Being a paramedic during the formative years of my working life, I’ve been surprised at how many of the lessons that I learned on the job have translated to the business world.

As I look back at my career and how I got where I am today, there is a consistent theme – learning. Way back when I entered college, I was convinced that I was going to be a surgeon. That was the career path that I knew I was destined to follow. Some of it made sense; I had had a strong interest in science since I was a kid, and my natural empathy led me toward medicine. Combine those with a desire to be challenged, and surgery was it.

I went to EMT school because I wanted to see if I could handle the blood and other aspects of medicine. I handled the classwork and clinical hours pretty well, so it made sense to leave the world of retail jobs and try my skills in the real world. I got a job with an ambulance company and started my training to help to transform what I learned in class into skills that applied to the street.

The learning curve that EMS threw at me was intense. My first few weeks were pretty mellow; I was too young to work full-time on the ambulances (couldn’t be insured until I turned 21), so I was doing part-time shifts on off hours and picking up special events. Then there was the concert. I expected a quiet evening to see a couple of bands I had never seen before, get paid, and maybe hand out a couple of Band-Aids. Instead it was chaos.

Before that night I had seen a few calls and transported a few patients, but I had never experienced anything like what I faced that night with the rest of the team of EMTs and paramedics that worked that show. We saw everything. Drunk and/or high concertgoers fighting with each other and with us. Various states of overdose. And, unfortunately, a person lost their life that night after we did everything we could to save them.

The challenge to my skills was drinking from not the fire hose, but the fire hydrant. I used every skill I had learned in school and was asked to go far beyond that comfort zone as we struggled to keep up with the flow of patients. By the end of the show I was completely drained, physically and mentally, and fell asleep on the floor of the rig as we rode back to HQ.

As I have moved forward in my career I have faced similar challenges, though perhaps not as intense. I’ve moved from one type of job to another, and the ramp-ups have been variously challenging. My transition to consulting after all of those years in various industries was that kind of challenge. There was so much to learn while still trying to be effective at the job. As I’ve grown into the role over the last few years, I’m finding that it’s the never-ending learning is one of the things I love the most about this career. Each assignment and each client is a new opportunity to develop a skill or learn something so that I can improve professionally and personally.

I am by no means unique in this passion for learning. Its part of our biology as humans – we are effectively hardwired to seek out new opportunities to learn, and are rewarded in our brains when we do so.[1] We as leaders need to be providing these opportunities lest we lose our top employees.[2] Employees that get bored disengage, yielding losses in productivity and profitability. By recognizing each person’s innate desire to grow and learn, we can help to maximize performance while increasing job satisfaction.

Being a paramedic during the formative years of my working life, I’ve been surprised at how many of the lessons that I learned on the job have translated to the business world.

When I worked on the ambulance, 24 hour shifts were the most common. A standard rotation on our “modified Kelly” shift averaged out to a 56 hour core work week – some more, some less. Depending on where you worked, that would be 24 hours of running effectively nonstop, or a few calls, a nap during the day and a full night’s sleep. “EMS” was known as Earn Money Sleeping except on those unlucky nights.

When I was promoted from EMT to paramedic, I saw a substantial pay increase, and I took full advantage of it. I worked for effectively six months straight. At that time I was working on an 11-hour bus, so anything extra was overtime over my 44-hour core workweek. A 24 hour shift was a nice bonus, and two in a row plus another 11 hour shift on my days off made for a nice paycheck.

Other times when I was back on 24 hour cars, I would pick up additional 24 hour shifts during our rotation, so I would be on duty for 72 or occasionally 96 hours at a time. Most of the time it would work out – I’d get 5 or 6 hours per shift and be pretty functional. But then there were those shifts… It’s scary now to think about how hard I was pushing myself.

While we need staffed ambulances, sometimes sitting idly by at all hours of the day and night, there’s a growing body of evidence that indicates that we don’t need to be in the office the same way. Many of us push ourselves or work in cultures where the expectation is set that the workweek is 70-80 hours with availability on weekends as well. This is dangerous for the people that work that much, and for the companies that they work for.[1] The health effects from sleep deprivation, stress, and burnout are well known. There is also a correlation between excessive alcohol consumption and overwork.[2]

Surprisingly, there is evidence that shows that all those extra hours produce no increase in productivity.

Research has shown that managers can’t tell the difference between those who pretend to work 80 hours and those who actually do.[3] What can be seen, though, is degradation in all of the skills that make us good workers and good leaders when we become exhausted from overwork.

My own profession is notorious for crossing the line for demanding hours and 7-day workweeks. Many firms (mine excepted) view it as a performance indicator – working all of those hours is considered basic

table stakes, regardless of the ability of the employee to deliver exemplary service within a normal workweek.[1] There is also a gender discrimination component of this behavior that makes it a bit worse.

As leaders, we must monitor our expectations of our employees and ourselves, and do what’s right. More hours doesn’t increase output; research indicates a 32-hour workweek may be the sweet spot for productivity and creativity.[2] By allowing ourselves a real balance between work and life, we can give the most to both sides and be the most productive overall.

Other Sources: Hbr.org and Inc.com

Being a paramedic during the formative years of my working life, I’ve been surprised at how many of the lessons that I learned on the job have translated to the business world.

The world of medicine, especially EMS, is one of ambiguity, intuition, and making decisions based on incomplete and ambiguous information. In my own career I had to make judgment calls in order to decide on what treatment path to take, what medicine to give, what intervention to use (or not).

Often for me and my peers, it was as much the ability to make a decision and act, or withhold a treatment because of that decision, that made the difference.

In the most challenging of cases – a cardiac arrest – decisions are made quickly with corresponding treatments given just as rapidly. Interpretations have to be made on the spot in an environment of stress and noise and other things not shown on TV that add to the confusion.

When I think about the first patient in arrest I ran by myself, I still get goosebumps. It was one of the most challenging runs I ever did, pushing my skills to their absolute limit. We ended up practicing nearly every skill that we had been taught in our attempt to keep up with the patient’s heart as it fluctuated wildly between patterns and arrhythmias. Decision after decision was made, reacted to, learned from, and discarded as we worked in the back of that racing ambulance.

Despite the chaos noise and adrenaline there was one singular focus: saving that patient.

In business, our focus is different, but decisions must be made, sometimes with what feels like the same pace and similar urgency. However, many people are reluctant to make decisions and act on them, and get stuck in a position of wanting perfect information to make a perfect decision each time. We all know that such perfect information is never available, and if perfect decisions were possible, we wouldn’t be needed. It’s our ability to intuit, to use our experience and see across the gaps to make good decisions most of the time that make us excellent leaders.

Businesses waste millions of dollars every year on analytics that still don’t lead to decision making.[1] Sometimes we have too much data available, and we dump it all into what Jim March calls the “garbage can,” where it’s all mixed together and people just agree to the solution that first appears.[2] Having all that data available and mixed together means that the wrong data is arbitrarily applied to the next problem, and the decision isn’t really a good one at all.

Another thing to consider is that, unlike medicine, there are rarely “right” decisions and “wrong” ones when looking at business.[3] Ethics and morality being the obvious exceptions, most of the decisions we make are along a spectrum where there is some good that results, and some negativity that follows as well, assuming we can even find the right measures to determine each side.

At the other end of the spectrum is the uninformed knee-jerk decision, which is particularly ineffective when followed up with “this is the decision we’ve made and we’re sticking with it.” Before making these types of decisions, the first question should be “why is this an emergency?” Rarely is any decision we make life-or-death, literally or figuratively.

How many of these emergency decisions can really take a day to have context developed, information gathered, and long-term consequences considered?

As business leaders, we must create an environment in which decision-making is supported and safe for those to whom we delegate those decisions. By ensuring that all decision makers, including ourselves, understand that decisions need to be made in the right time, with the right information, in the right context, and will never have all of anything that we want, we will allow for the best environment possible. As leaders, we have the ability to look at a situation and evaluate not just the urgency and long-term effects of a decision but can also consider and communicate the costs of inaction – failing to make a decision can be worse than making a bad one.

Being a paramedic during the formative years of my working life, I’ve been surprised at how many of the lessons that I learned on the job have translated to the business world.

Working as a paramedic, it is easy for your ego to grow to an unhealthy size. The job is one in which you work with either one partner on an ambulance, or as part of a small team on a fire rescue squad. You’ll find yourself in some crazy situations, expected to manage them effectively on your own. There are medical guidelines, but so much of what we did was “act, and ask for forgiveness” – especially if you were considered one of the good medics. And who didn’t think they were one of those?

Managing lifesaving care and emergency situations, driving like a bat out of hell (sorry, insurance companies), and taking charge of chaotic scenes adds up. We became adrenaline addicts, and we grew our egos to match – having that ego allowed us to take control in those situations of chaos where nobody was in charge. Sometimes that ability was essential for patient safety. Plus, it simply takes some ego to do some of the treatments that we had to do.

This isn’t a medical blog, so I will spare my readers the gory details. But we’ve all seen TV and movies where they use the defibrillator paddles: putting enough electricity through someone’s chest that equates to about 265 foot/lbs. of mechanical force. That takes chutzpah, and is terrifying the first time you do it. The 30^th time, when you do it in front of a crowd with nonchalance? That’s ego.

That same ego also tends to prevent us from admitting that we are capable of error. It drives us much further down the wrong decision path because to go a different direction would indicate that our diagnostic skills were less than optimal, resulting in a huge ego blow. I’ve seen it more times than I care to remember where a paramedic who outranked me made a bad diagnosis on a patient and continue to insist that their diagnosis was correct despite all the evidence in front of them. I admit my own mistakes, and feel fortunate that I was able to learn and grow from them.

In my professional life, I have learned that taking my ego out of the equation as much as possible, whether in decision making or a learning opportunity provides me with the best opportunity for success. As leaders, we have to remember that we are not in our position to take care of ourselves, but to provide the best for our organization and for those who have placed our trust in us.[1] Research shows that leaders who serve selfish interests are not ones that are successful in the long term; trust is lost, and people will lose their interest in following a person in that position.

An ego and that sense of self-service can also create other obstacles to success. When our egos are in control, we become convinced of our own greatness, and will allow ourselves to fall into a position where we won’t ask for help, we resist deviation from the path that we set, and we fail to learn from the mistakes that we inevitably make.[2] Setting goals that nobody could meet, we will micromanage from our perceived position of superiority while being unable to allow ourselves to allow others to be right, even when they are.

If an out of control ego combines with success, worse symptoms can develop – anything from paranoia to career- or life-ending decisions. Examples abound in the business world where a leader with an out of control ego has made bad decisions: John DeLorean’s cocaine deal as an attempt to finance his company.[3] Or, more recently, Elon Musk’s tweets leading to SEC sanctions and the loss of his position with Tesla.

So, how do we keep our egos under control? Leaders and executives in powerful positions can find themselves in a position where ego growth is reinforced. We have to take compliments and praise with acceptance, but not necessarily taking it to heart.[4] True friends are an invaluable resource that can provide real feedback to us that is unfiltered and check us as we need. And, we need to be ever self aware – yes, a bit of navel gazing is a good thing – as we look at what we do wrong, where we need to grow, and how we can do better.

If we can lead with selflessness and focus on the organization and the people that we mean to serve, we will be more effective leaders. Accepting our fallibility and learning from our mistakes will ultimately make us better at what we do, and lead us to making better decisions. Rather than misdiagnosing and killing our businesses, we can work with our teams, learn from each other, and thrive.

Being a paramedic during the formative years of my working life, I’ve been surprised at how many of the lessons that I learned on the job have translated to the business world.

There isn’t much I miss from my time in EMS. I did a lot, saw a lot, and my addiction to adrenaline has waned as I have gotten older. There was always one thing that I enjoyed, though. Running code 3 (lights & sirens). I have always enjoyed driving, and running code 3 was an additional challenge where we had to balance our patient’s life with the risks to ourselves and everyone else on the road.

I was always astounded at the behavior I would see the moment we lit up the rig – what seems like a simple thing for drivers to do becomes an insurmountable task. Instead of pulling over and stopping so that we could pass safely, we would see anything from brake checks right in front of our 13,000 lb. ambulance to motorcyclists trying to race us.

Despite all that, I loved it. I was really good at getting through traffic, avoiding the bad spots and navigating my way around the city. And, those times when I was driving back with a really sick patient in the back with my partner attending, I could make haste, yet if you set a glass of water on the floor of the treatment area, it would still be (mostly) full when we arrived.

The thing that we always were taught to remember was that we were driving a giant, loud, flashing billboard. Regardless of what was actually happening, what people thought they saw would become the reality, and if it was negative, it would come down on us. A perfect example happened in the middle of my career, when we were canceled on the middle of a response, and so we had to shut it down while we were in the middle of traffic. By pure chance, it was also breakfast time, and a favorite bagel chain was right there. So, I shut it down, caught the left-turn arrow, and pulled into the bagel shop for breakfast – code 7.

A few minutes later my partner and I were approached by a very upset woman who berated us for running lights and sirens to breakfast, and how it was unreasonable for us to be endangering and inconveniencing other drivers because we wanted a meal. Fortunately we were able to talk her down, explain what happened, and provided her our dispatch number in case she wanted to verify. Had she not spoken to us but just called and complained, it could have been a harder conversation with my shift supervisor.

I keep the rolling billboard in mind at work for any number of scenarios. One of the most obvious scenarios is something that none of us want to have to manage as leaders – how we or our employees appear. When I entered the world of consulting, I was given the expectation that I should be dressed just a bit above where the culture is where I am working – just slightly more formal. That expectation has allowed me to be sure that my appearance is not preventing my success or keeping my consulting work from being taken seriously.

Finding that line isn’t so easy, especially depending on what industry you find yourself working in. One client for which I have worked has a policy, yet I find different groups have created their own cultures despite that policy – engineers in casual dress, project managers in button downs and slacks, and other groups wearing suit jackets and blazers. None of these groups are customer-facing. As long as there is no business need, and performance isn’t suffering, perhaps this works out well.[1]

Not as obvious for us to think about, yet as bright as the red and blue strobes on the ambulance are the inconsistencies in messaging that we provide as leaders – effectively unreadable billboards. Sometimes we use clichés or vagaries – feel good messages that don’t actually say anything and end up doing more damage as those who we mean to lead try to figure out what in the world we meant.[2]

I can think of more than one time where anything from the next quarter’s goals to our overall corporate strategy were so vague and poorly communicated that no two employees would state them the same, nor be able to provide the same results for a critical strategy dependent on that messaging. A clear, concise message that is prominent and repeated and uses appropriate language, metrics, and symbols is necessary to ensure communication of these important concepts to employees, especially in larger organizations with distance between the messenger and the recipients.

Perhaps the most important way that we all need to make sure that we are not just doing the right thing, but ensuring that our billboards are providing the right message, as in our ethics in how we conduct our business. The news regularly reports on ethics failures that cost businesses and consumers many billions, yet still more than 40% of workers report seeing misconduct in the last year, and 10% felt pressure to actually violate ethics standards.[3]

Even if we are not actually violating standards, the appearance thereof can be incredibly harmful, to our reputations, our effectiveness, and ultimately to the business that we are trying to accomplish.[4] Setting an example leads subordinates to believe that such behavior is acceptable, and can lead to actual conflicts of interest or other ethical lapses.[5]

Ultimately, it isn’t about paranoia. We are being watched, but as leaders it is about being inspiring. We must lead by example, communicate clearly, and project the correct image at the correct time for the eyes that are upon us. And, we must inspire ourselves so that we continue to do the right thing, being aware of how our actions and words may be interpreted, for we are billboards and can be misread.

Being a paramedic during the formative years of my working life, I’ve been surprised at how many of the lessons that I learned on the job have translated to the business world.

I remember the first time I performed CPR like it was yesterday, though it was more than 25 years ago – July 4, 1992. My first cardiac arrest was a tough day in many ways, and took me a long time to process. I was so green, so naïve, and so young. I had training, but I really had no idea what I was doing. I had the support of the experienced team that I was working with to help guide me, despite the mistakes that I made. I tell you, I made plenty.

Probably the worst mistake I made that day was expecting to save that young person’s life. On TV people get CPR for a minute or two, cough, and are pink, healthy, and hugging their mom. Reality is so much different than that. It’s a workout for the provider, and brutal to the person receiving it. It truly is a lifesaver: people who have a cardiac arrest outside the hospital and receive CPR are 300% more likely to live[1]. My stepfather was one of them – he had a spontaneous cardiac arrest on his 50^th birthday while on a morning run, received CPR, and was able to be resuscitated by other EMTs and paramedics and ultimately recovered fully, other than a few weeks’ lost memories.

Each one of those EMTs and Paramedics was, at one point of their careers, just like I was on that July day – brand new, scared, flooded with adrenaline, and making mistakes. It is through those mistakes that they were coached and learned to become the skilled practitioners that they became, ultimately saving a life that meant a lot to me personally. Adaptability and creative problem solving are developed by being in an environment that allows learning by error and coached recovery from mistakes. These skills are what allow EMS professionals to do what they do to the level of effectiveness that they can.

In business, too often do we find ourselves expected to be perfect, the first time and every time. In a time where the young are being afflicted with anxiety and depression, we see an increasing trend of expecting perfection from ourselves and each other[2]. This drive towards perfectionism is associated with drastic harmful results, including suicide[3]. Some will want to dismiss this as a sensitivity of the young. However, such complaints are ageless:

… I find by sad Experience how the Towns and Streets are filled with lewd wicked Children, and many Children as they have played about the Streets have been heard to curse and swear and call one another Nick-names, and it would grieve ones Heart to hear what bawdy and filthy Communications proceeds from the Mouths of such… (Robert Russel, 1695)[4]

Or,

Our sires’ age was worse than our grandsires’. We, their sons, are more

worthless than they; so in our turn we shall give the world a progeny yet more

corrupt. (Horace, c. 20 BCE)[5]

Recognizing that this is not a generational problem, but a systemic issue is the first step. As leaders, we must create a culture of intelligent risk-taking, experimentation, and supportive recovery from mistakes and failure. Jeff Bezos from Amazon, Reed Hastings from Netflix, and James Quincey from Coca-Cola have been taking moves to establish these tenets in their cultures[6]. Whether canceling hit shows because they’re too easy and not risky enough, encouraging experimentation, or simply pushing management to get past the fear of failure, these CEOs have been driving cultures of innovation by creating safe places to fail[7].

Smith College has created a program on not just surviving failure, but on using it to advance[8]. It teaches the women who take the coursework to accept, understand, learn, and move forward from their failures, rather than be humiliated and intimidated by them[9]. As a result, they are more prepared to confidently approach creative endeavors and experiment where many of us would balk for those same fears that they have learned to move past.

As many as 1 of 3 businesses have a culture averse to risk[10]. Part of this may be a result of our ability to forget the lessons that we have learned from when we have made a mistake – if we have bothered to do so at all[11]. How many of us regroup after a project, especially a failed one, and discuss what has happened, what we have learned, and then actually take action from those learnings? I can’t say that I have ever seen an organization do it well, if at all.

If a business makes a determined and structured effort to examine its failures – not as a finger-pointing exercise, but as a means to gain knowledge and prevent similar problems in the future, these mistakes can be positive events[12]. This means taking an honest assessment of what happened, how it happened, why it happened, has it happened before, and assembling it into documentation that can be shared around the organization. This can be a scary proposition in companies where executives are jostling for position and power instead of working towards the same goals.

Ultimately, though, business is a human enterprise. There will be mistakes. Some of those mistakes will result in great advances – penicillin, Post-It notes, and inkjet printers were all created as a result of errors[13]. While most of us will not create the next penicillin, we may create something extremely valuable for our business if we are in an environment that allows and supports experimentation and error, and then examines those errors to make sure it learns everything it can about them to reduce the risk of them happening again.

[1] https://well.blogs.nytimes.com/2014/07/17/the-cpr-we-dont-see-on-tv/

[2] https://hbr.org/2018/01/perfectionism-is-increasing-and-thats-not-good-news

[3] ibid

[4] A Little Book for Children and Youth https://books.google.com/books?id=yaGqC78TGUcC&pg=PA211&lpg=PA211&dq=A+little+book+for+children,+and+youth+russel&source=bl&ots=lWdrfBCssf&sig=pIin7ggNRls8ww-C-NmwR_mpPts&hl=en&sa=X&ei=CvWyUKvREqXp0QHGs4GIAw#v=onepage&q=A%20little%20book%20f&f=false

[5] Book III of Odes

[6] https://hbr.org/2017/11/how-coca-cola-netflix-and-amazon-learn-from-failure

[7] Ibid

[8] https://www.nytimes.com/2017/06/24/fashion/fear-of-failure.html

[9][9] ibid

[10] https://hbr.org/2016/05/increase-your-return-on-failure

[11] https://hbr.org/2016/02/why-organizations-forget-what-they-learn-from-failures

[12] https://hbr.org/2016/05/increase-your-return-on-failure

[13] https://www.businessinsider.com/these-10-inventions-were-made-by-mistake-2010-11#scotchgard-10

Being a paramedic during the formative years of my working life, I’ve been surprised at how many of the lessons that I learned on the job have translated to the business world.

Watching EMS on TV and movies, especially when it’s fictional, is always entertaining. Everything goes smoothly, there’s very little blood (or anything else), and saving people is easy and always successful. Reality is something quite different. Life is messy, but it’s also beautiful. As a paramedic, I had the honor and duty of assisting as people took their first and last breaths.

Each process was hard in its own way, and ultimately provided insights into life that I would have gotten nowhere else.

Each of these times is so important for the person, but also for those who are present, whether a loved one or a bystander. When an infant is born, there are many things that can go wrong that we have to watch out for. Ultimately, though, if it has to be done in the field with a paramedic, we still try to make the experience as focused on mother and child as possible.

When someone is dying and a paramedic is called, we know it’s not going to be easy for anyone. Working an arrest/impending arrest (the term we use in the field) is the ultimate test of the skills and knowledge that we have gained as paramedics. It’s where we use most of the medications we carry, our EKG and physical assessment skills, airway management skills, and do it while also managing physically demanding work like CPR.

It’s a lot to do on a physical level, and it takes its toll emotionally as well, never mind for any family that may be there. We’re also trained to make the process of death as dignified as we can, despite what we have to do and how we have to do it. We talk to our patients and to the family. We provide what cover we can, and we help families begin the grieving process if we can as well.

So, what does this have to do with business? The transitions we have as employees, whether starting or leaving a job, are substantial life events with stress impacts of their own. Using the Holmes-Rahe Stress Inventory as a means to quantify stressful events on a 0-100 scale, we see that while losing a close family member scores a 63, being fired is still a substantial stressor at 47, retirement a 45, business readjustment 39, changes in financial state 38, and changing lines of work 36[1].

This scale is useful in predicting the likelihood of near-future illnesses, with scores of 150-299 predicting a 50% rate of illness, and over 300 producing an 80% risk[2]. Clearly job transitions create stress for us, even if they are positive moves.

In retrospect, my move into consulting had several associated stressors. When the scores are combined, it created a stress score over 100 – more stressful than the death of a spouse[3]. When we view these transitions in this context, we begin to see the need to ensure that the transition is designed to reduce stress as much as possible.

When brought into a new job at a new company, there is almost always some kind of orientation or onboarding process.

When surveyed, companies report that the basics are delivered: administrative items (88%), an introduction to the business as a whole (86%), legalities and procedures – the policy manual (85%)[4]. But what other efforts are provided to ensure that the transition from one position to another?

When performing research on the transition of newly hired executives of VP or above, just over half of companies actively work to ensure that a newly hired leader has her/his expectations aligned with new teams and bosses[5]. One-third organize introductions between new executive and stakeholders he or she will be interacting with, and fewer still work to familiarize them with the culture[6]. This leads to most new executives in an organization feeling like they don’t understand the basic norms of how their new company works, and that nearly 2/3 are not a fit with the culture they hired into[7].

One could argue that if this “sink or swim” approach is taken with VPs, things are probably worse for new rank-and-file employees. This may be part of why 40% of employees voluntarily leave their jobs within six months of hire, and 56% within a year[8]. Culture and opportunity are a large part of this trend[9].

As I wrote about in last week’s blog, bringing new employees on is an investment, and like any investment, there should be a positive return for the business. If a substantial portion of hired employees depart within the first 6 months to year, there is considerable cost to the business. Too often, leadership fixates on short-term costs of investing in employees, but we repeatedly find that those investments have substantial returns.

When companies invest in onboarding employees – spending up to a year on helping them leverage the skills and experience that they were hired for and integrating them into the culture and organization – profits are measurably increased[10]. Reduced costs and increased profits along with improvements in engagement, productivity, and talent attraction[11]? Win-win.

That, on average, 17% of new employees leave within the first three months is a difficult statistic for a company to manage, especially with the associated costs[12]. However, we all recognize that employment is necessarily a temporary agreement, whether it will last for weeks, years, or decades.

The end of that relationship should be treated with care and dignity. The loss of an employee and/or leader, especially one who has been with the company for an extended period can have significant impact on the business and must be managed effectively.

Perhaps the most feared loss with a long-term employee is the institutional knowledge that goes with the individual. Trying to capture all of that information after an employee has given notice can present a formidable set of challenges. Ideally, leadership will be looking across the organization and identifying where those single points-of-failure are, and having that information formally documented, backups delegated, jobs shadowed, etc., long before notice is given so that when that employee finally leaves the transition is much more positive.

It’s dangerous to assume that the person in that role will, or even can, document what they do and how they do it, and that they can do so in a typical job departure window. Leadership should be evaluating its workforce with what I call the “Powerball” test: think about each employee, one at a time, and decide how bad the impact would be were that employee to call on a Monday morning and say “I won $500 million in the Powerball, and I won’t be coming back to work.”

If any of these scenarios causes leadership to break out in a cold sweat, it is time to start distributing and preserving knowledge[13].

In my personal experience, one of the most forgotten and underutilized tools is the exit interview, if it is even conducted at all. Two-thirds of exit interviews are talk-based with no effective follow-up[14]. There certainly is cause for discounting the word of departing employees for fear of overvaluing the word of the disgruntled.

However, there is value in asking how and why that employee became disgruntled. We hire people to be excited and optimistic about the work they are doing, and we hope to bring them to a place where they will fit in and join our culture and be successful. If that didn’t happen, or if something changed and an employee that has served well for years suddenly departs, it is worth investigating what the root cause is, in case a problem that cost one employee grows to cost much more. Identification of ineffective or dangerous policies, toxic management, or similar situations can be difficult.

We know that high turnover and low performance go hand-in-hand, so if performing effective exit interviews can reduce turnover, there can be a positive return on investment[15].

Even for employees that are involuntarily departing, maintaining dignity throughout the situation also provides substantial benefits. By providing the departing employee with a departure that allows for that person to leave with a positive experience – yes, this is possible – can yield numerous benefits for the company in the long term[16].

While, obviously there are some instances in which a terminated employee must be shown out immediately, many terminations can be handled differently. Employees who are to be terminated can be given a departure plan that allows for job hunting and a departure to a new position rather than a period of unemployment will obviously leave with preserved dignity, but also a better reputation and have an easier time finding work[17].

That tends to ensure that the relationship with that employee is intact, if not improved[18]. With as small as some circles can be within industries, that preserved relationship can mean the difference between earned or lost business. The business also benefits with reduced risk of legal exposure resulting from the termination, an easier shift of duties to the newly responsible, and a better relationship between leadership and employees[19].

Ultimately, the entire lifecycle of employment is worth investing in as an overall strategy for the business. Investment in the company’s people, as well as product, customers, and sales, provides a net positive return for long-term success and growth.

[1] https://www.dartmouth.edu/~eap/library/lifechangestresstest.pdf

[2] ibid

[3] ibid

[4] https://hbr.org/2017/05/onboarding-isnt-enough

[5] ibid

[6] ibid

[7] ibid

[8] https://www.inc.com/adam-vaccaro/voluntary-turnover-six-months.html

[9] ibid

[10] https://hbr.org/2017/06/your-new-hires-wont-succeed-unless-you-onboard-them-properly

[11] https://tallyfy.com/benefits-of-onboarding-new-employees/

[12] https://hbr.org/2017/06/your-new-hires-wont-succeed-unless-you-onboard-them-properly

[13] https://hbr.org/2016/01/the-right-way-to-off-board-a-departing-employee

[14] https://hbr.org/2016/04/making-exit-interviews-count

[15] ibid

[16] https://hbr.org/2018/08/a-more-humane-approach-to-firing-people

[17] Ibid

[18] ibid

[19] Ibid

Being a paramedic during the formative years of my working life, I’ve been surprised at how many of the lessons that I learned on the job have translated to the business world.

EMS can be a remarkably difficult career. While there are times of boredom, the things that EMTs, paramedics, firefighters, and police officers see on a regular basis can be disheartening. I won’t delve into the details here but seeing the awful things that people do to each other, and themselves, can wear on anyone after a while.

Ultimately many of us burn out and leave the field entirely. When I was working, the conventional wisdom was that career life expectancy in EMS was 7 years. Research has borne that out, but trends are going in the wrong direction, as average paramedic tenure has dropped from 6 ½ years to 4 since 2011.[1]

As the toll of the job added up, my burnout increased. I knew that I was in trouble when my sister said that I looked like Nicolas Cage in Bringing Out the Dead; pale with hollow eyes and an emotional disconnection to the world. That emotional distance seems to be a way that paramedics deal with the stresses of the repeated emergencies that come with the job.[2]

That burnout and work exhaustion is correlated with feelings of loneliness, and the more exhausted we are the more lonely we are.[3]

Burnout and exhaustion are a problem across job titles throughout the United States. This burnout costs America deeply – $125-$190B/year in healthcare spending[4] and a loss of $150-300B/year for employers as 1MM people miss work daily from stress.[5] Half of us are burned out, regardless of profession or workplace.[6]

Unfortunately, employers fail to understand what is happening and why. They see burnout as a personal problem or related to talent management instead of recognizing it as a symptom of larger, systemic problems.[7] As the demands of competition and shareholder have increased and the philosophy of “do more with less” have driven businesses to push employees harder, the results are becoming clear.

An overestimation of the effectiveness of computer tools and automation leads to overwhelmed workers, and post-implementation workload evaluations are effectively unheard of (especially in those companies where overwork is celebrated).[8] People get stressed, and that stress results in decreases in productivity and reliability, increased turnover, and reduced service.

Sadly, executives have become so distant from their workforces that they don’t understand how much time and effort is spent on productive activities or how much is lost on unproductive ones.[9] Without that knowledge, it will be difficult for leadership to look inward and confront the company behaviors that create stress.

Most of us can relate to being short of time; even more so when buried with meeting after meeting that feel like they accomplish nothing but consuming time. Adding time management discipline from above could bring at least 20% relief to their employees’ days, were executives to take the right steps.[10] One workplace study had average managers losing more than half the week to email and meetings.[11] With that much time lost, productivity is sure to fall as well, even as the wall between work and home erodes.

As burnout builds, employee turnover grows as well – some quit, others are terminated because performance suffers. If a company creates policies that effectively reduce employee stress, turnover rates are more than 6 times lower than companies that don’t.[12]

While it has been taught that engagement is the solution to stress, newer research is debunking that thinking. 20% of highly engaged employees report high burnout and are the highest turnover risk.[13] Using challenge as a strategy to prevent burnout has also been shown to be a double-edged sword; it can motivate some but will create anxiety and stress for most everyone, lead to exhaustion, and those stretch goals may actually be creating worse results than moderate, achievable ones.[14]

How does this happen?

Part of the problem is that we naturally lean on the people that perform the best. If given a critical project that we need to hand off to our team, we will consistently lean on our top performers.[15] We then ask those same top performers to make up for their less-capable peers and work on other small non-mission-related tasks, all while managing the most critical work.[16]

All of this leads to our best employees burning out and ultimately leaving our companies. This is expensive; from 25-200% of that employee’s salary.[17] When viewed in this context, creating a business case for stress and burnout prevention should be relatively easy, especially when looking at the long-term health of the business.

While wellness initiatives show some effectiveness, to truly make a difference HR involvemen is necessary – monitoring demands, workload, etc.[18] By providing increased focus on the right support and recovery programs and workload management, stress and burnout can be more effectively monitored and reduced, and the subsequent consequences minimized.

As with so many other things in business, paying attention to the needs of the employee base, focusing on morale, and reducing stress can have returns far greater than their costs. The old theory that pushing people as hard as possible is the only way to get results ends up costing businesses far more than they receive, and ultimately we all pay with increased healthcare costs, decreased health, and diminished emotional capacity.

Trying to run a business and its people at maximum capacity, with every item a fire drill and every task a top priority leaves no capacity to increase productivity if an actual emergency happens. Instead, managing employee time effectively and using a study and evaluation of workload management strategies can reward a business in increased productivity, reduced insurance costs, better decision making, and reduced turnover – a win for everyone involved.

[1] https://www.jems.com/na/ferno/can-you-predict-how-long-your-new-medic-will-stay.html

[2] Ibid

[3] https://hbr.org/2017/06/burnout-at-work-isnt-just-about-exhaustion-its-also-about-loneliness

[4] https://hbr.org/2017/04/employee-burnout-is-a-problem-with-the-company-not-the-person

[5] https://www.forbes.com/sites/ashleystahl/2016/03/04/heres-what-burnout-costs-you/#40934a074e05

[6] https://hbr.org/2017/06/burnout-at-work-isnt-just-about-exhaustion-its-also-about-loneliness

[7] https://hbr.org/2017/04/employee-burnout-is-a-problem-with-the-company-not-the-person

[8] ibid

[9] ibid

[10] ibid

[11] ibid

[12] https://www.businessinsider.com/how-stress-at-work-is-costing-employers-300-billion-a-year-2016-6

[13] https://hbr.org/2018/02/1-in-5-highly-engaged-employees-is-at-risk-of-burnout

[14] ibid

[15] https://hbr.org/2018/06/how-are-you-protecting-your-high-performers-from-burnout

[16] ibid

[17] http://open.lib.umn.edu/humanresourcemanagement/chapter/7-1-the-costs-of-turnover/

[18] https://hbr.org/2018/02/1-in-5-highly-engaged-employees-is-at-risk-of-burnout

Being a paramedic during the formative years of my working life, I’ve been surprised at how many of the lessons that I learned on the job have translated to the business world.

EMS can be a dangerous profession; more EMS workers are killed per year than firefighters.[1] One study showed that 2/3 reported some form of abuse on the job in the previous year.[2] In my time in the field, I was hurt several times, got stitches once, was in a number of physical altercations with people that were abusing alcohol or drugs, and pulled weapons off of several patients. I had friends that were hurt in ambulance wrecks and associates killed in helicopter crashes.

Ingrained from the first day of EMT school is scene safety. In practical exams, proctors will fail you if you fail to address it in your initial approach to the scenario. On the streets it’s considered poor form to strain the system by taking your rig out of service, especially if you’re adding to the patient count on a scene. While we couldn’t anticipate every threat, situational awareness combined with active threat mitigation meant that most of the time we were ready for what was waiting for us.

In business, safety should also be front-of-mind. In addition to concerns about physical safety, IT security is a consistent failure point. Lessons from others’ failures seem to be lost instead of learning points. Even at an average cost of over $7m per data breach in 2017, we see continued failures to invest in the necessary mechanisms to create a secure data environment.[3] Whether it’s outdated, unpatched, or inadequate infrastructure, policy design or enforcement failures, or the continuing challenge of employee irresponsibility, inadequate data security will continue to be an existential risk for many businesses. In fact, 60% of small- and medium-sized businesses (the primary target of attacks) that suffer a cybersecurity attack will fail after 6 months.[4]

We the employees are the weakest brick in the cybersecurity wall – from the front-line workers through the C-Suite, we all contribute to an unsecure environment. 95% of incidents are a result of mistakes made by people with system access.[5] Poor training is clearly part of the issue. People are still clicking links they don’t recognize, opening PDFs and other files from people they don’t know, and providing data over the phone. Something as simple as password management is still a major problem – 80% of breaches resulted from password issues.[6] However, there’s evidence that the problem is more a result of policies that drive password-defeating behavior like post-its on monitors rather than actual password strength issues.[7] The major breaches have resulted from phishing attacks, not password breaches.[8]

If business leadership wants to prevent their business from being the next victim in the hurricane of data and security breaches, dedication and investment in security must be a committed focus from the C-suite. When security is left to a position of unfunded lip service, a costly and potentially business-ending breach may be more an eventuality than a risk.

[1] https://www.jems.com/articles/print/volume-36/issue-11/health-and-safety/studies-show-dangers-working-ems.html?c=1

[2] https://io9.gizmodo.com/5872364/the-hidden-dangers-of-being-a-paramedic

[3] https://www.businessinsider.com/sc/data-breaches-cost-us-businesses-7-million-2017-4

[4] https://www.inc.com/thomas-koulopoulos/the-biggest-risk-to-your-business-cant-be-eliminated-heres-how-you-can-survive-i.html

[5] https://hbr.org/2015/07/why-cybersecurity-is-so-difficult-to-get-right

[6] https://www2.trustwave.com/GlobalSecurityReport.html

[7] https://arstechnica.com/information-technology/2011/10/when-passwords-attack-the-problem-with-aggressive-password-policies/

[8] ibid

Being a paramedic during the formative years of my working life, I’ve been surprised at how many of the lessons that I learned on the job have translated to the business world.

Paperwork is perhaps universally a dirty word among those who have to do it. I have many a fond memory of sitting scrunched down in the passenger seat of an ambulance, racing to the next call, with the big metal clipboard on my lap and my pen flying as I tried to get my reports done from the last few calls before I blend all the details in my memory. The trip sheets were legal sized, printed in 8-point font, and crammed from top to bottom with required fields; and don’t forget to press hard to get all 3 copies!

While the hand cramps from hours of writing weren’t my favorite, I had been trained well about the necessity of good documentation. Without cameras in our mobile phones (I had been working in EMS for four years before a mobile phone was even a consideration), the only record of what happened on a scene and in the ambulance was what we wrote down. We had to make sure that we documented everything from what we found at the scene, what the patient said, and anything else that affected our call. We had to demonstrate that we had performed a head-to-toe physical assessment on every patient, and then document the care we provided, the impact it had, and our management of the call from beginning to end. This had to be done in enough detail such that if there were a legal question years later we would be able to testify accurately.

This training has continued to serve me as my career has grown over the last few decades. While I can’t remember the last time that I touched a carbonless triplicate form, I spend a lot of time ensuring that process, policy, procedure, and perspective have been documented appropriately and effectively. I have done this for my own jobs where I have been a potential single point of failure and I wanted to ensure that the company was covered. As a consultant, I have worked with clients to review and evaluate how they do what they do, document it, and refine those processes into best practices.

Documenting process, including demonstrating strong internal controls can reduce the scope of evaluation by external audit for SOX compliance, ultimately reducing costs.[1] As processes are reviewed and documented, gaps in what should be done vs. what is actually happening start being identified. When we start closing those gaps, we can substantially alleviate risks to the business.[2] And, by engaging workers to develop documentation of not just what is, but what should be the way work is done, best practices can be developed that are specific to a business while institutional knowledge is preserved.[3] This documentation of the mandatory, the recommended, and the discretionary createa a robust array of information about how and why different things are done, and what flexibility each individual has within the organization.[4]

My shift in understanding about the need for documentation from protection to proactive opportunity-finding has been an important maturation as I’ve learned about business. While it is important to provide that layer of protection that good organizational documentation provides, leaders should also leverage their employees and engage them to use the documentation process to reinforce a culture of improvement.

[1] https://hbr.org/2006/04/the-unexpected-benefits-of-sarbanes-oxley

[2] ibid

[3] https://hbr.org/2013/05/define-your-organizations-habi

[4] ibid

Being a paramedic during the formative years of my working life, I’ve been surprised at how many of the lessons that I learned on the job have translated to the business world.

Being a paramedic is a surprisingly boring job. There can be a ton of downtime (a running joke was that EMS stood for Earn Money Sleeping) and many of the calls that we ran on were essentially routine for us. While the experience started as terrifying and painful for the people we served, we used our skills to alleviate physical and emotional suffering as best we could. Much of this was accomplished by establishing that we were in control of the situation and letting everyone know that we were going to make things better. Then there were the tough ones – chaotic, out of control, violent, overwhelming scenes with too much happening all at once. When we would arrive, we had to be the ones that were in charge and that were going to provide the relief, no matter how bad everything was. Even if we were terrified on the inside, our demeanor had to remain calm, composed, and reassuring.

In business, we hope to never see these kinds of life-threatening emergencies, but we do have plenty of situations that feel like one. Whether it’s a project that goes sideways or a fiscal problem that creates a need for job losses, the people impacted will have the same kinds of physiological stress responses.[1]

When the brain is under this kind of stress, our ability to make good decisions is drastically reduced. We are all familiar with the “fight or flight” response that comes with adrenaline, but there are additional compromises that can result. Our thinking, in order to try to make us feel safe, drops into a state of confidence in our own correctness and others’ failure despite the reality of our own mistakes that have contributed to the situation.[2] Our memory becomes much less reliable, both for active use and the ability to recall after the event.[3]

To reduce stress and ensure that the business continues to operate effectively, leadership must work to create that sense of calm and control in others that paramedics do. Research has clearly shown that it is leaders who are capable of empathy and compassion that create the largest single factor for productivity and profitability in a business.[4] Employees of those organizations that have invested in the emotional well-being of their employees are markedly more productive, with a large ROI on that investment that is seen at the micro and macro level.[5] So, a company that seeks the greatest chance for success must cultivate within its ranks a culture of empathetic, compassionate leaders that are effective at reducing the acute stresses associated with work, so that those employees can focus instead on the work in front of them in a healthy and supportive environment. The old paradigm that created hostile, stressful environments has been shown to be much less successful.

[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4809001/

[2] https://hbr.org/2015/12/calming-your-brain-during-conflict

[3] ibid

[4] https://hbr.org/2016/01/help-your-team-manage-stress-anxiety-and-burnout

[5] Ibid

Being a paramedic during the formative years of my working life, I’ve been surprised at how many of the lessons that I learned on the job have translated to the business world.

An encounter with EMS is generally a life-changing one. The actions of the various teammates across agencies can make a profound impression. In the chaos of an emergency, the need to be brief and direct can come off poorly, and people can walk away with a negative impression. Plus, grind towards burnout that many EMS workers face can lead towards a reduced focus on the softer skills with patients and inter-agency. These bad impressions can result in lost business as resentment builds. As paramedics, we were constantly reminded that we effectively drove giant billboards and that we were under scrutiny every time we interacted with anyone while we were in uniform. As one of my reminders to provide not just the best medical care, but to provide it with empathy and kindness, one rule I set for myself was that every patient got a pillow and a blanket (unless medical necessity prevented, of course). That little touch made a huge difference in how my care was perceived.

Customer service is an issue affecting businesses across the country. Complaints are climbing, negative experiences are more frequent, and sales are suffering – in 2014 the estimated loss in business was $41B.[1] Customers are willing to cut ties with a brand over a single bad experience, whether online or physical.[2] Most purchases are made based on customer perception of the experience, and more than half is willing to pay more for good customer experience.[3]

Yet, for so many businesses, the trend is away from providing excellent service. With the never-ending focus on cutting costs, the things that differentiate a business and make its customers want to buy from them are removed in the name of savings. The fallacious belief that there is an endless supply of customers waiting to purchase a product or service helps to facilitate these decisions to cut costs.[4] The smart business owner must ask her/himself: have I really cut costs when I’ve lost a customer as a result?

If we believe the research that indicates that it’s 5-25 times costlier to acquire a customer than to keep one, and that a 5% increase in customer retention rates results in profit increases of 25-95%, we begin to understand how much those cost-cutting measures must really save to have a positive ROI.[5] Obviously, business efficiency is important – nobody would argue otherwise. However, simply cutting what are perceived as extraneous costs without a real evaluation of the impacts to customer service can result in a significant negative impact on the business in the longer term. Sometimes it’s better to spend a little on that pillow and blanket – they’re extra costs, but the return is substantial.

[1] https://www.salesforce.com/blog/2016/06/essential-customer-service-skills.html

[2] ibid

[3] ibid

[4] https://www.forbes.com/sites/micahsolomon/2015/02/26/has-your-customer-service-gotten-worse-as-your-business-has-grown-heres-why-and-how-to-fix-it/#3d6068634dc4

[5] https://hbr.org/2014/10/the-value-of-keeping-the-right-customers