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
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 Statistics1)
• 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 nurses 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 contd

• Hypothesis 3 On average, a rural EMS system
  must spend 1.25 times an employees 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

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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_at_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

ENTER
Username ?
Password ?
16
Pre-Hire Costs QuestionsHiring Costs

• Please enter the total number of hours each
  person on your roster spent interviewing new
  candidates last month.

Enter in of hours for each staff person who
spent time interviewing candidates last month
GO BACK
NEXT
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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

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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

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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

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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)

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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

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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

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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_at_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.
  62237-240.
• 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.
  2999-118.
• 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.

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References used

• Zuber A. (2001). A career in foodserviceCons
  High turnover. Nations Restaurant News.
  35147-148.
• 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.