Many people think of customer service simply as a consistent order from a fast-food establishment or a waiter or waitress who makes a dining experience exceptional. Have you ever tried to get a large coffee cup from a fast-food company but have it filled only halfway? What you'll find is bewilderment and confusion from a worker who is taught a rigid form of costumer service and is not empowered to meet the customer's need.

Many fire and EMS programs preach customer service. Alan Brunacini established many years ago customer service philosophies based around the fictitious Mrs. Smith. His Essentials of Fire Department Customer Service should be mandatory reading for promotional test and entry-level EMS workers.

But when you ask firefighters and paramedics what their agencies are doing to reinforce those principles, you find little or no formal programs. Most departments have customer service statements, but there's no specific delivery depth.

Lawsuits related to patient refusals and non-transports are going through the ceiling. Often it's not about the medicine. Rather it's because a firefighter or paramedic made someone angry by saying something inappropriate or compromising a person's dignity. An angry customer will tell nine or 10 people. The same person will tell five people if the problem is handled satisfactorily. Some customer service experts say that one-third of the people who have a bad experience will not complain because they see the process as too cumbersome or that management will not take action.

Mike Taigman, a noted writer on quality improvement, has identified a phenomenon among some emergency services providers he describes as “a patient must qualify to qualify for assistance from emergency services.” This has pre-hospital providers minimize or downplay the significance of an EMS customer's needs or situation. It usually takes a significant event for someone to call 911, and it's our job to bring some reasonable or creative solution to the caller's problem, whatever the emergency.

Last year my crew responded to check the welfare of a 78-year-old man. When we arrived, we found a man depressed from a marital separation and a recent diagnosis of prostate cancer. He had no family in town and the burden of his current situation left him disorganized. A veteran and a prideful man, he didn't have the heart to call his family.

Our engine stayed on scene for almost two hours waiting for a representative from a volunteer organization called the Trauma Intervention Program. This is a national organization that provides grief counseling and crisis assistance. It is strictly a volunteer group and receives money from the local fire and police agencies to cover cell phone expenses and operating costs.

While waiting, I took to the phone trying to track down this man's family, making a dozen phone calls to family and friends, finally locating a niece who was close enough to come to his home. The engineer learned that the man had not eaten, so he searched the pantry and refrigerator and made the man dinner. The paramedic gave the man a thorough exam and then helped the firefighter clean up the house and bring in the mail.

What is surprising is what happened after we left the scene. The TIP volunteer wrote a letter nominating the crew for an annual award called the TIP's Heroes of the Heart. The award was to be given at an annual fund-raising dinner at the Four Seasons Hotel. The TIP leadership asked for a representative to attend the banquet and receive the award, but we told them it was a crew effort and that the award needed to be presented to the entire crew.

Our deputy chief of operations planned a ceremony to commemorate the award-winners. The chief approved leave with pay to attend the ceremony and the overtime to fill the vacant crew positions. The department paid $1,500 for a table so that each member could bring a spouse or guest. The instructions were simple: Enjoy yourself, go in Class A or dress uniform, and change clothes if you go out afterwards.

The chief made it a point to acknowledge that the administration of our department created a mission and values statement that is all about customer service, and when someone gets that message and is recognized regionally, it's our responsibility to support and reward that kind of service.

You can't imagine the kind of effect this has on personnel. The tone reinforces the message of servant leadership. Being a recipient of that award and receiving support from chief officers places a new responsibility on the company officer and the crew to uphold those ideals and take it to the next level of service.

Many years ago James O. Page wrote about then-newly published information that indicated Americans rated the fire service 70% or higher as the most reliable government service. Compassion, kindness and service are the real reasons people trust the fire service. Some may say that this service is what the fire service is supposed to do. In fact, this type of leadership reflects the modern quality-improvement techniques promoted in the NHTSA QI program.

We spend about 80% of management activities trying to fix the bad behaviors or problems that account for 10% to 20% of the people. Frequently those people don't get any better at what they are doing, but the union environment often doesn't allow you to separate them from the organization. Imagine the effect you could have if you spent 80% of your time rewarding the right behavior or people who go above and beyond. Those people also usually make up 10% to 20% of the organization. The management science says that those who fall into the average to above-average category of employees will then move toward the rewarded behaviors because everyone likes to be on the winning team.

Recently a small book called The Fred Factor: How Passion in Your Work and Life Can Turn the Ordinary into the Extraordinary by Mark Sanborn topped The New York Times best-seller list. It tells the story of a mailman who, despite the trappings of a large bureaucracy, realized that he had control of the scope and quality of his work on his route. Fred the mailman created what Sanborn calls a personal pocket of excellence. Fred went above and beyond every chance possible to provide excellent customer service to the people on his mail route. It is a simple and fascinating story that has a parallel application to fire and EMS.

As the baby-boomer generation places more significant demands on the health care system, we can expect to answer more calls for service that don't meet the traditional definition of an emergency. Remember that a person on the floor, a cancer patient who needs an oxygen tank changed, or a scared confused senior citizen is an emergency to someone.

The fire service needs to take the next step to develop customer service by applying reward and recognition programs similar to those found in the private sector. Firefighter and EMT textbooks need to incorporate a customer service module. Those who provide excellent internal and external customer service need to be showcased at annual fire and EMS conferences. Accreditation standards need to add employee incentive or reward programs as part of the evaluation process.

The Chief Fire Officer Designation process needs to validate the customer service knowledge of a fire chief. The Commission on Fire Accreditation International's Exceeding Customer Expectations seminar needs to be delivered more regularly. The International Association of Fire Fighters needs to build a template for union contracts that tie reward mechanisms to the quality-improvement model.

More importantly, the fire service as an industry needs to start conducting research on customer service issues surrounding fire-based EMS and public service calls. There is virtually no customer service research showing what time of day, the nature of, or disposition of customer complaints related to fire-based EMS.

Our tradition and special position in the community will continue to make the fire service the nation's safety net. It is the vision and leadership of fire chiefs with a background in service leadership that will make sure that net catches the community and the customer service remains the best it can be.

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Bruce Evans is the fire science program coordinator at the Community College of Southern Nevada as well as an adjunct faculty member for the National Fire Academy's EMS and injury prevention courses. A captain at the Henderson (Nev.) Fire Department, he has an associate's degree in fire management and a master's degree in public administration.

Online Tools

www.tipnational.org

The national homepage to the Trauma Intervention Program, this site identifies how to get a chapter started and the resources that are available to organizations for grief counseling.

www.fredfactor.com

This site contains a simple test to see if you meet the Fred Factor principles as well as links to other resources from author Mark Sanborn.

www.firetimes.com/keupuploads/kefiles/active/beliefsNbehaviors.pdf

This site has a graphic on the beliefs and behaviors firefighters need to have when dealing with customer service issues.

www.nhtsa.dot.gov/people/injury/ems/leaderguide

This leadership guide published by the NHSTA explains the management processes that help strengthen customer service activities in EMS organizations.

www.wmfs.net/_documents/cust_care.pdf?id=52

This site is an example of a comprehensive customer service plan from a fire department in Texas.