TO AMR EMPLOYEES "PAY FOR PERFORMANCE PLAN"

[checkersfire]

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.

My apologies to the snf nurses on here. If your a snf nurse that was prior ems then I wasn't referring to you at all. The snf nurses with prior ems experience and er nurses are the ones that will give you the decent pt care report when picking up a pt and will listen when you are dropping off a pt. You can always tell the difference. I'm not joking when I say though that around here there are some idiot nurses in our snf's in the st louis area, I don't know if its that way in the rest of the country? I know we have some morons in this field also. I get disgusted when I go to pick a pt up on a serious call (they have advised dispatch that its non-urgent) when it clearly should have been an "emergency" call, then when you arrive, they are at the desk and the pt needs to be intubated (I had that actually happen recently) the nurse was at the desk, handed me the paperwork and says "the pt is in room 108 and ready to go" I get there and they are breathing 40 times a minute and labored. I wasn't a happy camper, but you can't say anything to them, they complain and then you get in trouble for pissing off a customer. Again, my apologies to the "good" nurses on here I may have offended.

[Dustdevil]

Well, to be fair, I don't think you will find many people here -- even among the nurses -- that will disagree that what you observe is all too common. You can't have spent a day in EMS without realising you are right, lol. It's just never pleasant for the exceptions to get lumped in with all the other losers, when they are trying so hard to be something better. But yeah, we all know where you're coming from. I wasn't really saying you were wrong. Just saying you were being offensive, lol. :wink:

[DwayneEMTP]

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.

While I know this isn't a phychology thread, (actually it is, but most won't see it that way) you are mistaken here...

Reinforcers are always more productive, when used properly, than punishments (negative reinforcement is an oxymoron that isn't used in behavioral psychology except when speaking with laymen. Just trivia, not sniping.).It makes no difference the group being studied, the age, nor even the species.

The issue arises when we attempt to define a reinforcer that will encompass varied groups. As Dust said, his pain may be my pleasure, and vice versa. But as much as EMS likes to consider themselves individuals and beyond description, Professional EMS has much in common.

Let's say Dust and ak and, I don't know one of the Docs, decided to start an ambulance company tomorrow. All we have is their posting history available to judge their intelligence, honesty, commitment to intelligent management and fairness, as well as their complete disdain for sloppiness and laziness. But we'll call it good as I've no reason to believe otherwise. So they are committed to up to date equipment, spotless ambulances, and way cool uniforms, and progressive protocols.

But, they can only afford to run this top notch service by paying wages 10% below local averages. Each person will start at a base rate, but will have a share of the profits at years end tying each persons EOY wages to the success of the company. No financial promises for individual acts of good behavior, but a promise of possible compensation later for outstanding behavioral habits. How many of you are going to leave your jobs tomorrow and go to work for them?

I'm going to take a guess that a bunch would. Because they've created an environment that reinforces the types of medics they would want working for them, and money isn't really even one of them. Professional look, aggressive medicine, access to management as well as access to the profit that their success produces. What do you suppose the retention rate would be?

See what I mean? I don't need a reinforcer to fit every person. I simply need a set of reinforcers that has proven to reinforce the type of person that I wish to keep. Add a set of punishments to this, and it is destroyed. Firing is the only punishment here, and that is only for issues that couldn't be trained away. (Because in our company field failure that isn't morality or ethics based is considered management failure. Hired poorly, trained poorly, managed poorly.)

Anyway...I know I've gone completely off the subject, but I start trying to write out these types of thoughts and then think..."hell....I should have stopped half an hour ago...but I can't really spend another three hours to finish"....and end up with this crap.

So here it is for what it's worth...

Dwayne

[triversbsn]

pps sucks deal with it daily, never heard anything about ioawa, but its going to nation wide, get prepared. meidcare leads the way for IPA and the insurance companies.

[JPINFV]

pps sucks deal with it daily, never heard anything about ioawa, but its going to nation wide, get prepared. meidcare leads the way for IPA and the insurance companies.

[Dustdevil]

pps sucks deal with it daily, never heard anything about ioawa, but its going to nation wide, get prepared. meidcare leads the way for IPA and the insurance companies.

[mshow00]

Don't know if you have heard yet, but the rumor mill here is that AMR already tried to implement this plan somewhere and all of the medics walked. Anyone know if that is true? Like I have heard it said here, if you don't like it leave. It is obvious nothing at our company is going to change, and a union would only cause us more trouble.

PS I still don't know who you are lol

[checkersfire]

Like I have heard it said here, if you don't like it leave. It is obvious nothing at our company is going to change, and a union would only cause us more trouble.

PS I still don't know who you are lol

Let Let me tell you something junior, I've been here ALOT longer than you have!! I have seen alot of bs at Abbott/AMR and have heard from people on the Missouri side that have worked for AMR in other regions. They loved it, there was no pp plan, they had excellent equipment etc. The person trying to implement this plan at other places is our own executives from here that have been promoted to the region level! How do you figure a union would bring more trouble? What, with better benefits, higher wages, no more pp plan? I don't even care about the pay raise, IF, they did away with the pay for performance plan and left us at "a" rate. Actually, I don't mind if they left it there for the paperwork, we can control our paperwork, we CAN'T control our times, unless you want to do like the Missouri crews and cheat your times one way or another. I refuse to cheat, I also refuse to give substandard care to meet a time quota! Like I've said here before, when I get tired of it I will leave, then you'll be even more short handed and you can run even more! lol

[mshow00]

I whole heartedly agree that patient care comes before all else. I can usually make my times up, get the difference back on some of the other calls. As for the union, usually to get something you have to give something up, would you be willing to loose the instance program, to gain a small raise? and then there is always the fact that Abbott already will not get rid of its employee's that are subpar. You KNOW who I am refereing too. A union will only make it all that more worse.

[checkersfire]

I whole heartedly agree that patient care comes before all else. I can usually make my times up, get the difference back on some of the other calls. As for the union, usually to get something you have to give something up, would you be willing to loose the instance program, to gain a small raise? and then there is always the fact that Abbott already will not get rid of its employee's that are subpar. You KNOW who I am refereing too. A union will only make it all that more worse.

I agree, but I would rather lose the instance program in trade for the "times" I also, can fix my times sometimes. But I refuse to be fraudenlant about it, and sometimes that would be the only way to stay at "a" rate. I also agree that they don't get rid of the "dead weight" they need to. I don't understand why, but its' been that way for years. It seems the worse you are, the easier it is to keep your job?