Workforce Engagement Survey Results, Part 1 - Intro & Vehicle Shuttling

I'd like to provide some feedback to you about the Workforce Engagement Survey we ran on May 21st. This article will be the first of three installments.  In this one, I'll provide some overview information, and then I'll summarize what we learned about Vehicle Shuttling.


Why this survey?

I published the survey to all current members of Virginia Beach EMS.  The goal of the survey was to establish baseline measurements in three topic areas:
  1. Vehicle shuttling, because this is in my Division's area of responsibility
  2. Quality management, because this is also in my Division's area of responsibility
  3. Fatigue, because assessment of provider fatigue is now a national-level recommendation that we want to comply with
We anticipate repeating the survey about every six months.  The data we get from the responses will help guide our ongoing process improvement efforts.

The breakdown of invitations was as follows:

Here's the breakdown of responses:

The breakdown of individual people who completed the survey was:


Encouraging results?

The data showed that when members are asked to move a vehicle to or from the city garage, they overwhelmingly (96%) do it.  That struck me as a very encouraging rate of cooperation, and it's about the same whether volunteer or career.


Or selection bias?

But surveys like this are prone to a problem called "selection bias".  That's when the answers to the survey are not representative of the group as a whole.

For example, among volunteer members, 67% said they were asked to move a vehicle to or from the city garage in the past six months.  Extrapolating this percentage to a system with approximately 1006 volunteers, we'd see that 674 different volunteers had been asked, and at a cooperation rate of 96%, 647 different volunteers actually moved a vehicle in six months time.

Although this is possible, I find it highly unlikely.  I strongly suspect that a small core group of volunteers do most of the vehicle shuttling, apart from when we enlist duty crews for this chore.  Several Squad Fleet Coordinators have told me as much, bluntly.

(About 94% of career members had been asked to move a vehicle, and they complied 100% of the time.  No surprises here since compliance is mandatory and they're moving units while they're on the clock.)

The following statement earned the following average score:
 "I AM SATISFIED with the way EMS vehicles get moved to and from the city garage."

If we actually have managed to spread the shuttling chore across so many members with such high cooperation, never unfairly burdening the same people over and over again, then what's not to be satisfied about?

I suspect that a lot of people who really do shuttle vehicles responded to the survey -- and a lot of people who don't shuttle vehicles did not respond to the survey.  So the answers are not representative of the group as a whole.  Selection bias.



The following statement earned the following average score:

"I FEEL ENGAGED in the effort to get EMS vehicles the preventive maintenance and repairs that they are supposed to get at the city garage."

Coincidentally, the "engaged" score was the same as the "satisfied" score.  The most popular answer to the "engaged" statement was "Somewhat".  The next most popular answer was "Not at all", and those two responses accounted for the majority.

I find this a bit disappointing, and have some thoughts about the cause, but I think the wise thing to do is to sit back and see if this grade changes over time.

The feeling of engagement tended to be lower among volunteers and higher among career members.  The opposite was true for satisfaction.


What next?

To confirm and overcome (or disprove) the selection bias, we would have to choose a different way of sampling answers from the group as a whole.  One technique might be to randomly go get the answers we need by visiting unsuspecting duty crews, instead of waiting for the answers to come to us online.  But this would be very time and manpower intensive.

Instead, I'll just make this request:
Please tell me (by reply email) what's preventing you from feeling "very much" satisfied and engaged with the way EMS vehicles get moved to and from the city garage.
Maybe you can suggest some interventions we can try before measuring these things again.


Where the rubber meets the road

Tires, wheels, the Holland Road Annex, and more

The following information was prompted by the May 9th Fleet Council meeting.


The city garage only installs tires that meet or exceed factory specifications.  They never install retreads.  On emergency vehicles, they never plug, patch, or otherwise repair a tire; damaged tires are always replaced with new tires.

Recently, an image was circulating that purported to show a retreaded tire on one of our ambulances. On closer inspection, it became evident that this was actually a picture of an unmodified Firestone Transforce HT All-Season Radial tire with underinflation damage.  It was not a retreaded tire.


For the past couple of years, the fact that vanity wheel covers can hide critical wheel mounting danger and damage has gotten a lot of attention.  Recently, an ambulance arrived at the city garage with one lug nut and stud completely missing, another lug nut and stud completely detached and rolling around inside the vanity cover, and a third stud cracked.  This kind of damage can be caused by failure to torque the lug nuts properly, but it can also be caused by collisions between the wheel and curbs or other obstacles.  As I've mentioned before, I was in an ambulance years ago when the ambulance suddenly tilted towards one corner, and the right rear pair of wheels rolled past us on the interstate as we scraped our way to a stop.

This explains why the city garage has been phasing out the vanity wheel covers across all departments.  They've also been adding position indicators to the lug nuts to provide another visual warning in case something is amiss.

Last Spring the news arrived that aftermarket alloy wheels and installation kits from Alcoa had become available for the Ford E-450 and Chevy G4500 (standard duty) chassis.  Among the many advantages of alloy wheels, they are designed to be attractive without vanity covers.  They are finished as brushed aluminum, unpainted.  They allow direct visualization of the critical lug nuts, so they're safer.

The Alcoa wheels do not void any warranties.  In fact, they are offered as an option on some versions of the above-mentioned chassis.  Nevertheless, at least one "upfitter" company has decided not to install aftermarket wheels for fear of losing its status as a Ford Qualified Vehicle Modifier because the vehicles did not attain their emissions ratings using this combination.  There is no prohibition against having aftermarket wheels installed elsewhere, however, and other Ford QVMs (including local Ford dealers) do in fact install these wheels when asked.

In our case, the city garage is willing to install the Alcoa wheels, and doing so will not affect the city's willingness to maintain the vehicles or to provide liability and loss insurance.

Holland Road Annex

Several of you are aware that some automotive services can be provided by the Public Works Waste Management facility at 3024 Holland Road.  This may be especially useful between the hours of 16:30 and 23:30.

When reconciled with city garage policies, the services that the Holland Road annex can legitimately provide are limited to:
  • replacing burned-out headlights and lightbulbs
  • replacing wiper blades
  • topping off washer fluid
Otherwise the unit should go to the city garage.   Given that the city garage's policy is to replace -- never to repair -- damaged tires on emergency vehicles, there is no benefit to getting any tire work done at the Holland Road annex, nor should a unit stay in service if it needs any other fluid topped off (except fuel and DEF, which crews can do themselves at the city fuel facilities).

Loaning ambulances

Squads that have preferences regarding which ambulances to loan to other squads can set things up for success by taking advantage of the Deployment guidance field in OscarTRACK.  We will be advising field supervisors to look for indications like "Loaner 1", "Loaner 2", etc, when they have to make an unexpected borrow-loan arrangement to meet operational demands.


Gear accountability

Knowing how our gear moves around is at least half the battle


For the second time in the past year, one of our members went looking for an IV box and a drug box that were supposed to be in secure storage, and found them missing.  Notifications were made, searches were conducted, the police were called, reports were filed, and a general sense of anxiety prevailed.  This is a big deal.  We were required to notify state authorities.  It damages our reputation and could have other far-reaching consequences.

Internal investigation

Part of the problem was that we had no good way to immediately determine the ID numbers of the boxes that were believed to be missing.  In fact, we only knew the IV and drug boxes were there in the first place because we were told so.  There was no tangible evidence available to support the claim.

Addressing a deficiency

The hospitals at least have paper logs where we enter the ID numbers of boxes that we are turning in, and boxes we are taking.  We must duplicate this system in our own storage areas.  And there are other important and expensive things that we typically put into secure storage along with IV and drug boxes.  Whatever logging system we use should take these other items into account too.

A way forward


Consequently, I have received approval to implement a Department-standard Gear Accountability Log system.  Sample materials are attached for your review.  After evaluating any comments you send me, I will place an order for custom-made log books, and we will deliver these log books to you.  The plan is to keep one of these log books in every one of the secure storage cabinets that we use to store IV and drug boxes and other important items.  We will publish materials to train all members how to use the log books and why accurate logging is important.  The expectation will be that every time an IV box, drug box, or other important item moves into or out of the storage area, the person making the move will make a new entry in the log book.  Squads will have to make sure a working pen is available.  The Department will provide replacement log books when one gets filled up.


The trade-off


The process I'm proposing will add a step to the sequence that our members are using to move important gear into and out of storage.  Whereas right now they just "grab and stow" or "grab and go", they will soon have to stop; make a log entry; then continue.  It's a bit of a hassle, but we're not taking this lightly.  Think about the alternative.  Think about losing track of:
  • Controlled substances such as morphine and fentanyl
  • A LifePak 15
  • An EMR
  • A portable radio
  • A LUCAS device
  • A video laryngoscope
Image the hassle that would ensue then. Also, realize that members already do this at the hospital without having a second thought.


Call to action


Please review the attached materials.  The table represents just one page of the log book.  Each log book would have 100 pages.  Please send me your comments as soon as you can.