Prehospital Profiles: Sedgwick County EMS

In January 2011, Sedgwick County EMS (SCEMS) in Wichita, KS experienced a time of substantial change, and employees saw the beginning of what it means to become a learning organization, says Paul Misasi, Deployment and Quality Improvement Manager.

Within just a few months there were several changes in top management in the roles of Director, Operations Manager and Deployment Manager. In addition, this new team initiated a new management philosophy founded on the tenets of Just Culture, Culture of Safety, Systems Approach to Improvement and a Learning Organization, Misasi says.

The new philosophy was presented to employees at the organization’s first “town hall” meeting in September 2011. “It was met with skepticism and rightly so,” according to Misasi. “The organizational climate had been overly punitive for quite some time. But the message was clear; the organization was taking a new direction.”

That new direction has included a new set of values and a new leadership academy.

STAR CARE Values

One of the first things the new SCEMS management team did was to establish a set of core values, and they selected STAR CARE, from the acronym created by EMS author Thom Dick. (Safe, Team-Based, Attentive to human needs, Respectful, Customer accountable, Appropriate, Reasonable, and Ethical).

“We wanted to articulate a new focus, and give the field personnel a true tool to evaluate all the decisions they make,” Misasi says. “We face a lot of ambiguity in the field, and a lot of situations where it’s difficult to know the right thing to do at the time, although it’s easy later to armchair quarterback.”

The set of values helps personnel choose a course of action and relieves anxiety because they can measure their decision. “If you’re able to measure the values appropriately, then your decision is the right one to make and you’ll be supported,” Misasi says.

He explains that the organization did have core values previously, but no one knew what they were, and employees weren’t explicitly held to the values as a standard of conduct. Now, employees know the values and understand that their conduct will be measured against them.

Misasi says he can see a difference since implementing the values; most notably a cultural change in which there’s an increase in the reporting of errors. This is because staff understand that the goal is to foster a learning environment, not to “hang people for mistakes,” which simply drives errors underground and inhibits improvement through lessons learned.

Leadership Academy

This dovetails into why the management team felt strongly about implementing leadership training, Misasi says. Amid ongoing change and outside threats to operations, “It’s the tenets of leadership that solidify our ability to navigate changes successfully,” he says.

Organizations don’t know what they’re going to face or what reimbursement they’re going to get, Misasi notes. “We tell students, ‘We’re not here to give you blueprints, protocols, procedures… we can never write procedures the way reality occurs.’

We trust them to bridge that gap in the face of volatility and ambiguity,” Misasi says.

Their first leadership academy was held in the fall of 2012 after six months of meetings on how best to navigate reorganization and promotions at the organization. Numerous people who had been unprepared for supervisory roles had been promoted and then turned loose, Misasi says, finding themselves in the unfair situation of having expectations set but no way to meet them.

“We needed to start by giving people those tools,” Misasi says.

The program is 40 hours, spread over five weeks. So far it has been held for employees promoted to a team leader position, and 32 have been through it: 27 the first year, and 5 this year. SCEMS management expects to continue to hold the training once per year, and may possibly add a modified “leadership academy light” version for other employees who are not currently being promoted but are interested in the program.

The organization also works to continue leadership education throughout the year, by circulating articles and asking leaders to engage in materials online, Misasi says.

The SCEMS philosophy is that if they focus on leadership and developing personnel to their greatest potential, “the rest of it will take care of itself,” Misasi says.

“If there’s any brainwashing,” he adds, “it’s to take care of your people.” This is not to say leaders should go too easy on them. “You nurture them, grow them, teach them—and you have that stake in their success,” he says.

“Since the leadership academy, we’ve had some individuals who were headed down the wrong path professionally who have really turned it around,” Misasi says. As an unexpected bonus, the organization has seen people benefit personally as well.

Misasi says the training has also led to one problem that’s good to have: a high number of well qualified, dedicated and humble servant-leaders to choose from when a promotion becomes available, making it extremely difficult to choose.

The basis on which they now select candidates includes humility; self-awareness (the foundation of emotional intelligence); internal locus of control; and ability and willingness to adapt in the face of uncertainty. “That’s the secret sauce,” Misasi says—the key ingredients they nurture and seek for organizational leadership.

Department Stats

• Name of department: Sedgwick County EMS (SCEMS)
• Type of department: paid, municipal county third-service
• Number of employees: 151 full-time
• Service area: 1008 sq. miles (all of Sedgwick County, including the city of Wichita)
• Call Volume: 56,566 calls in 2012
• Population: 498,000
• Number of vehicles: 27, with peak staffing at 18
• Annual operating budget: $17 million