Fire/EMS Merger: An Examination of Cultural Differences
BY PHILIP B. WEISS, BS, AAS, EMT/P
Hardly a week passes that the Wall Street Journal isn`t reporting some unification of firms. Generally these mergers are fueled by a desire for bigger market share, less competition, and ultimately larger profits. Collaterally, combining the back office lowers operating expenses. It was this aspect that intrigued city managers. Besides overlapping services, every department might have a payroll unit, a records unit, supply and support units, and so on. Consolidating agencies in a government could reduce costly redundancies; the savings might then be returned to the public by improving service or lowering taxes. So, the public sector jumped on the merger bandwagon, and municipalities began to combine departments.
A few years after this merger mania struck, problems began to arise in the newly consolidated companies. Gurus from the classic business disciplines (management, finance, economics, and so on) tried to figure out why. They noticed that even when companies in the same field entered a friendly merger, productivity and profits often declined.
Social scientists also examined the problem. They observed that two companies providing the same service to the same customer base might have drastically different ways of achieving that goal. Researchers postulated that perhaps the clash of the internal operating environments was to blame. Every company or governmental agency will have a unique approach to its job. There will be written policies and regulations to mediate the daily workload, and there will also be an unwritten code of conduct. These elements combine to form the organizational culture or milieu of the agency.
THE CASE STUDY
True bilateral mergers are rare in the public and private sectors. Usually one unit will take the lead role. The assertion of one organization over another can cause undue strife. Using the lessons learned in the private sector, this case study examines the pitfalls of a merger between a fire and an emergency medical service (EMS) in New York City. First, it must be understood that fire protection and EMS are adjacent industries. Adjacent industries provide different services to the same clients under similar but not identical circumstances. The merger of adjacent companies is called a “concentric merger.”
The merger of these two agencies could best be described as the sale of a subsidiary. It is important to keep this analogy in mind. The Health Department handed complete control of EMS over to the fire department. The managers approached the acquisition as though they had just made a grandious purchase. Culture is a set of assumptions, beliefs, values, and norms distinct to a specific group. It is visible in the symbols and traditions the culture holds dear. These artifacts become the boundaries behind which the culture and its members feel secure.1 Threats to the boundary and fear of what lies beyond it can cause a normally passive culture to become violently aggressive. Members may cling to insignificant or even distasteful practices to preserve their society. (1) Ignoring the milieu of an acquired company is considered by scholars to be a major reason mergers fail.2
CONDITIONS BEFORE THE MERGER
In this city, paid fire and ambulance service began at approximately the same time. The fire department grew out of volunteer roots and was organized with a paramilitary structure. There were problems with the transition from volunteer to paid firefighters, but the problems were handled, and the department was allowed to develop. By contrast, emergency ambulance service was provided by hospitals, several of which were city-owned. Each had its own ambulance service with little or no coordination existing. Dispatching was handled by the police department via telegraph and telephone. Attempts to develop a system with controls were largely unsuccessful. Finally after a century of disorganization, the emergency ambulance became a unified system. Under pressure from city hall, the city`s Health Department consolidated all municipal ambulances into a semi-autonomous unit. After this step, the Health Department took a laissez-faire approach and allowed the EMS unit to develop. Over the next 30 years, the EMS unit grew, and a unique and strong culture evolved. Knowing the merger was imminent, the fire department began to train firefighters in cardiopulmonary resuscitation (CPR). Engine companies were assigned limited EMS response as ancillary duties. Later this grew into a first-responder initiative, as firefighters were trained as defibrillation-capable certified first responders (CFR-D). CFR-D engine companies now respond on all high-priority assignments.
THE FIRE CULTURE: TEAMWORK AND DEPENDENCY
This fire department has a typical fire service culture. It acknowledges and supports the team effort required to do a dangerous job. The core of all fire departments is the unique work group called a “company.” The complement of its basic work unit is 19 to 25 firefighters, plus a captain and three lieutenants. One officer works with five firefighters at any time.
A firefighter`s company can be viewed as an extension of his family. Assumptions spring from this environment. The fire officer takes a parental role in the company/family. It is his job to keep the company/family together, get the job done, and not expose them to undue peril. It is the firefighters` job to help in the company/family`s endeavors. All do their part to put out the fire and keep the company/family intact. Anything that builds team unity and esprit d`corps is encouraged. Everything is done as a company. Firefighters eat, sleep, and work together. Company outings involving the entire company are condoned and supported by the department. Operational logic may be behind keeping the company together, but it yields greater rewards. It creates a more cohesive team.
The beliefs of this fire service are grounded on these assumptions. The department believes each firefighter will do his part in the team/company/family. The department and company believe company officers are competent leaders and excellent firefighters. This principle continues throughout the hierarchy. Each level presumes the next level is more qualified and therefore has the right to lead. Superiors believe their subordinates will do their job, and the subordinates believe the leaders will take care of them. The result is faith in and obedience to the chain of command.
Values in this fire department surround the nature of the work and the company. Strength, courage, and loyalty are expected. Members who embody these attributes are the most revered in the department. Firefighters who cannot live up to the minimum standards of these norms will not be accepted into the company, regardless of how well liked they are. Discipline in this fire department is also based on the team. Each individual wants to be needed and desired by the company; therefore, compliance with the rules and regulations is accomplished through peer pressure. It is rare that a firefighter will be formally punished for infractions.
The literature on organizational culture describes this type of milieu as constructive, leaning toward being passively defensive. The norms displayed by the fire department are supportive–recognizing membership achievements, the family-like environment, and setting humanistic achievable goals. However, this leads to dependency and makes the fire department resistant to change. It actively courts the media and public for approval and avoids confrontation, posturing only when threatened.3
EMS` CULTURE: COMPLEMENTARY AND
EMS also has work and work style at the root of its cultural assumptions. However, the operational dynamic is different, so the basic assumption is likewise different. Independence is the fundamental assumption of the EMS culture. Members of this service may be coupled with anybody, including EMTs whose skills need improvement. Therefore, they are trained to think and act independently. Teamwork is not important! A unit consists of three equally trained members, two of whom are working each tour. Partners spend two or three days a week working together. This partnership becomes a marriage–just like spouses, the dominant and submissive roles will flip-flop. During a specific incident, one partner will lead and the other follow. This partnership/marriage is the basis of EMS beliefs. Partners are equal in the eyes of the service, holding joint responsibility for patient care. This equality lends itself to less formal and more complementary relationships. Medics complement EMTs, partners complement each other, and supervisors complement subordinates. Each is expected to pick up what the other misses. In turn, each believes he will stand for the others in the same manner as a husband stands for his wife. The values in this EMS reflect these beliefs. Personality, skill, and fidelity are prized. Personality is extremely important. EMTs must be able to get along with their partners during periods of inactivity. Members are expected to be able to work with anyone and consider themselves lucky to have two good partners. Just like in a marriage, infidelity is the greatest sin one can commit. EMS personnel differentiate between a good EMT and a good partner. “Ratting out” a partner, even for gross incompetence, may have drastic consequences. Good partners are faithful.
Another element of this EMS milieu is a unique dual hierarchy. The service maintains the following administrative ranking: EMT and paramedic, lieutenant, captain, and chief, but it is subservient to the medical authority: EMT, paramedic, physician. The two hierarchies are independent, so it is possible for an EMT-lieutenant to supervise paramedics. This presented its own problems.
The nature of the EMTs and paramedics` work demands that they be aggressively independent. They are specifically trained to challenge authority to benefit their patients. EMS dealt with this incongruity by removing supervision from patient care duties. EMS supervisors served as evaluators, facilitators, and objective decision makers. Suspected patient care problems are referred to higher medical authorities.
Medical-legal considerations also impact on the EMS milieu. Evolving under the dictum “If it`s not down in writing, it didn`t happen,” documentation of actions and infractions is normal. Furthermore, supervisors who reported an infraction in writing needed to state the corrective or disciplinary action they took. The deterrent nature of punishment is how the organization maintained compliance and order.
The milieu of this EMS would be defined as aggressively defensive. Because of the EMTs` independence, the service is oppositional and characterized by an adversarial relationship between line personnel and supervision. Advancement above the rank of captain was attained through internal politics. Competition for off-the-line positions was keen, and back-stabbing among employees was uncommon. The general attitude was perfection. Although procedures and treatment protocols are meant as guides, members were routinely punished for personal interpretation. (3) Even two years after the merger, many of these attitudes still persist.
COMBINING THE CULTURES
Concentric mergers of adjacent industries like EMS and fire services should present only minor problems. Generally, they are limited to industry-specific expertise crossing the corporate border. Research suggests two strategies to consolidate concentric organizations: assimilation, in which the acquired agency is indoctrinated into the ways of the merging department, and integration, which allows for the equal flow of culture across traditional boundaries. The research also suggests stronger cultures will tend to resist assimilation and therefore should be integrated. Despite the apparent strength of the EMS culture, the fire department began an assimilation process.
Essentially, little changed for the average firefighters. Their job was enlarged to include tasks they don`t want, but the primary mission and structure of their agency remains. The fire company and the culture remain essentially unchanged.
On the EMS side of the fence, the situation is drastically different. The fire department reorganized the existing EMS hierarchy and placed a fire chief in charge of the new EMS Bureau. Members were directed to replace the EMS patch on their uniforms with newly issued fire department emblems. Likewise, the department repainted all the EMS ambulances and support vehicles, eliminating all links with the previous agency. The legends “Emergency Medical Service” and “EMS” were eliminated and replaced with fire department identification. This was met with only token resistance.
The first real problems arose when EMS personnel were issued firefighter-style uniforms. This caused a major rift between EMS and firefighting personnel. Uniforms are the most visible and tangible artifacts of each unit`s culture. Putting EMS members in firefighter uniforms blurs the differences and threatens both agencies` boundaries. Firefighters claim EMSers haven`t earned the right to wear the uniform, whereas EMS members complain about losing their identity and being swallowed up by the fire department.
The EMS deployment strategy paralleled the police model of precincts and sectors. Each unit had a primary response area. The unit would leave a central station and travel to an intersection in that area. It would then respond to assignments from that staging point. This strategy is called “on-the-street” staging and was developed by the same city administration that consolidated the hospital ambulance services.4 Alphanumeric unit designations were specific and EMT-proof. They reflected the area and care level: region of the city (first digit), area in that region (second digit), and care level (letter). Dispatchers and units instantly knew if someone was traveling a distance.
The fire department began to recreate the EMS structure in its own likeness. Under EMS, there were five regional commands, which coincided with the political subdivisions of the city. These regions were abandoned in favor of eight EMS divisions that were co-terminal with the fire divisions. The greatest impact came with the implementation of the fire department deployment strategy. Fire department management was convinced that paramedics would be better used in nontransport, quick-response vehicles instead of ambulances. These paramedic response units (PRU) would respond with a basic life support (BLS) ambulance. If the patient needed advanced life support (ALS) care, paramedics were there. If ALS was not needed, the PRU could return to service quickly. The belief was that since the paramedics can`t transport, they wouldn`t be tied up when they weren`t needed. The fire department also believed EMS supervisors couldn`t adequately oversee personnel. Before the merger, a boss at each station ensured units were in service and kept station records. Another officer was on field duty to provide direct on-scene supervision. The fire department`s new idea was to partner paramedic supervisors with paramedics and have them respond in supervisory PRUs to provide patient care and supervision.
The anthropomorphizing of EMS continued. On-the-street staging was replaced with a fire department-style, company-based deployment. Under the new model, ambulances would be grouped together in a pod of five, each with four BLS ambulances and an APRU–a supervisory paramedic response unit. From this “ambulance battalion,” BLS units would be dispatched on a “first-in, first-out” basis. PRUs would respond to provide ALS care. APRUs could respond to provide ALS care and supervision.
Units were redesignated by battalion number. Medic or ambulance prefixes and ordinal number suffixes indicated the level of care and the specific unit (e.g., Ambulance 123 is the third BLS ambulance in the battalion). This was the final step in EMS` assimilation.
IMPACT AND PROBLEMS
Changing the deployment model had a devastating effect. Its impact on morale was dramatic and palpable. EMSers had their entire world ripped from them. Since the fire department believed the battalion model was right, it effectively told EMS that its way was wrong and that it didn`t know what it was doing. Response time increased immediately. Management attributed the problem to unit spacing and dispatch algorithms.
Even after those issues were addressed, morale continued to plummet, and response times continued to rise. The fire department believed that the EMSers would welcome being part of the department. Perhaps they would, but nobody in EMS feels they are members of the department. Instead, they feel they are unwanted stepchildren. The subordinate status of EMS and its personnel was constantly reinforced. Firefighters are “uniformed” members of the department. Everyone else working for the department is a civilian employee. Although there are legal differences between the categories, for the most part, the terms distinguish between line and staff personnel. Prior to the merger, EMS used the same terms for the same reason. Now they found themselves in the same class as the fire department`s janitors.
Furthermore, although the EMS uniform is similar to the firefighter uniform, there are differences. Embroidered on the back of the EMS work uniform is “EMT” or “Paramedic” in large, bold letters. Firefighters do not wear a similar “Firefighter” brand. Dress uniforms, optional under EMS, have been issued under the fire department. However, they, too, reinforce the subordination of EMS. Fire chiefs wear a white hat with their dress uniform. EMS chiefs wear a blue hat with a black cloth band. (The volunteer fire service generally uses this hat to symbolize past service as an officer.)
What was retained from EMS is the Machiavellian approach to discipline. Even with a new “kinder, gentler” system setup, the attitude of EMS supervision and administration remains contentious. When something happens, someone has to be punished. Under the new discipline/punishment system, a commanding officer can fine an employee without having to file departmental charges. It is obvious that granting this kind of authority to adversarial supervisors can lead to abuse.
APATHY IS CONTAGIOUS
Fire department managers never addressed the lack of enthusiasm in the EMS bureau. Broken promises were abundant, further fueling EMS` depression. The fire department planned to build more than 50 new ambulance houses to decompress the 15 EMS stations. Although there has been some rehabilitation of old firehouses and abandoned hospital property, no new construction has begun.
EMTs who had the gumption to earn paramedic certification outside the service were promised upgrades, and the fire department pledged to have at least one paramedic class each year for those who wished to go at the city`s expense. No upgrades occurred, and the service held only one class. Instead, paramedics from outside the service were hired. Energetic, eager members were reduced to mediocrity, and mediocre employees sought ways to avoid work.
ENTHUSIASM IS CONTAGIOUS, TOO
Morale was at an all-time low, and productivity suffered. Six months after the new model was initiated, the fire department eased off. Control of the EMS bureau was given back to EMS chiefs. They immediately restored the regional command structure and returned to on-the-street staging. They also put paramedics back in ambulances and supervisors back supervising. The result of returning to their own familiar culture was amazing. Within a month, response time dropped two minutes. Morale picked up, and members began to discuss the future of the service again.
Operationally, fire department managers acknowledged that the old EMS system worked. It needed a tune-up, not an overhaul. To its credit, the fire department`s actions shook loose much of EMS` deadwood. Those now at the helm have a clearer vision.
Now, if the goal is to merge the two units into a single entity, steps must be taken to truly consolidate the two agencies. Fire department management must be visibly concerned and take proactive steps, such as the following, to take EMS into the fold.
Eliminate the subordination.
–Reduce as much as possible the use of the term “uniformed.”
–Add “FF” or “Firefighter” to the back of fire service uniforms.
–Give EMS officers the same white hats for their dress uniforms as fire officers have for their dress uniforms.
Restore EMS` identity.
–Put “Emergency Medical Service” on EMS vehicles and uniforms. This will increase morale and decrease the tension between the fire and EMS units by recreating the boundaries and will send the message that EMS is a separate, distinct–but equal–part of the fire department.
Reduce cross-cultural tension. Cultural immersion is a proven method of achieving this. EMTs and paramedics should be ordered to ride with fire companies. Likewise, firefighters should be ordered to ride on ambulances. The observations of how the other half lives will reduce the cultural stereotypes and allow an integrated culture to develop organically.
LEARNING FROM OUR MISTAKES
For other fire departments considering adding EMS to it services, examining the problems faced in New York City will prove invaluable. Managers, consider the culture of the organization you are acquiring before the merger occurs. When the two agencies are combined, take care to evaluate the culture of each unit. If the culture of the new acquisition is strong, then let it be. The new parent cannot seek to remake the addition in its own image. The acquisition will not accept it.
Machiavelli recognized the problem centuries ago. He observed that when a prince acquires a free state accustomed to living under its own rule, the best and easiest way to keep it is to allow it to continue ruling itself and to make changes slowly through hand-picked vassals, who will keep it loyal. Repression of a free state often results in rebellion. n
Copyright 1998, Philip B. Weiss, All Rights Reserved
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n PHILIP B. WEISS, BS, AAS, EMT/P, is a lieutenant in the Emergency Medical Service Command, City of New York Fire Department, assigned in the Morrissania section of the South Bronx. A New York City- and New York state-certified paramedic, Weiss has an associate of applied science degree from LaGuardia Community College and a bachelor`s degree in EMS management from the City University of New York. He served as a station delegate for the EMT and Paramedics of Local 2507, A.F.S.C.M.E. at Ambulance Station 34 in East New York, Brooklyn from July 1993 to September 1996. He is continuing research into organizational cultures and their effect on mergers.