& Emergency Medical Service Mergers:
The Leader's Role
By Capt. Michael Mayers
Hilton Head Island Fire
While considering what might be good for
your community, have you been contemplating a merger of fire and emergency
medical services? This is not a new idea, but the way people have
been acting toward mergers lately would make you think so. Daily
it seems that I read yet another article about the merger of a Fire and
EMS agency. Some of our largest and most traditional fire organizations
have incorporated EMS into their structure. Whether or not it was
a success in each of these cases is a whole other question.
EMS has been as much a part of the fire
service as it has been anywhere else since its popular increase in the
late '60's and early '70's. The issue at hand, however, is
the effective merger of previously separate entities, and thus, cultures,
nomenclature, equipment, etc. I have been involved with EMS since
1979 and I have seen some phenomenal changes. My involvement has
been primarily with the fire service side, in organizations ranging from
first responders to ALS treatment and transport providers. I have
been a volunteer as well as a career paramedic and I have worked in big
and small systems. As a result, I have made some observations on
how and why mergers should take place.
||Let me start by
disclosing that I am currently a career Fire Captain/Paramedic in what
is now a career-only organization. Our organization merged over eight
years ago. The corporate cultures in each of the three agencies merged
were as diverse as they could come, and at one point or another in my career,
I worked for each of them (among other agencies). To say our merger
was a success would be accurate, but I wouldn't say that it came without
Furthermore, don't assume that my bias
leans toward wholesale merger of the fire and medical services. The
responsible parties need to analyze their unique community and determine
what is in their best interest.
Why do mergers come about? The most
obvious answer is money. Doing two jobs with less management and
support staff is more cost efficient. There are fewer stations required
and increasing the numbers of responding units can result in significant
decreases in service delivery time. Mergers give "topped out" personnel
a place to branch to, keeping the cost of replacing burned out employees
down. There are perceived savings in benefits procurement (additional
bodies translate to more buying power when shopping benefits) and of course
the revenue from charging for treatment and transport doesn't hurt either.
Consider that if merging is being undertaken
to simply increase revenue, run out the competitors, or to increase your
little fiefdom, if the community fails to benefit, then my suggestion is
to leave well enough alone. A bone is just a bone until two lions decide
they want it. As soon as politicians and chiefs see someone is eyeing
their little corner of the world, things can get very ugly. Trust
me when I say that no one will benefit. And on top of that, Hell
hath no fury like a medic made to ride a fire engine against his or her
own will (or vice-versa). So move forward with care.
Some introspection is called for prior
to such an undertaking. Some of these questions should be asked and
Common goals and interests appear to be a
factor in successful relationships. Conversely, some contributing
factors in disruptive relationships appear to be differing goals, an inability
to communicate, dishonesty, selfishness, and most of all, inability to
compromise. The negative sides to the argument have been hashed out
more times than you or I could ever count. Some people years ago
formed your organization and decided they only wanted to provide medical
or fire service and formed their organizations around that intent.
If you hadn't noticed, things have changed. The customer expects
quality service and they want it now. This service is often perceived
as "one-stop shopping" or "streamlined service", resulting in community
leaders pushing organizations toward merging.
What is your goal in merging?
(What do you hope to achieve?)
If we decide to merge, what preparations
need to be made to insure success?
How does the corporate psychology compare
and how can we foster cooperation?
What things can hurt this merger and
how can we avoid them?
As the leader of this merger, I recommend
surrounding yourself with good people, but not "Yes" men. If an idea
you have needs reworking, you need to have people that can help you do
that and often that calls for objectivity. If your ideas are meeting
with resistance, make the complainers come up with a solution or participate
in solving the problem. I have a rule that I live by; "Don't raise
your voice unless you can raise your fists." In other words, don't
complain unless you're willing to do something to change the situation.
When merging organizations, leaders
Be clear about the mission. Your goals
should reflect your mission, your objectives should support the goals and
your budget should finance them.
Identify concerns and create opportunities
to solve them. Doing so allows your personnel to develop ownership.
Remember, this is the opportunity for some to shine, especially those who
were held in check by the previous status quo and those who desire change,
those who were overlooked in the old system (yours or theirs), and those
who desire a fresh start. Don't blow off trouble-makers right away,
make them put up or shut up. Get rid of the chronic complainers if
they won't work toward solving problems.
Make sure expectations are crystal clear.
Take a look at your policies and procedures. If you have no means/method/intent
of enforcing something, chuck it or fix it. A rule that falls in
this category is just something waiting around to bite you.
Show no favoritism. Enforce rules uniformly.
This is YOUR chance to do the things you didn't do right before as well.
Enforce the rules like you mean it. Set the example yourself.
Train, train, train. Preplan.
These tasks can solve a lot of problems. By training and preplanning
often, the troops: 1) are too busy to complain, 2) develop relationships
and subsequently improve team cohesion, 3) develop familiarity with the
previously unknown, and 4) identify their leaders, innovators, and slackers.
Previously foreign concepts, tools, techniques and nomenclature are exposed
to members of the team and as a result, misconceptions and misunderstandings
can be resolved.
Allocate equipment, personnel, training, time
to meet the mission. Failure to do so will severely hamper progress
and will cause you to lose forward momentum.
Categorize apparatus and equipment into "problems
and opportunities". Plan ahead to replace/upgrade equipment.
Standardize as much as possible. Plan ahead to make changes.
Get your personnel to make recommendations and implement them.
Be candid with the troops within reason.
Suppressing information is just itching for a fight. If you're considering
something/change, be out with it or get your ducks in a row prior to discussing
it with anyone. Suppressing information often just gives fuel to
the "conspiracy theorists". You may want to do something and can't.
Be honest and forthright about why you can't, otherwise, you're already
doomed because you're not trying to achieve excellence, you're just trying
to get by.
Insure that the parties of the merger are
committed to a positive outcome and the ultimate success of the project.
If anyone (management, politicians) responsible for leading this merger
are not committed to success, the plan is doomed to be rocky, if not fail
Develop individual team cohesion and morale
at all levels. Pick assignments to cause companies, divisions, officers,
firefighters, and medics to bond. Do team building exercises.
Have retreats. Missions, especially difficult ones, cause teams to
bond, especially if they're successful.
A main feature of leading requires one to
remain open to other ideas, but not to the detriment of your customer.
Schedule listening sessions, but realize that not all of the personnel
are going to open up right away. The most vocal immediate need just
may be the griping of a few or a symptom of a bigger problem. See
if management and the troops' stories match up before writing off the complaints
as whining and get some perspective from other less vocal individuals as
well. Consider the implementation of quality management teams that
will work the solution to a problem out across the entire range from service
professional to customer delivery. Follow up with customers to see
what changes could be made to improve service.
Be prepared to make some changes, then be
prepared to change those changes in order to improve the end product.
If you're covering ground that's never been trod before, you have to learn
from your mistakes. The beauty is, though, is that like I've been
saying, you're not alone. Plenty of emergency service agencies merge
every year. The private sector experiences mergers all the time.
What makes you think that your situation is any different than theirs?
Call around to other organizations and groups and get their ideas.
Talk to the troops as well as the brass. What may seem like a good
idea may not hold up to implementation but there's nothing to say that
the idea may not lead to further innovation.
There are no shortcuts here and there's
already going to be more emotion and rhetoric than you can stand.
Having leadership that is submarining the effort isn't going to get this
party started. There's nothing sacred and nothing absolute, unless
you're just planning to fire everyone and do it your way. If you are not
willing to work toward compromise or make some hard choices, success is
going to come hard. Relationships are sometimes about sacrifice.
Sacrifice is sometimes how you show you care. If it's "all about
you", it will be. Negatively.
Captain Michael "Mick" Mayers is
a career Captain/paramedic with Hilton Head Island Fire/Rescue in
Hilton Head, South Carolina.
Capt. Michael “Mick” Mayers has served
the resort community of Hilton Head Island, South Carolina as a firefighter
and paramedic since 1982. He came there after several years of volunteering
with Bridgeport (PA) Fire Company #1. Read