How Corporate Culture Impacts Customer Services in EMS

March 20: Ben and Danielle arrive at work at All-City EMS, an ambulance facility providing both ALS and BLS services in Metropolitan City. As they enter the building, they are confronted by their supervisor, who proceeds to chew them out for leaving the truck a mess after their last shift. As Danielle starts to explain that they got held up for a late job, he cuts her off with an “I don’t care…this is your responsibility, so get it done.” A few minutes later, while checking the truck, Danielle relates how that late job caused her to miss her daughter’s piano recital. Ben responds, “Sorry to hear that. Remember how rude the dispatcher was when you mentioned that it would hold us over? Then that annoying old man took forever to get his things!”

July 1: James has been an administrator at All-City for two months. One day he arrives at work to find an irate voice mail message. The local ED nurse manager is angry over a complaint by a patient’s family member. He states that a BLS crew had manhandled the patient during a transport that occurred almost three months ago. Apparently angry over having been given a late assignment, the crew was rude and unnecessarily rough with the patient, causing him distress and exacerbating his chest pain. The anger and frustration in the manager’s voice is almost palpable as he relates that this is the fifth time he’s called and he has yet to receive a return call. He finishes with, “What kind of organization are you running over there? Doesn’t anyone return phone calls?”

A few days later, after reporting the call, James witnesses the director of operations yelling at the operations coordinator in front of some employees over this same incident. Later that afternoon, the operations coordinator tells James how much she hates working there, as do a number of the other coordinators. She complains that there never seems to be any support from the upper management. It appears that a few supervisors, along with some senior field personnel, may be actively looking for jobs elsewhere. James is stunned. When he interviewed for the job five months ago, the agency seemed like a team, a great place to work where everyone pulled their own weight. Now it seems that everyone from the line personnel to upper-level management wants to leave.

Corporate culture is defined as the environment—social, physical, political, emotional and economic—within which you work.¹ More succinctly, it’s “how things are done around here.” If you have ever experienced a chain of events similar to those mentioned above, you understand the importance of a positive corporate culture. The lack of a strong, supportive corporate culture will erode even the most motivated employees over time. A good way to identify organizations suffering from this lack of “moral compass” is to look at their track record in regard to customer service. This involves examining not only how they treat external customers, such as patients, but also how they handle the most important internal customers—their employees. There are many aspects to establishing an EMS service that is attuned to providing good customer service on all fronts. This article will focus on customer service as it is affected by the corporate culture, and ultimately projects the mind-set of the entire organization.

Corporate Culture

The values, beliefs and practices of an organization’s work environment contain the power to directly influence economic performance and overall effectiveness. But what determines the structure of these building blocks? You, as the manager/administrator/supervisor/leader, have significant impact on establishing this foundation. Actively shaping corporate culture in your organization means being willing and able to effect change, determine what you are doing right and identify where you can improve. And there is no better place to start than the top. When the various levels of management aren’t getting along, the resulting cause-and-effect relationship can lead to an unhealthy corporate culture.

Effecting change on an organizational level means more than putting up slogan signs that declare “Compassionate Service Every Day” or “Patient Care Is Job No. 1.” It requires demonstrating a commitment to the mission of your organization, to your employees, to the patients, their families and all of your other customers.

The Harvard Business School reports that the single biggest challenge to any new initiative is simply getting people to change their existing behavior. While this is not a new thought, it is often overlooked. Think of your own way of interacting: Have you ever verbally disciplined an employee in front of other employees? Have you ever chewed out a supervisor or manager in front of the employees that he or she supervises? In most cases, embarrassing an employee will have a negative effect that lasts long after the actual event. Would it be that difficult to speak to someone in the privacy of an office? Remember that in a supervisory capacity you serve as an example every day, in everything you do. Acting in a professional manner and demonstrating respect for those who work for and around you will send everyone the informal message that this is how you do business.

Types of Customers

One of the more common pitfalls is not adequately identifying who all the customers are. Administrative and management-level personnel need to realize they have both internal and external customers, just as line personnel do. External customers include those outside the actual operation of the EMS system. The obvious ones are the patients and their families, but just as important are fire and police personnel, governmental entities, the community, and insurance companies and other third-party payers. Internal customers are those who are involved in, or with, the operation of the EMS system. These are the system’s providers (career or volunteer) and members of the leadership councils or committees that plan and coordinate the system. They include the variety of agencies that interact to form an ongoing, functioning EMS system, as well as other healthcare providers, including hospitals that join with the EMS service to provide healthcare to ill and injured patients. Additionally, internal customers include other staff that we at times may not consider “part of the team.” These are our administrative office assistants, secretaries, payroll, human resources professionals and other support staff members.

There is a difference between your internal and external customers: Their needs are quite distinct. Employees need and deserve a pat on the back and a “thank you” for their hard work, and your external customers need answers, clean vehicles and prompt and personalized service.

Direction

So, what is your EMS agency doing right and what needs improvement? Take a look at the agencies that demonstrate excellence in customer service and you will see that they are successful at sharing their vision with their employees as a way of persuading them to change both their thinking and their behavior. Don’t assume that a few customer service classes or an outside consultant in a “one-shot deal” will be all that’s needed to fix an inadequate corporate culture. Time has proven that while these actions might be successful in jump-starting the engine toward change, only a consistent managerial demonstration of commitment to customer service will work in the long run.

It is critical to understand that employees’ willingness to embrace change is governed more by emotional appeals than by actual facts and figures. Every person in the organization has a dramatic impact on corporate culture. No one needs an official title to lead with integrity. A great deal of work must be put into making an organization a healthy, safe and happy place to work. And it will show—in the quality and efficiency of your customer service and the loyalty of your customers.

Examples of good customer service include:

• Returning phone calls promptly
• Passing along good information
• Structuring both administrative and operational policies on customer needs and not on upper-level management wants
• Solid communications on all levels
• Clearly written rules and guidelines.

Conclusion

If you have read this article and realized that you and your agency do not need to be more attuned to issues pertaining to corporate culture, then keep up the good work. If, however, you see room for improvement, there are certain ideas to keep in mind:

• Customer service training programs should focus on modification of both behavior and attitude, while addressing the unique environment of EMS, both on the street and within the office.
• Customer service practices must be employed from both a “top down” and a “bottom up” approach simultaneously.

Unfortunately, EMS providers (including management) can develop the belief over time that patients (and personnel) need not be treated like customers because “we are the only game in town” and “where else are they going to go?” However, an examination of failed EMS services—commercial and otherwise—in the last 30-plus years reveals plenty of situations where the patients and the community found they did indeed have a choice, and they exercised it. Agencies found themselves replaced or operations absorbed into other organizations, in both national and local arenas.

Jack Stout, one of the founding fathers of modern EMS, had this perspective on corporate culture:

“Image matters. When public officials or reporters take an interest in your company, what do they see? They don’t see your clinical performance or your dedication to patient care, and they don’t see deep inside your heart to your humanitarian motives. They see your vehicles, your dispatch center, your administrative offices, your maintenance shop, your personnel and you, and that’s all. In short, they see the externals. And from those externals, they draw conclusions about you and your entire operation. More often than not, those conclusions are valid.”²

Employees draw similar conclusions from the same sources. If management thinks it is acceptable to put non-repaired and dented vehicles back on the streets, then how important can it be to keep those same units clean? And, if areas that are more easily maintained (such as administrative offices) are consistently a mess, why should the field providers strive for better on the streets? If field-level personnel never hear a “Thanks” or “Hey, you did a good job back there,” staff motivation and pride will suffer. If managers, directors and other office personnel don’t dress in a professional manner, even in the relatively controlled administrative sector, why should medics be concerned about their own appearance and demeanor under the adverse conditions of field operations?

EMS organizations are either professional or they’re not. To be successful, there can be no in-between: You can’t be an amateur in the office and a professional on the streets. If management cares more about money than about employees and patients, then that corporate philosophy will eventually penetrate and affect all facets of the entire organization. Corporate images matter—inside and out.

If, as someone once said, perception is reality, it is safe to say that in EMS, perception creates reality.

References

1. www.speakingaboutwork.com (accessed April 20, 2004).
2. Stout J. Corporate Image. JEMS. April 1988.