How to Diagnose Complacency
Complacency is both a sneaky and insidious process. It functions much like a bacteria, since there is no immediate indication that complacency has taken root and is beginning to spread. As such, one doesn’t even recognize that they have become infected because initially, like any disease process, there are no signs or symptoms. Unfortunately, once the observable changes begin to occur, complacency has gotten a solid and potentially permanent foothold.
In the early stages, the behavioral changes are small and may be easily missed or ignored. For example, instead of showing up 15 or 20 minutes early for shift change as has been the pattern in the past, now it’s right on the money or maybe even a few minutes late. You may also notice changes in hygiene and attire. Where once upon a time every shift kicked off with a nice, crisp uniform shirt, now that same shirt goes on a hanger and will get worn two or three shifts unless someone complains.
At some point, you can’t help but notice that your partner’s rig checks that used to take a half hour now take just a couple of minutes, leaving no doubt in your mind that the task is not getting done properly.
As the level of complacency worsens, expect to see a fog of indifference slowly but surely envelop the provider. If it hasn’t already started, expect the complaints about having to run calls to go from every now and then to pretty much every call. At some point, every patient becomes stupid and every call becomes a waste of time, as it is clear that these patients just don’t understand that they are not being respectful to a life-saver of such incredible potential.
At some point the deterioration in practice will become glaring, often manifesting in things like fabricating vital signs, not bothering to take the time to read transfer paperwork, etc. It is critical to recognize that where, initially, issues were small and seemingly innocuous, the changes you are now seeing have more far-reaching implications.
For example, the made up vitals signs that were added to the patient care report might easily make the ED staff think the patient is more stable than the vital signs indicate, and as a result there might be a significant delay in care that allows the patient’s condition to deteriorate. In the worst case scenario, the patient might actually die.
Choosing to ignore the transfer paperwork might easily result in a nasty situation such as a MRSA patient being moved to the rig (it’s now contaminated) and every member of the EMS team being exposed to this dangerous infectious disease process. At this level of complacency, the actions of the provider, or in some cases the inactions of the provider, can clearly impact the well being of not just those members of the immediate EMS team but potentially any member of the squad.
The end point of complacency is often heralded at some point with a comment like: “You know, I just don’t care anymore. No, I am still doing my job. I just don’t care.” Irrespective of what the person making that comment actually believes, if they truly don’t care then there is no way that they are putting anything close to 100% commitment into their medicine. Ask yourself if it is even possible that someone who truly doesn’t care could actually provide competent, compassionate care to another human being. Once you think about it, the outcome is glaring and staring you in the face: if a provider doesn’t care, then they aren’t providing care. They are just going through the motions.
It should be clear that once this process starts, it usually doesn’t end until some sort of catastrophe occurs, either in patient care or with an event that impacts the EMS team and/or the squad. If there is any hope of the situation turning around, it will ultimately involve some sort of intervention, ideally at the grassroots level, but more likely at an administrative level. That being said, the solution lies with the complacent provider. If there is no real motivation or incentive to change, then nothing of significance will ever change. The only hope is the complacent provider will change professions before he hurts too many patients or causes harm to come to the EMS team.
Ignoring the problem or assuming that it will magically self-correct borders somewhere between denial or an unhealthy fantasy life. If you start to see these type changes in a fellow provider, make the time to talk with them about what you are observing. Also recognize that the sooner intervention occurs the better, lest patients and crew members alike get impacted by this insidious process.
Until next month…
Mike Smith, BS, MICP, is director of clinical education and lead instructor for the Emergency Medical & Health Services program at Tacoma Community College in Tacoma, WA, and a member of the EMS World editorial advisory board.
