Employee Dilemmas from Competing Organizational Objectives: Insights from Emergency Medical Services

Abstract

Organizations face unique challenges when simultaneously pursuing conflicting organization-level objectives. We study how frontline employees deal with competing financial and social objectives within the context of Emergency Medical Services. Using data from 31 US states, we find that even in the absence of direct financial incentives, emergency crews are responsive to the financial objective of their agencies by providing differential service to patients based on their ability to pay. Private insurance and Medicare patients receive more procedures (6.1% and 1.9%) and have longer transport times (5.3% and 4.0%) than Medicaid patients after controlling for call and patient characteristics. Importantly, we also find evidence suggesting that EMS crews vacillate between the financial and social objectives between calls, depending on the relative salience of the objective.