Repetitive Persistence

Heather Darata

Editor’s Note: The bulk of information for this CDE came from Chapter 5: Caller Management Techniques from the Principles of Emergency Medical Dispatch.

Have you ever called your insurance provider really upset about a bill or something else that didn’t go right, and then you spoke with a customer service representative who was able to turn things around? Perhaps they weren’t able to refund your money or give you everything you were looking for, but the customer service representative offered you wonderful customer service—they really listened to your concerns, they did everything within their power to make things better, and they even called you by name, making you feel like they knew and cared about you.

Customer service is often an underrated skill—it’s not always about solving a problem as much as it is about helping someone feel heard and then offering what you can to help their situation. It can turn a negative experience into a positive one.

Now, I bet you can think of a time when you’ve offered customer service as an emergency dispatcher that really helped a caller who was in a bad situation. It might have been someone trapped in a fire, a soon-to-be first-time mom who was home alone and ready to deliver, someone requesting a welfare check, or an alarm situation. Callers count on you to be their lifeline no matter how immediately dire their situation is. It’s important to them, and that’s why they called you.

But during a long or unusually stressful shift, it can be especially challenging to offer each and every caller great customer service.

“Let’s say you’re on your fourth shift in a row and the 200th (or what seems like) call in the last four days where someone is just screaming at you,” said Jayme Tidwell, QPR Operations Manager for Priority Dispatch Corp.™ “You might normally ask their name, take that extra step to be compassionate or more patient, but you are just over it today. Now this caller does not get the same service they may have gotten on your first shift that week or with someone else in the center that day. The humanness in calltaking is such a balance. It is so wonderful because of all the empathic and understanding emotions but being human we also have other emotions like frustration and annoyance. How you counterbalance those so that each caller experiences the same or similar customer service tactics is challenging.”

Caller behavior is predictable

Not only can you reach burnout or have compassion fatigue, but it may seem like each caller is different and therefore each call must be handled differently. But that’s not often the case. For example, some callers are too worked up to give you the information you need to gather for responders. You’ve answered calls from people who are too scared to talk and callers who are angry and pepper the call with obscenities when you ask questions.

As an emergency dispatcher, you can still offer help regardless of how the caller behaves, whether the caller can describe the problem well, or if the caller has a fear that emergency services won’t work for them. When you understand caller behavior patterns and predictable events, it can help you tolerate their behavior and maintain an appropriate relationship.

First, how common is hysteria? It turns out it’s not as common as you might think. Studies have shown that less than four percent of callers are really, truly hysterical. According to the Principles of Emergency Medical Dispatch, “hysteria is a state of tension or excitement in which there is a temporary loss of control over actions and emotions.”

Hysteria turns a caller into someone who had the potential to assist with the situation but can no longer render aid. When people are out of control, they want someone to tell them what to do. Remember that the caller’s words are expressing a need, even when their behavior seems out of control. While it may not always seem possible in the heat of the moment, you really do have the potential to break through the hysteria threshold and help the caller regain self-control to enable the most promising outcome.

“Guiding the caller’s emotion has always been a bit of a passion for me,” said Brett Patterson, IAED™ Medical Council of Standards Chair. “I truly believe the dispatcher has more influence over the caller’s emotion than the actual emergency does.”

What is repetitive persistence?

So, how do you help a caller regain self-control? Let’s examine a caller management technique called repetitive persistence. It’s the most effective way to reduce a caller’s anxiety level below the hysteria threshold. This technique might be one that most emergency dispatchers are confident they know how to use and do so regularly. But let’s go back to square one.

The four features of repetitive persistence:

  1. Repeat more than once, if necessary, a request for a desired action
  2. Supply a justification for the desired action that the caller will connect with.
  3. Each time the request and justification are given they must be said using the exact same words.
  4. Each time the request and justification are given they must be said using the exact same volume and tone of voice. For example, “Bob, I need you to listen very carefully so we can help your son.”

This meets #1 and #2: giving a request for a desired action and giving a justification that the caller will connect with.

Why is it challenging to use repetitive persistence?

If repetitive persistence seems so straightforward, then how come not all emergency dispatchers are using this tool?

“It has been my experience for many years that repetitive persistence simply does not come naturally to us during times of communication stress,” Patterson said. “Our normal, more instinctive response to heightened emotion is to raise our voice, make demands, or even simply go silent. Just like it is necessary to practice good thoughts to replace the bad ones in certain situations, I think we need to study and practice repetitive persistence to make it more habitual.”

Repetitive persistence goes against a lifetime of conditioning in which we are used to varying our message the next time we deliver it. For example, “Maria, please make your bed or you won’t be able to go out and play.” Next, “Maria, if you don’t make your bed you won’t be able to go out and ride your bike with your friends today.” The third time, “Maria, I need you to make your bed now.”

When using repetitive persistence, however, the message is repeated exactly as it was given the first time—same words and same volume and tone of voice (#3 and #4). This is why repetitive persistence may feel unnatural—like it won’t work. This phenomenon is mitigated simply by practicing the technique. The more you use it, the more natural it becomes. And the more you experience it working, the more confidence you have in using it.

Remember, callers who are stressed, anxious, and maybe even hysterical all need something other than normal communication techniques. Looking at it from the caller’s perspective, any variation in the wording of the request
or in the tone or volume of the EMD’s voice implies uncertainty or indecision on the part of the EMD. If the caller believes you are uncertain or indecisive, it can reinforce the belief that their situation is hopeless and increase their hysteria, effectively working against your efforts to calm the caller and take control of the call. It is key to remain calm and confident while being helpful but firm when dealing with hysterical or uncooperative callers.

Just as these techniques and state of mind help you calm the excited caller, the opposite is also true. Inappropriate techniques or attitudes can actually cause problems, turning even the calmest and most cooperative callers into a real challenge. Beware of the following inappropriate behaviors:

• The emergency dispatcher does not properly prepare the caller to receive the protocol’s questions

• The emergency dispatcher implies no help will be sent until the protocol’s questions are answered

• The emergency dispatcher ignores the caller’s concern about help not being on the way and fails to reassure the caller

• The emergency dispatcher demeans, judges, or insults the caller

• The emergency dispatcher questions the caller’s integrity

• The emergency dispatcher uses any kind of offensive or confrontational language

If you use any of these inappropriate behaviors, the caller may remain or even become uncooperative, believing you are unable to help because you are unprofessional or incompetent. Instead, give the caller reason to trust you through your confident and concerned attitude. You should sound as if you want and are prepared to help. If you project these emotions, the caller will instinctively cooperate with you.

Take control of your emotions and avoid prohibitive behaviors. Remember, callers are not upset with you personally; they don’t even know you! They simply want help and get frustrated, even angry or hysterical, when they feel helpless or sense nothing is happening. Take the time to practice repetitive persistence and other caller management techniques to help you help your callers. It will put you in the driver’s seat to succeed. You’ve got this!

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