ACROSS THE BOARD
September 3, 2015
By Audrey Fraizer
Allina Health EMS is everything—and nothing—like the “mom and pop” ambulance service of its founding days.
The “everything” is the organization’s similarity to the lean and hungry philanthropic charm of family-owned establishments. They performed jobs that satisfied all stages of a person’s life. Calls were made from seven-digit numbers posted in the Yellow Pages. Crewmembers kept several overcoats in their office lockers, suited for catering to living and deceased patients and switching jackets depending on whether it was a hospital run or a morgue delivery. They ran hearses and limousines, had a one-seat dispatch center in the same building, and wrote the address of the emergency on a piece of paper handed to the driver. They believed their idealism in putting the patient first would pay off.
Today, Allina Health EMS—formerly known as Smith-Martin, HealthOne, and HealthSpan—is a division within Allina Health system, which offers a full spectrum of medical care, from clinics and tertiary care hospitals to home health care and hospice serving the Minneapolis/St. Paul area in Minnesota.
The 60 employees when Chuck Kaufman started there in 1976 has multiplied by 10 to a staff of 600, providing assistance to nearly 1.1 million people in 100 communities inside and outside the Twin City metropolitan area. Calls come in to the center in various languages: Hmong, Somalian, Spanish, Russian, and English.
Kaufman, who moved through the ranks from “ambulance washer” while in high school to director of the Allina Health EMS communication center, credits the double “p” of care to the company’s continued growth.
“The care is on a much larger scale, but the philosophy hasn’t changed,” he said. “We’ve always been about putting our people and our patients first.”
The secondary PSAP in St. Paul manages 111 EMS vehicles covering a 1,800-square-mile area. They direct ambulances and other support vehicles to the scene of an emergency and, also, the interfacility ambulance transport for highly acute and neonatal transfers. Dispatchers stay in constant contact with EMTs, paramedics, and clinicians navigating crowds on bikes and in golf carts. They do this during large-scale events, such as the popular Prior Lake Music Festival and Twin Cities Marathon.
The communication center is also part of a progressive EMS system exploring ways to treat patients beyond ambulance transport and hospital readmission. The recent move to an ACE is a step toward reaching that goal within the entire Allina Health system.
“We knew ACE was something we had to pursue, but until the past couple of years, we hadn’t made any traction,” Kaufman said. “We started using MPDS in 1993 and had always talked about becoming an ACE.”
Get into full swing
Three factors created the traction Allina Health EMS needed to achieve ACE in April 2015, just in time to accept the award on stage at NAVIGATOR 2015. The EMS community paramedic program started in 2014 was showing positive gains, and the accreditation paved the way to using the OMEGA response through the Emergency Communication Nurse System (ECNS). The two are complementary. Community paramedics visit patients in their homes to promote preventive care, while ECNS offers non-acute patient care beginning with the call to 9-1-1.
The second factor was Victoria “Vicki” Peckman, Supervisor, Technology and Emergency Planning. She is the steamroller that took the talk into an action plan.
“We never let ACE fall off the radar,” said Communication Center Manager Angela Fox. “It was a goal we were always serious about, and when Vicki came in full time, it became a push.”
The third was the caliber of staff.
“We have a strong team that provides excellent care,” Kaufman said. “ACE was a way to measure it, prove it, and celebrate the good work they do every day.“
Reality set in. Push became shove on a bumpy road.
Pre-Arrival Instruction compliance was a major obstacle. Dispatchers added extra words and struggled with pathways to take on choking calls and when to start CPR if the patient wasn’t in obvious cardiac arrest. Moving to performance standards version 9a indicated problems in correctly identifying the patient’s Chief Complaint.
Breaking old habits was another, and even tougher, challenge.
“To our more senior staff, the message was they weren’t doing their jobs right,” Fox said. “Actually, they were doing their jobs really well, but we knew there was a better way to do it. We wanted them to be more confident and comfortable when using the protocol.”
Give it your best shot
Kaufman contacted the Academy, and the Academy’s former New Business Development Director, Mark Rector, flew in from Salt Lake City. Rector encouraged regular review and feedback and suggested performance strategies that resonated with dispatchers, such as sports idioms (put it over the goal line and a slam-dunk, although never throw in the towel or drop the ball).
Rector cautioned leadership of possible consequences. Not everyone might come around. That bothered them.
“We’ve had people working here for a long time,” Kaufman said.
A tips and tricks column for protocol and ProQA went into each Allina EMS newsletter. A three-minute video produced on-site acknowledged the effort ACE required and the hard work toward reaching that goal. Training Supervisor Katie Paulson transformed into a drill sergeant to reinforce complicated pathways during monthly skill-building classes. She developed ways to explain the reasoning behind the protocol standards, devising memory aides to help them remember how they must give instructions.
The EMS Medical Director pitched in, coming into the center to discuss a more aggressive start to CPR.
“He told them they couldn’t hurt people by starting CPR,” Fox said. “He calmed their fears, put them at ease, and said he’d back them.”
The leadership team—Kaufman, Fox, Peckman, and Paulson—advanced new approaches to foster a positive experience, many of which continue.
Signs were posted on lockers to recognize compliant and high-compliant calls and were cleared away at the end of each month to make way for the next month.
“The dispatchers are pretty competitive about it and know exactly how many locker signs they currently have, and who has more or less than them,” Fox said. “When they were struggling they didn’t care about the locker signs. But the first time they got high compliance and a sign went on their locker, they were grinning ear-to-ear. It’s simple, but it works.”
The high-compliance calls were entered into monthly drawings, and the winner could choose from a $25 Allina-branded clothing item certificate, reserved indoor parking for a shift, or a meal out at a local restaurant of their choice with the leadership team while on duty.
“Every single dispatcher chose lunch out,” Fox said. “They love to debate which restaurant they should go to and flaunt their win as they wave out the door. We enjoy celebrating their good work and getting to know them better.”
Dispatchers delivering babies using the protocol receive a stork pin and a locker sign; the names go on a stork pin board and cake is served in their honor. A cardiac save provides healthier returns—a fruit and vegetable tray—and a locker sign, certificate, Lifesaver pin, and his or her name listed on the Lifesaver board.
A dispatcher accompanied Kaufman and Fox to NAVIGATOR 2015 in Las Vegas to accept the ACE award. Allina Health EMS Dispatcher James Domeier, Specialist First Class with the Minnesota Army National Guard, was awarded IAED Dispatcher of the Year and gave his “thank you” and acknowledged the team effort on Skype from his deployment in Sinai, Egypt, as part of the multinational force.
Back home in St. Paul, leadership rolled out the red carpet, complete with an ice sculpture depicting the ACE award figure shown on the certificate. IAED Associate Director Carlynn Page joined the celebrations and, along with the leadership team, announced each dispatcher by name on stage in front of families invited to the unveiling of the framed ACE certificate.
“The reception was amazing,” Page said. “They served refreshments, gave toasts with non-alcoholic sparkling grape juice, and brought food over to staff on shift at the center. They really did things top notch.”
Rector’s cautionary advice proved just that—cautionary.
“Mark [Rector] said that it wasn’t unusual to lose dispatchers during the ACE process,” Kaufman said. “I’m proud and happy to say, we did not lose one person.”
The benefits of accomplishing ACE stand out in a crowd.
“They’re relaxed and comfortable in the protocol and can focus on empathy and compassion instead of wording,” Fox said. “They have pride for their work and confidence in themselves.”
They no longer consider Pre-Arrival Instructions a chore to complete or an obstacle blocking the change during shift to radio dispatch.
Peckman said they’ve become their own best critics.
“They bring calls to my attention,” she said. “They point out issues with the call. They want to do it right so that everyone succeeds.”
Step up to the plate
The Allina Health EMS communication center’s journey to ACE taught lessons leadership willingly passes to centers striving toward the same goal.
“Focus on two things, positive recognition and constant explaining/training,” Kaufman said. “Figure out recognition that is highly visible for everyone in the room to see, find something you can do that they care about and really celebrate it. There will be naysayers; do it anyway.”
Fox said never throw in the towel.
“We were 3 1/2 years into this, despite never-ending call reviews, face-to-face feedback, newsletter tips, and CTO training, and I still have dispatchers who all of a sudden get the ‘aha moment,’” she said. “Keep at it; keep explaining what you may think should be obvious by now. Tweak the message each time and keep putting it out there.”
Kaufman said there’s bound to be some anxiety in dispatch no matter the evolution of the center or progression of an individual’s career.
“I was so nervous giving PAIs when the primary PSAP started transferring 9-1-1 callers to us,” he said. “But it’s a feeling that goes away. You’re helping people at their worst moment. You are their lifeline. That compassion is the same today as it was when we started.“
Keeping the ball rolling
Allina Health EMS has long recognized the importance diversity brings to their services through several community programs, particularly Freedom House Station 51. Founded by the city of St. Paul, its fire department, the Inver Hills Community College, and Allina Health EMS, Freedom House has provided ongoing financial support for an EMT training program targeting youth of diverse backgrounds.
The company provides grants for purchasing AEDs and placing them in public and private locations, and they offer training for bystander CPR and AED use.
To keep their employees healthy in light of their stressful jobs, they have a chaplain on duty to offer counsel and support following unsettling events, such as an upsetting call or a horrific crash involving Allina health clinicians, and to identify compassion fatigue and burnout. They recently implemented a system that notifies the chaplain if certain keywords are noted by dispatchers during a call.