EMS 2.0

Recently Justin Schorr had a post about how he hated the term “customer” in EMS. I honestly understand how he feels, because I used to feel the same way.

But I don’t anymore.

So I left a comment. Go ahead… you can go read it… I can wait.

Hopefully while you were there hopefully you also read Justin’s reply. If not then go ahead… you should read it… I can wait.

I was going to reply over there, but truth be told is that I hate leaving blog posts in other people’s comments, so I figured I would just reply over here with perhaps a little more focus on why Customer Service is important in EMS.

Dispelling The Myth That Good Customer Service Equates To “The Customer Is Always Right”

I think its important to understand where this phrase actually originates from. There is some dispute as to the origin of the phrase “The Customer Is Always Right“. Some attribute it to Marshall Field in Chicago and others attribute it to Harry Gordon Selfridge in London. It may surprise you to find out that Selfridge was actually born in Wisconsin. So no matter which way you cut it, the term is undoubtedly American and those who originated it did not intend for it to be taken literally.

So why use the phrase at all? By using the phrase this accomplishes, in the minds of the retail moguls that coined it, three things:

1. Lead customers to believe they will get good customer service at this store
2. Create the expectation of good customer service from the employees
3. Provide employees with a simple guideline to follow in order to deliver good customer service

Of course the truth is, as many of you may already have first hand knowledge of, is that the customer is in fact not always right.

For that matter, there have been a number of successful service companies that have taken the opposite stand. They realize that the mentality of “the customer is always right” in fact creates resentment of the customer, which breeds worse customer service, and in an atmosphere where the customer has an unfair advantage. They are companies that place a greater value on their employees than their customers.

Of course I would be remiss not to point out that these companies are not always bastions of great customer service. They have their issues too, most notably when this kind of atmosphere inflates the egos of their employees with a false sense of authority. The most notable recent customer service debacle would be Southwest Airlines and their entanglement with director Kevin Smith. Of course when Southwest admitted fault, they did so without laying blame solely on their front line employees while acknowledging that it could indeed have been handled better. PR spin? Maybe.

It’s still better treatment than the medics got by the coward Michael Huss in Pittsburgh… but I’m digressing.

Recommended Extra Credit Reading: Top 5 Reasons Why “The Customer Is Always Right” Is Wrong

Dispelling The Myth That Customer Service Doesn’t Belong In EMS Culture

Customer service ultimately is about providing an experience that will result in customer satisfaction with the provided service. Sure the needs of some customers are easier to meet than others, but that’s part of any type of service business.

Excuse my slight tangent, but when I first became an EMT one of the first things I got along with my twenty pound Bat-belt, fifty pound responder bag, and personal oxygen tank was a nickle plated shield.

The shield had the State of New York seal, read Emergency Medical Technician, and had my 6 digit state certification number on it. I had a leather (pleather?) shield backing with room for 6 citation bars above the shield. I bought that backing, sure I’d be back for another one soon because I would undoubtedly earn way more than 6 citations.

I was “official” with that shield.

I was a medical “authority” (at least until the first medic arrived) with that shield.

Over the years I wore the shield less and less until I was at the point of wearing it only to formal occasions. Then after a short burst of activity in 2001, I put the shield (with the same backing) in a drawer at my mother’s house. I have used it exactly twice since then, and there it remains.

Why? Because I figured out that the shield did not actually imbue me with any special “authority” to medically treat people. It also did not imbue me with any “authority” to treat others poorly, medically or otherwise, by asserting my will over theirs. In the end I learned its more about the patient (and their perspective) than it is about me… although I still think it’s not all about the patient either.

This authoritative stance that EMS seems to imbue into its providers is a hurdle that we need to overcome on not just the service level, but rather industry wide. On the bright side, medical school isn’t doing that great a job with the doctors either, and I’m sure we all have tales of our personal Nurse Ratchet.

As for the concept that our current incarnations are “the only game in town”, that is a fallacy that we need to stop disillusioning ourselves with. Municipal contracts generally come up for renewal. Right now, bidding on the municipal contract in Alameda County is under scrutiny because the 40+ year provider was outbid by another agency. There is always someone else who not only wants to do what we do, but think they can do it better.

But let’s go one step further down a darker path.

In the middle of EMS Today I saw something that I was a little shocked to see there. It was a small little hatchback van with a stretcher inside. There were no shelves or room for supplies because it was a non-emergency stretcher transport system. How soon will it be until ambulances are replaced by these transport units driven by a non-certified driver? Sure, they’re catching on in the private sector first, but it will only be a matter of time before they end up replacing municipal units as well.

So is there a place in EMS Culture for providing customer service? I dare say that there is, and I also dare tell you that the person who talks about it most often is actually Steve Whitehead from The EMT Spot. The quest for good customer service in EMS can be found simply by following the Ultimate EMS Protocol.

In Conclusion

We need to be able to provide the service that is expected of us. If we want to change our customers expectations of our service then we need to effectively communicate to them both our limitations and value. If we want to change the service that we provide, we need to also communicate that by framing it in an easy to understand message that highlights the benefits this will have for the customer. The fact that we don’t already communicate effectively both our abilities and our value is something that we need to correct as soon as possible, but in the meantime we need to provide the service expected to the best of our ability and constantly prove that we are worthy of their trust in providing that service on a reliable basis. To do so is not just good customer service… its our job.

Just like the kid at the sandwich shop who gets the order right.

After the arrest of a volunteer EMT for possession of a similar style shield as my own, NYS DOH revised their policy statement specifically stating that they do not issue shields, shields would be the responsibility of the issuing agency, and therefore should not have the State Seal of New York on them

Ever since coming back from EMS Today the core of this post has been rattling around in my head. Last week I read EMS 2.0: The Logistics of Change by Kelly Grayson and I felt both a greater need and urgency to write this post. Unfortunately, as it is a common occurrence, unforseen circumstances have delayed me until now (which was actually 3 days ago).

The Real Influencers of Change

The process of change is not going to be an easy one to endure. I agree with Kelly Grayson when he says, “We don’t hold the reins of EMS. None of us do.” This is something I’ve understood from early on.

Where I respectfully disagree with Kelly is when he says, “No, the people who will shape the future of health care in America, and by extension EMS, are politicians and policy wonks who know little of our concerns.”

The real people who will shape our future are our potential patients. Ironically this is playing out in our political system right now with the current healthcare reform proposals. The politicians and policy makers have been forced to revise and revamp those proposals constantly due to pressure from the people they are there to serve, the actual everyday public.

Higher education in EMS would be nice, but I don’t think it is a necessity to effect the majority of the change we appear to be seeking because the people who really matter don’t care about the letters after our name… they care about how the change will affect them and we need to be able to speak to them in ways they will understand. It’s vitally important to recognize that fact. For the change we are looking for specifically in regards to being considered a profession as opposed to an occupation, that is something that we need higher education in EMS for.

The Role of Social Media

So where does Social Media fit into all of this?

Social Media is simply providing a platform and is what we make of it. It is a tool that we can use to speak to those that can actually effect change about the issues and ideas that matter most to us and get feedback from them on their thoughts and what matters most to them so we can look and see how it can be made better by meeting everyone’s needs.

Social Media isn’t the star of this show as some people would believe… but it is the idea of communicating from the people behind the creation of the media that is the real star.

The Potential Process of Change

Understanding all of the above, here is what I think a potential process of change could be for EMS 2.0:

1. Start the conversation from within – This has already started with blogs, The Chronicles of EMS, podcasts and the seemingly never ending 140 characters of Twitter. The conversation, even 9 months or so in, has really just started and will likely continue for another 2 years or so
2. Identify the priorities – From the conversations we’ll be able to identify the priorities. It’s important when doing so that we don’t alienate a sector of EMS. Traditionally we are an industry divided along the lines of municipal paid agencies, commercial paid agencies, and volunteer agencies as well as other service “based” EMS agencies as opposed to stand alone EMS agencies. Excluding one sector or another will in all likelihood be the downfall of any proposed change.
3. Take the top 3 priorities/goals and develop a message – Once we can identify the top 3 priorities/goals we need to create a message. It’s important to understand that the message needs to be framed to those that matter most… so saying, “We will be able to refuse to transport a patient to a hospital when it is a non-emergency” won’t go over as well as perhaps “We will be able to save the patient, and the tax payer, money by being able to refer them to a facility better equipped for their needs”. We need to remember that the message needs to be about them, and not about us.
4. Communicate those messages effectively to those that matter most – We need to be able to effectively communicate those messages. Social Media provides another great resource to do this, but it will require us to break out of our comfort zones. We need to be able to build relationships with those in our communities who are not directly involved in EMS but have the power to effect the change we want to see. Facebook, MySpace, and local blogs are three examples where we can do this easily.
5. Address the concerns of those that matter most effectively – Someone is going to raise the opposition to change. We need to take a page from Web 2.0 on this and be transparent and address that opposition head on.
6. Collectively support the efforts to effect the change – When that politician does take the first step after being cajoled by their constituents and that legislation does get drafted, we need to support it as a collective even though individually it may not affect us. It’s like the smoking ban, all it took was one state to do it and the rest followed like virtual dominoes

Does the process above look easy? If it does, then I’ve obviously not communicated it effectively… because it will indeed be a very hard and difficult road. The toughest part will be the time frame, which I would give a 7-10 year estimate on, simply because we have become such an impatient society and want what we want now.

Yes. I said 7-10 years before we can effect any real change. Now this isn’t necessarily the process that’s going to happen, and I’m not even really advocating this as the process to use… but I think that realistically it is something similar to this that will need to happen for real change to occur.

What You Can Do Now

So while change is still further away than most of us would like, let’s talk about things that you can do today to help make that change actually happen:

• Participate in the conversation on blogs, in forums, and wherever the conversation is happening
• Support the communities where the conversation is occurring
• Go find 10 non-EMS blogs that you can identify with, add them to a feedreader, and build a relationship with that blogger. It doesn’t matter the type of blog (although political blogs, local blogs, personal blogs, and mommy blogs are probably the most likely genres to help spread the message when that’s ready) just as long as you are building an authentic relationship through commenting, linking, and having a conversation even if it has nothing to do with EMS
• Identify what YOUR priorities for EMS 2.0 would be and communicate that
• Be patient but remain passionate. Rome wasn’t built in a day and change will not magically happen overnight but it definitely will not happen if you lose your passion for it

As always, feel free to share your thoughts in the comments…