Peer-to-Peer Feedback in EMS: the what, the how, and the why.

Peer-to-Peer Feedback in EMS: the what, the how, and the why.

Many academic and historical articles have shown us that the more feedback between individuals within a team, the more likely that team will be successful. Peer-to-peer feedback in EMS has historically been given from a clinical perspective. You will easily find multiple articles speaking about peer reviews for clinical performance, quality improvement for patient care, and quality assurance; however, you see little to no information on the value of peer-to-peer review for your organization when it comes to overall crew performance in non-clinical areas. While the clinical peer review process has proven to be successful, a non-clinical peer review can serve to be just as useful for EMS organizations, and it starts with peer-to-peer feedback.

Paramedics at work with an ambulance Stock Photo - 112594643

When it comes to giving feedback, there are two main parts: praise and criticism. Each of these has particular and separate purposes when developing useful feedback and each of them should be given based off of an individual’s work and behaviors.

Nature of praise in EMS:

The purpose of praise is to help individuals discover what success looks like as defined by the industry, the organization, and as compared to their immediate peers. It communicates openly what is of value and encourages repeated success by highlighting performance.

Contrary to popular belief, praise is not given to help individuals feel good. Its sole purpose is not to lift a provider’s spirits about their performance. Instead, it should be a tool used to foster cooperation between partner, used to enhance patient outcomes, and bolster the interactions between EMS and the definitive healthcare facilities who receive the patients.

Criticism in EMS:

What is commonly referred to as constructive criticism, serves as a platform for helping individuals understand and know what they can do better.  It should highlight the individual or crew effectiveness, while bringing recommendations, in the form of measurable steps, that can be taken to meet the expected standard.

Criticism does not serve as an evaluation of one’s personality or one’s intelligence. It is not an evaluation of factors that one either cannot quickly or cannot possibly change. Critique or rebuke of an individual rarely leads to change in performance, often times it does exactly the opposite resulting in a progression down the emotional and performance spiral so common in this field.

When you think about these factors, their purposes and break them down, you can start to see them as platforms in which people will be able to be more successful within their roles. Effective use of these tools by leadership and peers helps the provider find more success.

Who should be giving feedback?

In EMS it is all too common that it is only the managers and supervisors who are tasked with giving feedback to the field team members. This, in many respects, makes no sense and is an unrealistic expectation in such a diverse industry. Not only does tasking only the managers and supervisors with this process set the organization up for possibly inaccurate information, especially when they may have little to no daily contact with the team members they are supposed to be giving feedback to, but it places an extraordinarily unrealistic and time-consuming process onto them which can be challenging to manage. Tasking only these leaders with the review process historically leads to reviews that are past due, not detailed, based off of third-party information, and somewhat unreliable. Due to the nature of the industry, many times these evaluations are not based on a year-long performance arch, but a series of extremely recent or memorable instances which are not reflective of the overall performance.   

When peers are tasked with providing feedback, it holds much more leverage in the organization. First, there are significantly more peers than there are supervisors or managers within the organization. Second, the competitive nature of EMS providers is a driving factor that motivates teams to be successful, as compared to their peers, either by crew, shift, or statistical measure that is valued by the organization. Now, it is essential to note that the definition of a peer can be quite broad and non-specific, however, allowing peers to give and ask for feedback directly from their peers:

  • Increases productivity
  • Improves peer-to-peer relationships and trust
  • Allows for specific feedback on areas they specifically want to improve on
  • Allows the peers to drive their own development and learning
  • Allows for a non-threatening and in-the-moment regular process
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So how can peer-to-peer feedback be performed in EMS?

One of the main dilemmas faced with the peer-to-peer process in the EMS industry is typically the difficulties in merely making contact with specific team members, especially if your organization runs by system status management. There are a few creative ways you can ensure that multiple team members are being reached and connected with.

Peer-to-Peer Praise in EMS

The Mascot Method:

This method has been performed at multiple larger organizations and has proven to increase engagement. It motivates employees to speak freely in a creative, fun, and different way than they are normally prompted to. Typically it is performed in large team meetings, however, since EMS is so diverse a little creativity is required to make this process fit.

Purchase a stuffed cheetah (or another mascot of your choosing) and select a truck at random. With it, attach a note requesting that the team on board for that day provide feedback about at least two crews directly to that crew with their direct supervisor copied on their email. In the note mention that the cheetah, coined the trauma cheetah or some reasonably similar creative phrase, is their mascot for the week (or shift) and should be turned in at the end of the week (or their shift). This can be repeated multiple times, and the mascots can be changed. You can also ask the crew to pass the mascot along to another team with the note attached and report back to you who they gave it to.

The Peer Bonus Method:

This method may be the most popular method amongst organizations. Develop a program in which if a team member witnesses another team or team member performing remarkably they have the option to email their direct manager (operations manager, etc.) detailing the incident and nominating them for an award. The manager then has 24 hours to reply to that email either in agreement or disagreement after which the recipient of the recognition will receive some reward. Rewards can be in the form of:

  • free lunch on their next shift
  • a monetary incentive on their next paycheck
  • free movie or local event tickets
  • have your vehicle washed/restocked by the supervisor

Peer-to-peer Criticism in EMS

The Personality Assessment

There are various assessments available for organizations to use which look at the personality and behaviors of team members and which provide them with individualized feedback. These assessment tools can not only give your team members an idea of how they are perceived by their peers but can drive a realization within them of how their peers see them and how they can improve. Whether your organization choses Myers-Briggs, DISC, or some other standard, having the team measured, communicating the results and using that as the basis to enhance communication has seen marked improvements across many industries.

Perception is often considered reality, especially within the EMS industry, the awareness of a possibly inaccurate perception can drive a team member to work towards positive changes. It’s important to note that if this method is chosen it should be repeated on a regular schedule, engrained into the organizations culture for continuous evaluation.

The Open Critique Method:

The ability for a team member to critique their peers is vital to obtaining accurate quality reports about team member performance. EMS is often seen as a family therefore crews have been known to hold their fellow crew members opinions to high regard and value the feedback, they receive from them. More often than not, a crew member prefers to hear observations directly from the people that they work with and trust. Remember that critique is not always negative but is an avenue in which one can be given a platform for understanding and knowing what they can do better. Remember, the ultimate goal of any program your organization adopts is to enhance the quality of the service and care provided to the patients and customers.

Setting up a platform in which peers can access would allow them the ability to critique to one another in an open manner and it can be reported on, tracked, and reviewed for any progress that the crew works to make from it. This can be accomplished by setting up an online survey in which the results are sent to the recipient of the critique, or a platform that the employees can access to give their observations directly and immediately. You should promote this platform to your team members as an option available to them and one in which they are free to request a peer to use if they desire feedback.

Advice word cloud concept. Vector illustration Stock Vector - 102634333

Wrapping it all up

The key to peer-to-peer feedback is that it should be seen as a non-punitive and positive change for the organization. It should be promoted as an opportunity to make authentic and real improvements in which team members can translate into multiple areas of their professional and, at times, personal lives. It should be seen as an opportunity to dismantle or side-step your team members’ natural defenses to the evaluation of their performance, allowing the information to be received and properly applied. Team members frequently have a different relationship with their peers than they do with their supervisors and managers. This does not mean that their peer-to-peer relationships are better, or worse than another, but that it is different and, in many cases, since they spend extended amounts of time with one another they can find added value from peer-based feedback.

The promotion of the peer-to-peer feedback program should be focused on raising morale and improving the overall culture of the organization. To avoid bias and unreliable reports it should not be tied to performance evaluations in a monetary sense, it should start with and focus on the good stuff, the positive, and it should be seen by team members as an opportunity to gain value within the organization and within themselves. Remember, this program should not strictly be about giving a team member criticism or praise; it should be about changing your EMS culture into one that is open, accepting, and continuously working towards improvements in all aspects of quality service delivery.

Our goal with this article is to provide you with some of the most common challenges that EMS organizations face when seeking to develop embracive and rich high-performance cultures and to offer practical solutions that will help you overcome them. You now have the tools and techniques that will help you improve your organizations: feedback, performance review, and hiring processes.

Do you need some support while you figure out your next steps? nSightify would love to help you build an inclusive, high-performing culture. Reach out to us to learn how our performance management solution can support your goals!

Sources Used:

https://www.emsworld.com/article/10324718/power-peers

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