Turnover Costs in Rural Emergency Medical Services

1. Turnover Costs in Rural Emergency Medical Services Daniel Patterson, PhD, MPH, EMT-B Principal Investigator Research Assistant Professor Department of Emergency Medicine University of Pittsburgh School of Medicine

2. December 28, 2005 Paramedics' ranks decline in rural areas November 16, 2005 Lack of paramedics creates concern for residents November 10, 2005 Survival Rate: The city's EMS crisis leaves a 22-year-old dead Background – Turnover The Berkshire Eagle January 24, 2006 EMT shortage worries stockbridge officials The Indianapolis Star October 8, 2005 Medic! Stat! Shortage puts paramedics in high demand

3. Background – Turnover • Focus of organizational research for 50 years (March et al, 1958; Mobley, 1977; Allen et al, 2003) • 28.6% annual turnover in Health & Education (Bureau of Labor Statistics[1]) • Some turnover is inevitable (Abelson, 1987) • 100% or greater annual turnover in some sectors (Zuber, 2001)

4. Background – Costs of Turnover • Turnover is costly! (Abbasi et al, 2000;) • Billions / year for some industries (White, 1995) • Costs often underestimated b/c most costs are hidden (Abbasi et al, 2000)

5. Background – Costs of Turnover • ~$1 million per hospital in FY1988 (Jones, 1990) • Nursing turnover is expensive (Cheryl Jones, 2005) • 1.3 times a nurse’s annual salary or $67,100

6. Study Goals • To determine the annual rate of employee turnover • Identify the costs associated with turnover • Create for all of EMS, a budgeting tool for calculating the costs of turnover Long term goal: • Spur the development of cost-effective programs for reducing turnover in EMS

7. Study Hypotheses • Hypothesis #1: Among rural EMS systems employing a mix of paid and volunteer staff, greater than 25% of staff turnover annually. • Hypothesis #2: Annual turnover of full-time and part-time paid personnel increases with decreasing workload, and turnover of volunteer staff increases with increased workload.

8. Study Hypotheses cont’d • Hypothesis #3: On average, a rural EMS system must spend 1.25 times an employee’s annual salary and benefits to replace one paid (part-time or full-time) employee. Costs associated with replacing a volunteer EMS professional are hypothesized to be substantially less than costs required to replace paid personnel. • Hypothesis #4: Costs associated with turnover are responsible for 20% of the average cost of an EMS transport and consumes greater than 20% of the average per transport payments from Medicare.

9. Study Overview – Who will we study? • Select at random, 50 eligible rural EMS agencies • Enroll 25 agencies and follow for 6 months • Use web-based data collection system • Involvement meant to be low-burden and extremely beneficial to individual participants

10. Participating Groups • NCEMSC • CARE Consortium (North/South Carolina) • Rural EMS agencies of Pennsylvania

11. Who is eligible to participate? • Must be located in a rural area • Defined by the Rural-Urban Commuting Area Codes • http://depts.washington.edu/uwruca/about.html • Staff a mix of paid and volunteer personnel • Self-described hospital-based, fire-based, government, rescue-squad, free-standing, or volunteer EMS agency • Be able to distinguish costs of providing EMS service from other services (e.g. rescue, or hospital facility services)

12. How do we calculate turnover? • No gold standard measure exist • We adopt a previously used approach: • Turnover as a whole, and • Turnover across different types of positions • FTE, Part-time, Volunteer

13. How do we calculate costs of turnover? • We use an established methodology with a deep roots in the business community (Jones, 2005)

14. The Web-Based System

15. Study of Turnover Costs in Emergency Medical Services Principal Investigator: P. Daniel Patterson, PhD, MPH, EMT-B pattersond@upmc.edu Funded by: The North Central EMS Institute & The Federal Office of Rural Health Policy, Grant # R04RH08596 Approved by the University of Pittsburgh IRB: PRO07090118 Username  ENTER Password 

16. Pre-Hire Costs Questions:Hiring Costs Please enter the total number of hours each person on your roster spent interviewingnew candidates last month. Enter in # of hours for each staff person who spent time interviewing candidates last month GO BACK NEXT

17. Benefits & Risks • Benefits • $250 in incentives • Chance to win an incentive package • Detailed report on turnover and costs to agency • Free access to an easy to use turnover budgeting tool • Risks • Extremely remote possibility of breach of confidentiality of study data

18. Study Safe Guards • IRB Approved study • Secure data collection system developed by experts • www.crhc.pitt.edu/datacenter • All data presented in aggregate and de-identified

19. In Summary • Focus on identifying • Turnover • Costs associated with turnover • Enroll 25 rural EMS agencies • Follow for 6 months • Collect utilization, staffing, and financial data • Agencies receive • $250 in incentives • A chance to win a bonus incentive package • A detailed report • Free access to a turnover budgeting tool

20. Potential Impact • Consequences of high turnover cannot be ignored • Organizational performance • Brain drain • Job dissatisfaction • Potential for high turnover to put at risk patient and provider safety (AHRQ Publication No. 03-E031)

21. Future plans • Expand study to include both rural and urban EMS agencies • Compare costs across rural and urban models • Track trends in turnover and costs • Providing a key resource in the battle against high turnover

22. Co-Investigators • (Co-I) Nick Castle, PhD • Univ. of Pittsburgh Graduate School of Public Health • (Co-I) Michael Hubble, PhD, NREMT-P • Western Carolina University • (Co-I) Cheryl Jones, PhD, RN • University of North Carolina at Chapel Hill • (Co-I) John Engberg, PhD • Rand Corporation • Matt Carr, BS, NREMT-P • Research Assistant, Project Coordinator • Univ. of Pittsburgh, Dept. of Emergency Medicine

23. Funding • Health Resources and Services Administration, Office of Rural Health Policy • http://ruralhealth.hrsa.gov/ • Grant # R04RH08596 • North Central EMS Institute • http://www.ncemsi.org/

24. Questions? – Contact Us Daniel Patterson, PhD, MPH, EMT-B Principal Investigator Research Assistant Professor Department of Emergency Medicine University of Pittsburgh 412-647-3183 pattersond@upmc.edu

25. References used • March JG, Simon HA. (1958). Organizations. New York: Wiley. • Mobley WH. (1977). Intermediate linkages in the relationship between job satisfaction and employee turnover. Journal of Applied Psychology. 62:237-240. • Allen DG, Shore LM, Griffeth RW. (2003). The role of perceived organizational support and supportive human resource practices in the turnover process. Journal of Management. 29:99-118. • Bureau of Labor Statistics (1) http://data.bls.gov/cgi-bin/surveymost?jt • Abelson, M. (1987). Examination of avoidable and unavoidable turnover. Journal of Applied Psychology. 77(3):382-386. • White GL. (1995). Employee turnover: The hidden drain on profits. HR Focus. 72(1):15-18.

26. References used • Zuber A. (2001). A career in foodservice—Cons: High turnover. Nation’s Restaurant News. 35:147-148. • Jones C. (1990). Staff nurse turnover costs: Part II, measurements and results. Journal of Nurse Administration. 20(5):27-32. • AHRQ (May 2003). The effect of health care working conditions on patient safety. Publication No. 03-E031.