Monthly Archives: December 2011

SAMPLE Your Agency

Judging interest of the EMS community based on searches that end up at this website may not be a fair assessment of the larger group, but interest sure seems to be growing around performance concerns.  I don’t know if there is any acute cause but a longer term irritant has certainly been the economy and legislative reform in the overall healthcare industry affecting the delivery of prehospital services.  With the end of the year at hand, it also seems like a good time for a field assessment of your agency.

The SAMPLE history mnemonic is a beneficial tool when assessing a patient, but could it work on your agency as well?  Try it with me.  Regardless of whether you operate in a local government, a private agency, a non-profit, or a volunteer organization – there are expectations on your service.  What are the Signs and Symptoms of the service you deliver?  Objective measures, or Signs, could certainly include response time, safety record, and the clinical quality of patient care.  Hopefully you have objective standards for these measures to serve as a baseline to compare current performance but more importantly observe any trend.  How often do you take, or again more importantly publish, these observations either internally or externally?  Is a stable vital sign good enough or do you expect a consistent move toward improvement?  As for Symptoms, what is your patient satisfaction like?  Quantification can be a good thing, but I believe most of us have a fair idea of how we are viewed by the public even without a survey.  Are there complaints about your agency performance?  How are these concerns addressed?  Has a concern about the performance of your system been a topic for public meetings or public officials?  Are you experiencing unhealthy competition from a Fire service, commercial provider, or volunteers?  These can all be Symptoms of a failure within your agency.

How about Allergies?  What do you avoid within your service when compared with others?  Have you ever said, “we could never do that here” about a good idea that works elsewhere?  What about your organization constricts the flow of ideas?  Are you taking any “Medications”?  Is there anything you are doing to promote healthy improvement of your service?  What specific improvement programs do you have in place already?  Are you compliant with these medicinal procedures that can promote improvement?

We all have a history that makes us who we are today.  While some of that history cannot be changed, the way we are bound to the effects of that past are not always inflexible if we recognize the bias it causes.  So, what is the Pertinent past history that has you in your current situation?  What prejudices have you inherited from your parent organization(s) or leadership that cause specific actions that may not always be in the best interest of the patient?  Some of it may not be easily changed, but what do we have control over and how much of the current way we do business is simply a product of “the way we have always done it” instead of being based on current understanding.  We operate in a field that is constantly changing and challenging previous assumptions.  What has been proven ineffective in your processes but remains ingrained anyway and how are others making improvements that we ignore simply out of convenience?

I will need to modify this next one slightly, but it still fits well.  What has our Last intake or new hire looked like?  Who are we bringing in to our system to form our future?  Unless our employment process is so screwed up that we spit out the latest employees before they can make a difference, the new hire will represent how we grow and change in the future.  Do we maintain high standards looking for the “locally grown, organic style” employment candidates or go for the convenience of the “fast food hire” to simply get another able body in the truck?  Our view of how employees shape the development of the organization is fundamental to good hiring.  So we must consider whether we are simply eating up employees or offering them personal and professional growth opportunities that encourage them to stick around and contribute to the overall growth of the agency.

Finally, there are the Events leading up to the current state of your agency.  What has been happening lately?  Are there news stories about your agency in the media?  What is the underlying story communicated through the press?  Is your agency a progressive advocate for community wellness with an outward focus or is there just a struggle to keep out of the headlines and maintain the status quo?

So, how does your agency look now?  What is the general impression of your patient?  If treatment is indicated, there are many options available.  Look at attending industry conferences next year and make it a special point to meet representatives from successful, healthy agencies and get to know them.  Check out new vendors and new ideas.  That doesn’t mean you fall for every line they pitch at you, but consider what good advice you can glean from each and judge who is there to help you in the long run.  For those conferences you can’t attend, read our future “Quick Thoughts” posts throughout the year to catch up on what you missed.  Consider webcast presentations and podcasts that don’t require travel expenses.  If your agency does not participate in any accreditations, review what they offer.  Some examples include the Committee on Accreditation
of Educational Programs for the Emergency Medical Services Profession
, the Commission on Accreditation of Ambulance Services, the National Academies of Emergency Dispatch, and other professional development groups like International Paramedic.  They exist to help you and help our whole profession.

Make a commitment to change in the new year and commit to continuous improvement through this new year and beyond.  It is the best medicine for all of us.

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Index of Suspicion Includes Me

It doesn’t take long in an EMT career before the excitement of “rushing to an emergency” turns in to “just another transport call.”  The philosophy of “you call, we haul” in nearly every service can break the community servant’s spirit by turning a skilled paramedic into just an ambulance driver.  But our system “just is what it is,” right?

Well, far from being a service based strictly on tradition, EMS is constantly challenging previous assumptions and struggling to reinvent itself.  How we administer CPR has changed (again), we question the effectiveness of C-spine immobilization that we do standard on nearly every trauma patient, or argue the very validity of the “Golden Hour” around which many services have been designed.  Almost all assumptions are open to be questioned.  I say “almost” because I have found that there still are some boundaries to the willingness of many EMS practitioners to consider change.  Some limitations are easily admitted, like the aversion to legal liability that means we transport anyone who asks us to do so regardless of their suspected need or ability to pay, but there are also less easily acknowledged sacred beliefs.

One of those that comes quickly to my mind is response time.  To many, a quick response indicates excessively fast driving and is contraindicated by safety concerns.  Besides that, we can justify ourselves since very few of our daily calls actually “require” a code response.  While that point may be strictly valid medically, I would argue that our performance is often measured by the public in the agonizing minutes between the 9-1-1 call and the ambulance arriving at the curb.  A patient does not need to be in some form of arrest in order for them, or their family members, to be distressed.  Part of our job is being a calming and supportive influence.  At the same time, I admit that it does not justify putting the driving public or ourselves at risk with an ambulance speeding to every call. But is it really a given that one means the other?

System Status Management – oops, another term laden with strong negative feelings in the field – is actually all about improving performance (both time and economic efficiency) without sacrificing safety.  As advocates for patients, medics see themselves sometimes fighting the system in order to provide the best possible care.  Talk of economic efficiency is seen as just making their job harder.  But again is it really a given that one necessitates the other?

Imagine a system where patient needs are accurately forecast in advance. Where the posting of ambulances is not just another place to sit and wait, but in a practical sense it is the staging for a call that has yet to be received.  Response is thereby improved not by excessive haste, but by the strategic pre-positioning of resources.  The cost savings is not simply an amount  taken from others in a “zero-sum game”, but effectively rescues budgets for proactive wellness programs or, in the current economy, may mean simply saving jobs that allows us in turn to save lives.  This process really works and these systems do exist.  They are called “High Performance EMS” systems and many are profiled here each month while others receive recognition through accreditation agencies like CAAS.  What sets them apart is often observed in technology, but the reality is that it is a culture of seeking constant improvement by the entire staff that makes a difference.

While we consider improvements to the many technical aspects of our profession, let us not neglect the philosophical perspectives that motivate us as individuals.  We operate as a team, not just the pair on the truck, but the whole EMS system is one team with a singular goal.  A goal to do even better each day. So, as we continue to assess our profession should the index of suspicion not include our attitudes toward improving the overall system?

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