AMR Case Study


American Medical Response (AMR) is the largest private EMS company in North America.  AMR engaged Avatar for many years, beginning in  1985.  AMR was confronted with difficulties in attracting and retaining physicians, nurses, paramedics and EMTs, and thus turned to Avatar for a wide range of human performance solutions. However, they primarily sought a more effective hiring and selection protocol.

Initially, the focus was on medics, EMTs, nurses and emergency room physicians.  The project grew to include 11 different categories, though, including physician recruiter education courses, billing center employment tests and several other tools not initially contemplated by AMR or Avatar.


Medical professionals are in short supply because they are hard to find and attract. Once hired, they often voluntarily quit within the first year. Turnover was costly and disruptive. Moreover, overtime was very expensive and customer service, as measured by response times, was slipping. As a result, AMR needed better retention.


Avatar provided expert guidance and counsel along with the design and development of a multiple-hurdle selection protocol.  We conducted both organizational and role-specific job analyses to identify best-fit candidates. We also conducted secondary research into industry best practices and literature review of contemporary scientific articles and studies.  From this research, we developed our proprietary Can Do/ Will Do™ Model for each of the key roles.  Next, we produced a series of synergistic pre-employment assessment instruments that could be used to identify best fit candidates and screen out those who would be more likely to fail on the job or voluntarily resign.

The selection process had several stages:

  • Pre-screening interview (Knock out questions)
  • Standardized applications (with a biographical events focus)
  • Realistic Job Previews
  • Written pre-employment assessments (Content valid – knowledge)
  • Written pre-employment assessments (Construct-valid – personality)
  • Behaviorally-anchored structured interviews (Values – motivations)
  • Reference and background checks
  • Content-valid pre-employment physical agility tests
  • Drug and alcohol tests
  • Formalized job offer/on-boarding process (to enhance alignment)


The strategies were developed within the original budget forecast and completed in three months.  However, Avatar’s work yielded unexpected benefits. Voluntary turnover decreased by 54 percent; Avatar and AMR both expected that change. Surprisingly, though, involuntary turnover initially increased by 12 percent.  Upon further investigation into this phenomenon, we learned that AMR was, for the first time, able to terminate poor-performers because they now had a larger applicant pool and lower voluntary turnover.  This led to improved patent response times, operational efficiency and improved financial results, saving thousands of dollars per week.