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Association Between Organizational Culture and Emergency Medical Service Clinician Turnover

Author

Listed:
  • Jacob C. Kamholz

    (National Registry of Emergency Medical Technicians, Columbus, OH 43229, USA
    Division of Health Services Management & Policy, College of Public Health, The Ohio State University, Columbus, OH 43210, USA)

  • Christopher B. Gage

    (National Registry of Emergency Medical Technicians, Columbus, OH 43229, USA
    Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, OH 43210, USA)

  • Shea L. van den Bergh

    (National Registry of Emergency Medical Technicians, Columbus, OH 43229, USA)

  • Lakeshia T. Logan

    (National Registry of Emergency Medical Technicians, Columbus, OH 43229, USA
    Fort Sam Houston, The United States Army, San Antonio, TX 78234, USA)

  • Jonathan R. Powell

    (National Registry of Emergency Medical Technicians, Columbus, OH 43229, USA
    Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, OH 43210, USA
    ImageTrend, Eagan, MN 55121, USA)

  • Ashish R. Panchal

    (National Registry of Emergency Medical Technicians, Columbus, OH 43229, USA
    Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, OH 43210, USA
    Department of Emergency Medicine, The Ohio State University, Columbus, OH 43210, USA)

Abstract

The organizational culture significantly impacts employee behavior, satisfaction, and retention. Historically associated with hierarchical, fire-service-based structures, EMS cultures vary considerably, and their influence remains unclear. We aimed to identify organizational cultures within EMS agencies and examine their association with clinicians’ intent to leave within 12 months. We performed a cross-sectional survey of nationally certified civilian EMS clinicians aged 18–85 in the United States who recertified with the National Registry of Emergency Medical Technicians between October 2022 and April 2023. Respondents completed the validated Organizational Culture Assessment Instrument (OCAI), categorizing organizational cultures into adhocracy, clan, hierarchy, market, or mixed. Multivariable logistic regression evaluated the organizational culture and clinicians’ intention to leave, adjusting for personal demographics, workplace characteristics, and job satisfaction. In total, 30,762 survey respondents were included. Mixed and hierarchy cultures predominated, followed by clan, market, and adhocracy. Clinicians in adhocracy and hierarchy cultures had significantly higher adjusted odds of intending to leave EMS compared to clan and mixed. The organizational culture in EMS significantly influences clinicians’ intentions to leave. Adhocracy, hierarchy, and market cultures are associated with an increased likelihood of turnover, but clan-oriented environments do not increase risks. These findings suggest that optimizing EMS agency cultures towards collaboration and supportive environments may enhance clinician retention.

Suggested Citation

  • Jacob C. Kamholz & Christopher B. Gage & Shea L. van den Bergh & Lakeshia T. Logan & Jonathan R. Powell & Ashish R. Panchal, 2025. "Association Between Organizational Culture and Emergency Medical Service Clinician Turnover," IJERPH, MDPI, vol. 22(5), pages 1-12, May.
    • Handle: RePEc:gam:jijerp:v:22:y:2025:i:5:p:756-:d:1653684
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    References listed on IDEAS

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    1. Beatrice Thielmann & Julia Schnell & Irina Böckelmann & Heiko Schumann, 2022. "Analysis of Work Related Factors, Behavior, Well-Being Outcome, and Job Satisfaction of Workers of Emergency Medical Service: A Systematic Review," IJERPH, MDPI, vol. 19(11), pages 1-15, May.
    2. Beatrice Thielmann & Robin Schwarze & Irina Böckelmann, 2023. "A Systematic Review of Associations and Predictors for Job Satisfaction and Work Engagement in Prehospital Emergency Medical Services—Challenges for the Future," IJERPH, MDPI, vol. 20(5), pages 1-16, March.
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