facilities
             Fewer financial resources/tax dollars to fund services
             Lower levels of training (i.e., fewer ALS providers)
             Reliance on dwindling pool of volunteer personnel
             Aging population with increasing health care demands
             Lower provider reimbursement - Competing with
              compensation of urban/suburban services to retain
              providers

Ohio EMS Recruitment & Retention Project                     January 18, 2007 30
          Rural & Appalachian Challenges
                Aging infrastructure may not currently have the
                 response capacity to cope with surge demands
                Need for better communication tools and access to
                 technology to assist care over remote areas
                Access to qualified medical direction
                Access to quality training & continuing education
                Responding to normal fluctuations in patient volumes
                 (i.e., during flu season) often creates problems
                Inadequate insurance reimbursement for services
                Abuse of 911 system for non-emergencies
                Lack of systematic coordination among agencies
                Trouble adapting to changing nature of EMS business
                 from volunteer to paid or part paid.
Ohio EMS Recruitment & Retention Project                     January 18, 2007 31
          Implications for Ohio EMS

           Supply                             Demand
                Labor force 55 and older          Aging population will
                 is growing faster than             have increasingly
                 the younger labor force.           complex health needs
                                                    as health status
                Fewer entrants to
                                                    declines.
                 workforce, fewer
                 potential volunteers.             More elders living in
                                                    community.
                More EMTs approaching
                 retirement age and                EMS being used more
                 leaving workforce.                 as a gatekeeper to
                                                    health care system
                Family demads
Ohio EMS Recruitment & Retention Project                       January 18, 2007 32
            Retention Issues

               Time Demands on Volunteers
               More Demanding Training and Continuing
                Education Requirements
               Increasing Emergency Call Volumes
               Leadership Quality and Continuity
               Changing Nature of the Business


Ohio EMS Recruitment & Retention Project      January 18, 2007 33
          Time Demands on Volunteers
                     Volunteers have less time due to
                      demands of family and work life.
                     Employers may not be supportive of
                      volunteer work.
                     More dual income and single parent
                      families working multiple jobs.
                     EMS may be disadvantaged in
                      recruiting volunteers due to the high
                      level of commitment in certification
                      and long hours.

Ohio EMS Recruitment & Retention Project            January 18, 2007 34
          More Demanding Training & CE
                 Training demands are increasing due to
                    New federal requirements requiring
                     higher standards of care and consistency
                    EMS evolving into gatekeepers into
                     primary health care role
                    Public expectations about the skills of
                     EMS providers



Ohio EMS Recruitment & Retention Project              January 18, 2007 35
          Increasing Call Volumes
                          Aging Population
                          Population Growth
                          Increasing use of 911 as
                           source of primary care




Ohio EMS Recruitment & Retention Project          January 18, 2007 36
            Leadership Quality & Continuity
             More demands are placed on agency
               leaders to:
              Exhibit flexible leadership styles to create
               an agency culture matching the needs of
               new volunteers with changing
               generational values.
              Develop leaders and key professionals
               for growth and continuity
              Manage larger and more complex
               organizations
              Lead the transition from a volunteer to
               part- or all career professional staff
Ohio EMS Recruitment & Retention Project          January 18, 2007 37
           Changing Nature of Business
                 EMS is evolving due to:
                  Transition to fee for service and other funding
                   changes
                  Moving from independence to
                   interdependence with other service providers
                   due to concept shift into public health system
                  Increasing public expectations
                  Transitioning from volunteer to paid staffing
                  Adjusting to shrinking traditional pool of EMS
                   volunteers 16 – 34 years
                  Retiring “Baby Boomers” and Integrating
                   Generation X & Y providers

Ohio EMS Recruitment & Retention Project                 January 18, 2007 38
         Focus Group Summary
              Lack of Opportunities for advancement
              Difficulty separating work from personal
               life
              Lack of respect from ER and hospital staff
              Lack of or low compensation
              “Hassle factor” - More demanding
               training, certification, and continuing
               education requirements
              Changing system and customers with
               more complicated billing and
               Medicare/Medicaid

Ohio EMS Recruitment & Retention Project         January 18, 2007 39
          Focus Group Issues
          Inappropriate use of 911 by community &
             skilled nursing homes leading to burnout
            Lack of access to new technological
             developments as they relate to training,
             medical oversight/direction, etc.
            Interpersonal problems
            Poor or lack of agency leadership
            Family commitments & other time demands
            Lack of attentiveness “mental health” needs
             caused by job stress
            Perception of EMS in Fire Departments

Ohio EMS Recruitment & Retention Project       January 18, 2007 40
          Survey – What Attracted you
          to EMS?
      • Most (more than 70%) of responding
        providers were initially attracted to
        EMS because of friend or family
        member in EMS.
      • Word of mouth has traditionally been
        used to recruit personnel.


Ohio EMS Recruitment & Retention Project   January 18, 2007 41
          Survey – Employment Barriers for the
          Volunteer Provider
          • Work issues a barrier to volunteer survey
            respondents.
          • Work commitments are #1 reason preventing
            volunteers from providing more hours to EMS/Fire.
          • About 45% indicated their employer did not allow
            them to leave to respond to EMS/Fire calls.
          • More than half of responding volunteers work
            more than 10 miles from the EMS/Fire station.
          • Most volunteers do not live in the same
            community in which they work, whereas most
            career providers do.


Ohio EMS Recruitment & Retention Project            January 18, 2007 42
          Survey Data - Benefits

             Quality training and education
             Communication
             Meaningful and regular performance
              improvement/feedback
             Reimbursement for education/training
             State-of-the-art equipment

Ohio EMS Recruitment & Retention Project      January 18, 2007 43
          Survey Data – Activities leading
          to Agency Success

             Continuing education
             Customer service
             Communication between leaders and
              volunteers/providers



Ohio EMS Recruitment & Retention Project    January 18, 2007 44
          Leaders’ Responses – Rating of
          Most Serious Retention Problems

             Publicity for outstanding service
             Grooming for leadership
             Competency-based pay
             Special pay and benefits
             Providing more advanced training
             Addressing job stress

Ohio EMS Recruitment & Retention Project   January 18, 2007 45
          Recommendations for Local Leaders
          1.   Develop R&R programs within agency
          2.   Recruit outside the box
          3.   Focus on the development of leadership
          4.   Focus on quality and usefulness of
               education and training
          5.   Search for available funding for R&R
               activities and leadership training
          6.   Advocate for EMS at local and state level
          7.   Coordinate and integrate local services
Ohio EMS Recruitment & Retention Project        January 18, 2007 46
             Common Retention Barriers over
                the Volunteer Life Cycle
         0                                    Poor job match
                  Invest/Train
         1                                    Inadequate orientation
         2         Active                     Time conflicts
         3
                   Involvement                Interpersonal conflicts
                                              Burnout
         4         Mastery/
                   Leadership
                                              Commitment
         5                                    Competency
     Years
Ohio EMS Recruitment & Retention Project                       January 18, 2007 47
                         Recommendations for
                           Ohio EMS Board
          1.   Improve data collection on EMS population
          2.   Continue R&R efforts (e.g., committee of Board)
          3.   Continue to obtain local provider feedback
          4.   Encourage development of model R&R programs
          5.   Study the quality & effectiveness of initial training
               and CE throughout state
          6.   Focus on need-based grant funding
          7.   Advocate and promote (market) EMS as an R&R
               strategy
          8.   Consider and envision long-term regional and
               statewide solutions to develop a comprehensive EMS
               system that serves all Ohioans
Ohio EMS Recruitment & Retention Project                 January 18, 2007 48
             1. Improve Data Collection on
                                 EMS Providers
           Redesign EMS provider database so it is possible to
            study the Ohio EMS population and identify trends.
           Refine EMSIRS to ensure data provided to local
            agencies meets their needs and is useful for
            performance improvement, training efforts and
            benchmarking.
           Collaborate with the NREMTs on the LEADS study.
            Obtain Ohio EMS provider data to support R&R
            efforts.
           Collect volunteer status, gender, race/ethnicity,
            education, marital status, to better inform planning.
           Examine minority recruitment efforts to better
            understand retention problems in urban areas.
Ohio EMS Recruitment & Retention Project               January 18, 2007 49
                 2. Continue State-level R&R
                    Support and Activities
             Form a subcommittee to address rural issues &
              report back to Board. Recruit rural provider
              members to help develop solutions that best
              meet their needs.
             Seek additional funding to hire a staff person to
              liaise with the R&R Committee and coordinate
              statewide R&R initiatives and provide R&R
              technical assistance to local EMS agencies.
             Continue to research other state models and
              discuss long-term funding solutions for rural
              EMS providers.
Ohio EMS Recruitment & Retention Project              January 18, 2007 50
                 3. Continue to Obtain Local
                     Provider Feedback
              Obtain additional feedback on local R&R issues through
               town hall meetings and focus groups arranged at pre-
               scheduled meetings such as state and regional
               conferences or trainings.
              Continue to review ongoing data related to the R&R
               survey. Examine responses by different populations, such
               as by years of service.
              Encourage rural and volunteer providers, in particular
               from south and southeast Ohio, to offer feedback to the
               EMS Board on R&R issues.
              Ensure that rural representatives of EMS agencies have a
               “voice” at the state level by designating a position on the
               Board.

Ohio EMS Recruitment & Retention Project                      January 18, 2007 51
                           4. Encourage Model
                               R&R Programs
             Hire R&R staff person.
             Develop R&R toolkits for local EMS agencies.
             Provide technical assistance to local agencies.
             Offer regional trainings with national experts in EMS &
              volunteer R&R and highlight local success stories.
             Offer regional trainings for EMS managers
              transitioning from volunteer to part-paid staff.
             Use EMS grant monies to fund innovative, pilot R&R
              projects in areas of greatest need (i.e., rural).
             Support culturally-, age-, gender-, race-, appropriate
              R&R efforts so EMS represents the population.
Ohio EMS Recruitment & Retention Project                 January 18, 2007 52
               5. Study the Quality and
            Effectiveness of Training & CE
           Review CE requirements for duplication &
            consolidate as appropriate. Emphasize quality of
            CE as evidenced by skill-based assessments and
            performance improvement. Link education to what
            is happening in the field.
           Delegate Education Committee to study & review
            quality of initial training & continuing education -
            Crucial retention issue for agencies with low run
            volumes, few critical care calls, minimal MD
            involvement or little performance feedback.
           Promote & provide funding & training for distance
            learning, videoconferencing, internet connectivity &
            telemedicine technology that is applicable, feasible
            and cost-effective for CE and care in rural areas.

Ohio EMS Recruitment & Retention Project               January 18, 2007 53
                6. Evaluate Grant Process to
                Ensure Need-based Funding
              Emphasize funding for training/CE over equipment.
               Limit the amount of funding disbursed for
               equipment.
              Reinstate need-based grant award formula to ensure
               that funds are going to areas of greatest need.
              Consider R&R activities as falling under training
               priority. Many EMS agencies require training in R&R
               & leadership skills or they will not be able to sustain
               service.
              Advocate for FEMA to include EMS-only agencies to
               be eligible for SAFER grants providing some
               compensation for wages -
               http://www.firegrantsupport.com/.
Ohio EMS Recruitment & Retention Project                   January 18, 2007 54
          Fewer Financial Resources




Ohio EMS Recruitment & Retention Project   January 18, 2007 55
          EMS Grant Awards by CES
          Classification




Ohio EMS Recruitment & Retention Project   January 18, 2007 56
          Grant Awards




Ohio EMS Recruitment & Retention Project   January 18, 2007 57
        7. Market EMS as an R&R strategy.
              Provide training & technical assistance to local
               providers in how to market EMS.
              Improve perception of EMS among fire, allied
               health and ED personnel
              Work with other state agencies to promote EMS.
              Advocate for and assist local agencies with
               integration into community public health and
               safety planning networks including hospitals,
               local health department, fire, police, primary
               care networks, etc.
              Assure that all counties in the state have 911
               service, and encourage the implementation of E-
               911 and wireless enhanced (WE-911) statewide.
Ohio EMS Recruitment & Retention Project             January 18, 2007 58
           8. Consider and envision long-
           term regional and statewide
           solutions to develop a
           comprehensive EMS system that
           serves the needs of all Ohioans.



Ohio EMS Recruitment & Retention Project   January 18, 2007 59
          Limitations
             Limited participation in focus groups
             Lack of participation from young/new
              providers in FGs and survey
             Lack of (e.g., gender, race, management
              status, volunteer/employment status) &
              limitations in examining certification data
             No ability to link providers to agencies

Ohio EMS Recruitment & Retention Project         January 18, 2007 60
                       EMTs and Paramedics are
                     included in occupations with
                    high employment prospects in
                                 Ohio.
                     Ohio Department of Job & Family
                     Services, Bureau of Labor Market
                      Information, 2004 Projections




   “Generally the cost of
replacing EMS employees is
  approximately half their
     annual salaries.”

21st Century, Nov 2002, EMS


                                      8/11/2011
Next Steps…




              8/11/2011
Thank you!




             8/11/2011

				
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