TO AMR EMPLOYEES "PAY FOR PERFORMANCE PLAN"

[checkersfire]

Easy fix to this problem: the 60 day "grace period no longer exists. This will eliminate the employees becoming accustomed to the higher wage. You said yourself that you are officially hired at the "c" wage. Just because you have to maintain standards to continue to receive a higher wage does not mean that the employer is taking money from you.

If you don't like the wage you are maintaining, you have the following options: do a better job, get a better job or get a better education. Personally, I would suggest all three.

Or, you could just get used to the taste of hot dogs.

Everybody here seems to be missing the point. It's not a matter of "doing a better job" you are being penalized for things that are out of your control! I think I do a wonderful job, thanks for the input anyway! I don't like dropping a dollar an hour my first week as a medic because I'm more worried about my patients and ended up 1 minute over the alloted time. I owe the company one year for helping with my education, so I'll be there for my obligation and then I probably will move on to something better. It doesn't matter how you look at it, whether your losing money or not getting the "bonus" either way your losing money!!!!!!! I can tell from some of the comments in this forum, alot of you must be in management. Management is the ONLY people who benefit from these kinds of plans.

[JPINFV]

Would you be happier if everyone just stayed at C grade pay then?

[checkersfire]

If it's fairly set up I believe in the concept of performance bonuses. Multiple pay rates based on performance are great for those of us willing to put in the effort required to provide an excellent standard of care.

I agree in bonuses also, we used to have a bonus for perfect attendance, clean driving record after 2000 driving hours, they took those away. It's not about how good the pt care is, they are worried about the signatures so medicare will pay for the trip. I see you are from Canada, so you don't have to worry about those things up there. An example, someone that has chest pains, what would you put in your report for an assessment?? R/O chf, mi or something along those lines? They want us to put in the assessment block a reason the person has to go by ambulance. If I don't put what suits them, I can potentially lose a dollar an hour. These are the kinds of things I'm talking about in here, not being rewarded for doing a job that's above and beyond. It's not just here, paramedics and emt's across the u.s. aren't being paid what their worth. Not for the hours we put in (extra hours for ceu's etc) that we don't get paid for to maintain our licenses. I'm not trying to be a smart ass, but if your not with a company that has this sort of plan (like amr) here in missouri and illinois, then it's hard to understand exactly how it works. It's not just one or two little things to maintain, I couldn't possibly explain them all here. I'm just one of the many here that are unhappy with it, there is getting ready to be a major exodus from this company if they don't change things. I know a letter was written to the CEO about this and hopefully they will at least look into it.

[checkersfire]

Would you be happier if everyone just stayed at C grade pay then?

are you with amr? at least your union there, the last time someone tried to bring the union here, they fired about 10 of them that were trying to organize (although that was before amr took over here). no i refuse to work here at "c" rate! our last "across the board" pay raise is contingent on you being at "a" rate. if you drop to b or c rate, you also lose the pay raise (which i think was 10 or 15%) not sure to be honest. i'm just curious if anyone else in amr has the same plan??

[DwayneEMTP]

If checkersfire is explaining his incentive program correctly, that you start at the higher rate and then lose it for 'below standard' performance, then his attitude is exactly what this company should be expecting from their program.

From a behavioral psychology point of view there is a HUGE difference between giving the incentive before it's earned, and then taking it away for substandard performance, and starting at a lower base and adding for superior performance.

It's the difference between punishment and reinforcement.

Let's start from the point of view that the reward/punishment system isn't perfect, as he describes it.

With reinforcers you are rewarded for "being better." So the incentives don't only increase your ability to supply for your biologic needs (more money helps buy food, pay bills, lessens stress) but they also, for most, define the companie's opinion of you as an employee and a person. More bonuses equals "you are superior, thus we like you better, (and for many), therefore you are better." So the reinforcers don't only make you want to continue to chase the carrot, they help you shape your work related behaviors so that it becomes easier and easier to actually catch the carrot on a regular basis (shape new habits, instead of individual examples of random behaviors). As well, it becomes fun to play the game, because I never really lose, I simply win at different levels.

Punishment on the other hand, the removal of the reinforcer, is negative. It tends to decrease your ability to supply for your biological needs, but much more important it sends the message that, "You have failed. You are unworthy." So instead of being a punishment for specific behaviors (which it can do, in the short term), for many, it becomes a reinforcer for negative attitudes and behaviors. People will work strongly to support their idea of their self image, so in an effort to not be a 'failure', they will find ways to describe to themselves why they are better than the company and each punishment, or lack of reinforcement, reinforces this image that "I'm great, but the company sucks."

Sometimes punishment is absolutely necessary. For instance, if you mishandle a patient in a non dangerous manner, you can stay home for a couple of weeks without pay. Do it again and you can stay home for the rest of your weeks as well. I don't have time to engineer this problem away. This will work, and will decrease the number of people that exhibit this type of behavior, but it is a short term solution. It is much more powerful to reward those that exhibit the behavior I'm seeking, thus adding confidence that the behavior will become habit and be continued even when not monitored, than to punish those rare instances of 'bad' behavior on the few occasions that I can catch them. More important is the fact that the 'bad' behaviors are easily hidden, therefore removing my ability to deal with them in a consistent, predictable manner.

Should any of these punishments/incentives be necessary when dealing with adult professionals? I don't know. What I do know that they are very powerful tools in the management toolbox and, as with any other tool, using them indiscriminately, without reading and understanding the instructions is just as irresponsible for management as many of the behaviors they despise in their employees.

Dwayne

[checkersfire]

If checkersfire is explaining his incentive program correctly, that you start at the higher rate and then lose it for 'below standard' performance, then his attitude is exactly what this company should be expecting from their program.

From a behavioral psychology point of view there is a HUGE difference between giving the incentive before it's earned, and then taking it away for substandard performance, and starting at a lower base and adding for superior performance.

It's the difference between punishment and reinforcement.

Let's start from the point of view that the reward/punishment system isn't perfect, as he describes it.

With reinforcers you are rewarded for "being better." So the incentives don't only increase your ability to supply for your biologic needs (more money helps buy food, pay bills, lessens stress) but they also, for most, define the companie's opinion of you as an employee and a person. More bonuses equals "you are superior, thus we like you better, (and for many), therefore you are better." So the reinforcers don't only make you want to continue to chase the carrot, they help you shape your work related behaviors so that it becomes easier and easier to actually catch the carrot on a regular basis (shape new habits, instead of individual examples of random behaviors). As well, it becomes fun to play the game, because I never really lose, I simply win at different levels.

Punishment on the other hand, the removal of the reinforcer, is negative. It tends to decrease your ability to supply for your biological needs, but much more important it sends the message that, "You have failed. You are unworthy." So instead of being a punishment for specific behaviors (which it can do, in the short term), for many, it becomes a reinforcer for negative attitudes and behaviors. People will work strongly to support their idea of their self image, so in an effort to not be a 'failure', they will find ways to describe to themselves why they are better than the company and each punishment, or lack of reinforcement, reinforces this image that "I'm great, but the company sucks."

Sometimes punishment is absolutely necessary. For instance, if you mishandle a patient in a non dangerous manner, you can stay home for a couple of weeks without pay. Do it again and you can stay home for the rest of your weeks as well. I don't have time to engineer this problem away. This will work, and will decrease the number of people that exhibit this type of behavior, but it is a short term solution. It is much more powerful to reward those that exhibit the behavior I'm seeking, thus adding confidence that the behavior will become habit and be continued even when not monitored, than to punish those rare instances of 'bad' behavior on the few occasions that I can catch them. More important is the fact that the 'bad' behaviors are easily hidden, therefore removing my ability to deal with them in a consistent, predictable manner.

Should any of these punishments/incentives be necessary when dealing with adult professionals? I don't know. What I do know that they are very powerful tools in the management toolbox and, as with any other tool, using them indiscriminately, without reading and understanding the instructions is just as irresponsible for management as many of the behaviors they despise in their employees.

Dwayne

Thanks Dwayne, that's exactly what I was trying to say. The only thing is, they don't care so much about the pt care part of it. If you mishandle a pt, some misconduct etc, depending on who you are, you might get corrective counseling, a day or two suspension. If, you happen to be someone they want to get rid if, then you will be terminated for fairly minor offenses. I don't think the company sucks, just some of the mgt. I have been with them many years and have seen some good emt's and medics come and go. What I have been trying to tell people on here (mostly the amr folks) that may end up with this plan, because I hear that amr actually likes the idea, is that you may end up with the same plan and it stinks. Our morale is at an all time low and it's because of the "a", "b" and "c" rates. Another change was implemented, now if you can't have the pt sign the back of the form, you must get a proxy (which has always been the case) but now you have to document in the "objective" section why the pt can't sign the report, and if it isn't an rn proxy at the snf or er/destination, then you have to also put in their address and if you don't you drop in pay again. I just think our pt care should come FIRST and all this other crap second. I guess also what I'm trying to say is, it does affect the way our people do pt care. I have been at "b" rate because of my times, I refuse to lower my standards and like I've even told mgt, eventually, I will become tired of losing my pay and I will leave and go somewere else to work. I do know crews (both emt's and medics) who have/will give poor patient care to stay at the "a" or "a" plus rate, will commit fraud, forgery, cheat their times etc. We have an excellant Medical Director, he told me he didn't even realize this plan until a few weeks ago, no one had brought it to his attention. He knew their was a plan, but the way it was explained to him it wasn't punishment, but reward. Our employees have heard the last 8 months or so (since we were bought out by amr) that there was going to be a big change in April. My point is, I know of about 4 medics and 6 emt's that are leaving in a couple weeks if it doesn't change. We can't afford to lose anymore people, we are so short handed now, I could work my 16 hours a day x7 days if I wanted because of the staffing now. emt's aren't so in demand right now, but it only takes approx. 4 months to train them, it's a little longer to get a medic through. Maybe someday, someone in this company will wake up and change things for the better here and we can keep people.

[checkersfire]

If it's fairly set up I believe in the concept of performance bonuses. Multiple pay rates based on performance are great for those of us willing to put in the effort required to provide an excellent standard of care.

Some of you seem to be confusing the issue here, or at least not getting it!!!! Example: I explained about the times, 31 minutes bls and 42 als. If I am waiting at the p/u for 35 to 40 minutes for the facility to get the pt ready for me to transport (I'm talking about non-emergent calls), and I get to the destination and have to wait another 15-20 minutes for an rn to sign and take over pt care or just waiting on a bed, then my times are shot and I just lost a dollar an hour, or if my truck breaks down while your still on scene your times keep running (I know because it has happened to me before) I was considered to be on-scene90 minutes waiting on the tow truck. These things are BEYOND my control, has nothing to do with my skills as a medic, but I still lose just the same. I don't have a problem with them docking my pay for substandard paperwork nor anyone else's. Paperwork and pt care you CAN control, just not your times. They don't count your driving times because frankly if a crew was in an accident and told the court they would be punished for driving times, I think there would be a nice little lawsuit there? Many times we are dispatched to p/u at a snf or hosp when we are 5 minutes away, normally there is a 30 dispatch time. I can't justify taking 30 minutes to get to a location when I'm posted less than a mile from there. But when I call on scene, my times start rolling and if the pt isn't ready, there is nothing I can do about it. Now and then you will get a dispatcher who will tell you in advance a call is coming out at a certain time so you can time it right, but that's not the "norm". So I have heard people on here praising this plan, who doesn't really understand the whole idea!! Yes, there is a 60 day grace period as a new hire, and you stay at the higher rate of pay from the start until you mess up, so basically everyone expects it. The thing that really pisses me off (pardon the french) is that a couple yrs ago, I was in financial trouble, had to file bankruptcy. They called to verify income, they gave them my "a" rate of pay, not based on "c" rate. I filed the chapter 13 payback plan were your payments are based on your income. The company denied the different rates of pay when the lawyers questioned them during the bankruptcy. If your ashamed of your policy, then don't have it. If your not ashamed up then why are you denying it? Still havn't got a straight answer on that one and probably never will lol.

[Dustdevil]

hey, i'm not the one that started taking the shots!

Not surprisingly, the SNF nurses here that I have spoken with feel differently. So do I. Just think before you speak in the future. The beauty of this site is that we all come from such diverse backgrounds. Unfortunately for you, that includes nurses, and other people with intelligent grammar skills. We do appreciate your improved efforts though, bro.

Regardless, I'm with you on the confusion factor of the criteria they are using for this programme. It would be a lot easier to sell to the employees if it were based upon criteria that were more within your control. There is no disputing that. I'm betting that most people go into it with a relatively positive attitude, until the realisation that they simply cannot control the criteria themselves sets in. Then it just breeds frustration and a bad attitude. Totally understandable.

On the other hand (and no, I am not management. Not even supervision.), I absolutely see where management is coming from too. The criteria they are grading you on are the criteria that make the difference on how much money they make. The more they make, the more they can share. And while you may not always be able to control how long you are stuck in the ER with your patient, you have to admit that many times you can. Same goes for the other criteria. The indisputable fact is that, if it results in more money, you will try harder, which is the very point of Performance Based Compensation. And, after all, all employees are pretty much on equal footing with this programme. You all face the exact same obstacles, and have just as much opportunity to overcome them. And now, you all have the same motivation to try harder too. Nothing unfair about that.

So, why don't they give you extra compensation for excellent patient care? First of all, how would you objectively measure that? Simply following monkey protocols to the letter doesn't exactly constitute above-and-beyond care. In fact, that's worth about level-C compensation. It is below the minimal level of care, as far as I and most real professionals would be concerned. There really is no way to objectively determine who is rendering that higher level of care. While I am a big proponent of professional documentation, it simply does not always reflect the actual quality of care rendered. Just like in the other criteria, the numbers themselves don't tell the story. So really, unlike the non-patient care criteria, quality patient care is not something you can or should encourage through compensation. It's simply the minimum that should be expected or accepted.

As for the psychology of motivation, again, there is no one-size-fits-all generalisation that can be applied here. That's because different people respond differently to different kinds of motivation. While it can be generalised that positive reinforcement is supposed to be more effective than negative reinforcement in the adult learner, the actual numbers will vary with various populations. People are motivated by only two things: pleasure and pain. But many would contend that pleasure and pain are actually only different ends of the same stick. Pain isn't really pain. Pain is simply less pleasure, and vice-versa. And, depending upon how well an employee understands that concept, his response to so-called "negative reinforcement" may be much greater.

It's all in how you look at it. If you believe the glass is half empty, then you think PBC sucks. If you believe the glass is half full, then you embrace PBC and excel at it. You see, not everything that sucks really sucks. Sometimes, it's just your attitude about it that sucks. If you want to be a victim all your life, and complain about the man "taking your money" from you, then you're doomed to mediocrity for a career. But the reality is that PBC is not negative reinforcement. They aren't taking anything from you. They are offering you a chance to achieve more. And anybody who is truly motivated by a quest for excellence will have no problem doing that. Those are the people I want happy.

AMR didn't invent this concept. This is exactly how the sales profession has operated for decades. Any of you ever been a salesman? Sales, like EMS, is not a 9-5 job where you just show up and enter Peg-A into Slot-B all day long, like a factory worker. You are expected to not just do a job, as spelled out in a protocol. You are expected to do the very best you can do, and be the very best you can be, to produce the greatest amount of income for the employer, who in turn can share that with you. So they hire you, they buy you some nice clothes, and they start you out at a better than average wage. Then they give you about 90 days to start showing what you're worth. After that 90 days, you start getting paid what you are worth. That may be more than what you were making. That may be a lot less than what you are making. But the fact is, you are no longer being GIVEN a salary. Now you are earning it. It's a successful strategy, and that is why it has spread to the non-sales industries. It still has bugs to be worked out, as applied to EMS, but I truly believe that it is an excellent tool for EMS management. It separates the professionals from the slugs. And the proliferation of slugs is exactly why EMS -- after thirty-five years -- is still not a true profession.

[mrmeaner]

Everybody here seems to be missing the point. It's not a matter of "doing a better job" you are being penalized for things that are out of your control! I think I do a wonderful job, thanks for the input anyway! I don't like dropping a dollar an hour my first week as a medic because I'm more worried about my patients and ended up 1 minute over the alloted time. I owe the company one year for helping with my education, so I'll be there for my obligation and then I probably will move on to something better. It doesn't matter how you look at it, whether your losing money or not getting the "bonus" either way your losing money!!!!!!! I can tell from some of the comments in this forum, alot of you must be in management. Management is the ONLY people who benefit from these kinds of plans.

First off, sorry you took "do a better job" as a shot at your pt. care skills. I was referring to the times, signatures and other requirements for your bonus. However I did leave it open to interpretation. If it's outside your control, then do what you can. Just don't use it as an excuse to lower your efforts.

Yes, I am in management. Actually, was. I quit my management job yesterday (I'm feeling much better now). I said things the way I did is because most likely you will get no favorable response from your management without a lot of work. Most likely you will lose benefits as a punishment for complaining about the pay situation. The job market sucks right now. People are watching the news and hearing about high gas prices, a crashing housing market, stock market slumps and increased unemployment rates. Employers are not really worried about losing employees. Especially large companies. Yes, it may take a little while to get people trained, but they are typically willing to bite that bullet rather than admit fault and restructure their pay system.

In order to make a change, you will need to put in a lot of work. There are a few people on this site that I would believe could give you ideas on how to approach this task if you post the question in another thread.

I understand the point you are making in that you feel like you are losing money. The company will see it as you are failing to meet standards that they have placed emphasis on by offering a bonus to achieve them. Plus they even gave you 60 days at the higher rate because they wanted to get you started off right and gave you the opportunity to maintain the bonus status. Not necessarily how I feel about it but I'm sure it's the way they feel about it. Dwayne gave a great explanation (also showing why part of NR testing should be essay based) illustrating the difference between a bonus and a penalty. Perspective.

In the end, my advise remains the same: do a better job, get a better job or get a better education. Personally, I would suggest all three. If you have to stay long enough to uphold your end of the bargain, then that's what you have to do.

Also, thanks for addressing your post format. This is the internet, but it's still nice to believe that English is still part of our school systems.

[mrmeaner]

You know, It's just much easier to just wait for Dust to post again rather than once again realize how long it takes me to type up a response. :x Maybe I'll just throw in a smart ass comment occasionally and call it good.