Letting the Employees Steer the Ship

   In the last 10 years, the population of the Reno-Sparks (NV) metropolitan area grew by more than 20%. Its paramedic transport system grew with it. Patrick Smith, president of the Regional EMS Authority (REMSA), had always been able to keep tabs on what was going on with his employees through informal meetings and talks. But as REMSA grew so quickly, that was no longer a viable option. In the space of a few years, it went from 100 employees and 20 ambulances to more than 350 employees and 43 ambulances.

   Toward the end of this growth period, Mike Williams came to REMSA as its vice president of operations. Williams had previously managed several other EMS organizations. With those services, he had used employee input and meetings to help transition through some challenging situations. Together with Smith, Williams developed focus groups as a tool to find out what REMSA employees are thinking and what concerns they have about their organization.

   These focus groups are held twice a month. Each group consists of 10 people selected at random from a department within REMSA. These employees are paid to come to the two-hour meeting. The results help guide changes to REMSA policies.

   "You have to be willing to change based on what the employees want," says Williams. "You have to believe they know some things you don't and, at times, know how to do things better than the managers. People are going to criticize management decisions and even managers themselves. You have to be able to take that and find out what can be done differently to satisfy the employees and improve the organization."

   Ground rules for the meetings are set at the beginning. Anything that is said stays in the room. Participants are told they can talk about anything or anybody, even the managers running the meeting. If an idea from a focus group is implemented, management won't say who came up with it--just that it came out of a focus group.

   Someone on the management team "owns" each issue and its follow-up. Sometimes an issue can be resolved in a matter of days. Some take months because of their impact on the organization as a whole. Leaders also may wait for other focus groups to meet to get additional input on a problem and proposed solution.

   If an issue involves a small group or an individual, feedback on the solutions is handled on a one-one basis. For larger issues, the company as a whole is kept updated on progress through newsletter articles, memos, etc. Leaders want to try to bring closure to each issue.

   "We now have people who want to be part of focus groups," says Williams. "In the early days, employees would bring up issues and expect management to find solutions. Then they began to come with issues and ideas about how to handle them. They've found that if they bring a solution to the table, management will often try it. Now, about 70%-80% of the time an issue is raised, the person raising it has a recommendation on how to fix it."

   There are advantages and disadvantages to this system. Employees often come up with better solutions than management because they are closer to their issues. There is also great satisfaction for employees in knowing they can effect change and make things better. The process also invests the employees in making the solutions work, because they came up with them.

   The disadvantages are trying to discover if you're doing it often enough and getting a large enough cross-section of employees to truly get an accurate view of everyone's feelings, opinions and concerns. Situations can be made worse by not doing anything about employees' concerns brought to management's attention. Management has an obligation to try to find solutions and implement them.

   Before the focus groups began, managers developed REMSA's posting plan, deployment plan and shift schedule. One of the big things that came out of the focus groups was that employees wanted to be involved in these areas. So classes on how to develop these plans were held for any employee interested. Management then created employee committees, chaired by managers, for each of these plans. This concept has developed to where these committees are now chaired by employees, and they develop plans with basic parameters provided from management.

   For more on REMSA, see www.remsa-cf.com.

   Barry D. Smith is ground CQI coordinator for the Regional Emergency Medical Services Authority (REMSA) in Reno, NV. Contact him at bsmith@remsa-cf.com.