Back at the ranch, EMTlife.com, one of my fellow Community Leaders asked our community members what they thought about performance-based compensation for medics. His query really got me going!
It is becoming more and more popular for public school systems to base teacher compensation on performance. It used to be that if your students did well on the standardized test one received a bonus. The bonuses are long gone and NC teachers haven’t received a raise in years, but this year a teacher’s continued employment is based on his or her students’ scores on standardized tests.
How would you feel about performance based compensation in EMS? Would it help weed out the poor providers? Would providers pursue additional education to better maintain their skills?
The whole thread is HERE.
First of all, how do you compare a teacher to an ambulance medic? The way I see it, one shapes lives and the other saves lives. Perhaps that is my biggest objection to the whole idea of performance evaluation in the first place for either job description. What a true teacher or a true medic does is make a difference!
How do you evaluate that and what do you pay for it? The truth of the matter is, when it comes to shaping or saving lives it’s the things you don’t see, the things you can’t document, that really matter and deserve recognition.
(As a slight digression, on tour the other day I had a few teachers from the same school district. One of their schools hit 100% on their standardized tests two years ago. Last year, they did the same. There was NO improvement, so none of the teachers in that school got raises. Gee, sounds like that system works!)
Reward or upward mobility for compliance with company and/or system policies and the like make perfect sense to me but in EMS it is IMPOSSIBLE to accurately and fairly assess “performance” in rendering care.
There’s no “standardized” metric that can measure it. That’s what we do; we render care and the most valuable things we do are never rewarded because for the most part, they go unseen. The things that are visible may never accurately reflect how effectively we are performing for our patients. All they reflect is how we perform for our companies or systems, and quite frankly, that is not what is most important.
Here are a few illustrations of problems inherent in determining performance criteria for the compensation of medics.
Anyone with a few years of experience under their belts knows that calls, successes and failures come in “runs”. Some weeks you do nothing but strokes, others trauma and still others, just move-ups. Sometimes you go through stretches where every patient you have has veins nobody could hit, not even with a 50 gauge needle!
That means that you’d have to have some sort of a mathematical formula to deal with the probabilities that a few calls gone bad were just the by-product of the odds. Or were they due to poor performance on the part of the medic? There are simply times when everybody dies on you. Performance, when evaluated during those times is going to look bad. Do you see any reason your future economic stability should be determined by that?
The same would hold true with successes. Sometimes, nothing you do can kill them! Do you see you or any of your co-workers as immune from the fickle finger of fate?
But to me, even more critical is all the things that would NOT be evaluated in the review of someone’s performance in the field; all of those moments where the medic invests that little bit more to ensure the comfort and welfare of his or her patients, the safety of people and co-workers on the scene, and all the bad situations successfully avoided. All those moments when the medic renders professional care that makes a difference.
Being a good ambulance medic is about sending out ripples in a pond, not about hitting the bullseye.
Remember, “performance” is something you track and the only information you have available to you is on records reviewed by someone who wasn’t there; wasn’t in the skin of the medic on duty or in the experience of the patient.
Rather than weeding out poor providors, I could see performance evaluation-based compensation as discouraging excellent providors. Those who focus on the visible — the volume, the documentation, the time schedules – get rewarded; those who focus on affecting their patients favorably – contributing to their ability and willingness to begin healing — are ignored. There’s no one who can evaluate those kinds of contributions other than the medic or patient him/herself.
“Patient satisfaction surveys” were suggested, yet the goal could easily become a succesful survey rather than a succesful outcome, couldn’t it?
Sorry for being the cynical ass that I am but really, if performance evaluations were to become part of EMS, the education that it would produce would be more about medics schooling themselves on how to get better and better performance evaluations!
Not that I don’t have faith in you, it’s just this human nature thing! What incentive does improved compensation due to favorable performance evaluations provide? I believe it becomes the goal of improving your compensation BY winning the game of getting a good performance review.
Don’t get me wrong, I’m all for playing games, just keep my relationship with my patients’s welfare and the mysteries of life and death out of it!
How about a little of everything? The more factors, the harder to game and the more meaningful. Random patient satisfaction surveys, random run CQI, assorted statistics like out-the-chute and response times, consideration for additional training (continuing education modules, certifications, pertinent college courses, etc.), even knowledge-based evaluations. Your raise is linked to your overall score. If you do it right, it’s a well-rounded record, and although it won’t be perfect, the only way to “play to the test” is to become a darn good provider.