Risk vs. Benefit Analysis in EMS

Texas EMS Alliance – October 2016

Risk vs. Benefit Analysis

By Jonathan Sell

j-sell-06-20-16Emergency services management is often overwhelmed by attempting to avert or deal with problems by creating and enforcing policy and procedure. By doing so we generally answer the questions of “who, what, when, and where” with a policy, and the question of “how” with a procedure. Unfortunately, this often leaves the question of “why” unanswered and leaves our staff with a long frustrating book of rules, without any of the fundamental understanding as to why those rules are important. By shifting the focus of our leadership to the question of “why” and by incorporating a model that encourages the discussion of why from the top of the organization all the way to the bottom, we can create a culture that has a higher cognitive understanding, and thus, needs fewer rules!

Risk vs. Benefit is the model that I chose to use in my organization. Whenever a question is raised asking why we do (or don’t) do something we analyze the situation using RvB. To do this, we simply draw two columns on a white board, one entitled “Risk,” and the second entitled “Benefits.” We then spend time describing the risks involved, and, if possible, quantifying those risks. While quantifying the risk isn’t always necessary, it does ensure that the result is less biased by anecdote and personal experience. We then repeat the process with the benefits. We then spend some time weighing the two sides, and considering if the action is still wise, or if there are ways to mitigate the risks to make the equation more beneficial. The goal in our organization is that nothing we do (or don’t do) is “untouchable.” Everything can, and should, be considered in the RvB model to see if there are changes we can make to improve our organization and our service to our customers.

Below you will find an example of one of the first times we used RvB with our entire staff, as we addressed the question of the speed and type of responses to a neighboring community. This is an example that will only truly fit our system and our particular variables.

After considering the RvB we determined that the risk of the excessive speed outweighed the potential benefits, and as a service chose not to respond at such a high speed. It is not the purpose of the example to say no one should speed to respond to a call, but rather to give you the tool to consider scenarios in your particular situation. Remember that as variables change, your RvB will change as well. There are countless variable that should be considered for each organizational decision, so don’t be afraid to reassess the RvB every so often to see if the variables have changed to the point that the result should change.

Finally, this is not an upper management exercise. It’s a cultural mentality from top to bottom. My staff members all know that if they break a policy here they will be expected to explain. I will expect them to have considered the RvB and to present their reasoning. My goal is not to regulate my staff into doing things the right way, but it is to change their thought process so they understand why the correct action is correct, and when the “correct” answer needs to be reevaluated. RvB gives me a tool to communicate throughout my organization in a language that we all understand, because we have practiced it as a group on multiple occasions. RvB isn’t the only tool that can be used for this, there are many others. Whichever you choose, make it a part of your culture by actively using it on a regular basis with everyone in your organization.

Jonathan Sell is the director of Booker EMS in Booker, Texas and the president of Innovative Solutions Management. He can be reached at Director@bookerems.com. The article’s content was taken from a presentation made by Mr. Sell at EMS EVOLUTION 2016 in June 2016.