YOU CAN'T FIX A CHAIN UNLESS YOU KNOW WHERE IT'S BROKEN
November 21, 2012
By Scott Freitag, NAED President
Traveling with Brian Dale as much as I do gives me the opportunity to learn more about the guy. Brian is a deputy chief with the Salt Lake City Fire Department and speaker extraordinaire at both the Euro and UK Navigators that were held in Berlin and Bristol, respectively, in 2012. While Brian can talk of most matters Academy, his strength lies in quality performance and that takes in everything the Academy does.
Brian is the long-standing Accreditation Board chair, which is more than a figurehead position. Yes, he does hand out the Accredited Center of Excellence (ACE) awards at the Navigator conferences in the United States and abroad, but he also sits in a lot of meetings where an occasional nod of the head is not considered acceptable behavior. Discussion gets fairly pointed among a table of career-minded emergency services professionals and far be it from Brian to back off from debate.
Brian was among the first to recommend the Academy move away from a strictly point-based scoring system divided into broad sections to a process that looks at incremental steps. The process also assesses the dispatcher’s attempts and ability to calm callers and persuade them to follow instructions. The scoring system did not take those variables into account, which, as every dispatcher knows, is primary to patient satisfaction and delivery of appropriate care.
The results of the relatively new performance standards provide a gradient observation of quality indicators. The standards pinpoint an area where a tweak in the call routine can improve the dispatcher’s overall service. From monitoring our Q Forum, he believes the refined approach is better at defining the Academy’s goals.
As Dr. Jeff Clawson has preached from Day 1, emergency dispatch is part of the EMS chain; it is not an entity unto itself. Performance at any link in the chain has a direct impact on patient outcomes. What happens at the call level sets the tone for each succeeding level of patient interaction. From the call analysis, the EMD-QR can determine performance fix-it spots and whether the subsequent advice or training was sufficient. Even modest change can have measurable effects down through the line.
The one hot spot has been the dispatch perspective and trying to make it clear that this is not a punitive procedure. In fact, the philosophy behind quality management is quite the contrary. This is about dedicating time to synchronize. Everyone’s contributions are important in the overall scheme of operations.
Although dated, conclusions reached in a 1991 United States General Accounting Office (GAO) study of Malcolm Baldrige National Quality Award applicants speak to the relevance of bringing employees into quality review. The GAO was asked to examine the impact of quality management practices on the performance of companies following an on-site evaluation, independent of whether or not the company was selected for the award.
According to GAO findings, companies that adopted quality management practices— and, remember, these were not necessarily the award winners—achieved better employee relations and greater customer satisfaction. The employee relations result was determined by increased job satisfaction, improved attendance, and decreased turnover. The companies used quality indicators to improve performance to their advantage consistent with goals that included customer focus, management leadership, employee involvement, an open culture environment, and partnerships. In fact, companies without a quality advantage were found to be at a disadvantage. In addition, failure to take into account quality gives rise to distortions in evaluating service. Customers go someplace else to find better service, when the option to do so is available, and without quality processes, we might never know why.
Of course, our customers, 9-1-1 callers, and the fire, police, and medical responders we serve, do not have that option. Their calls cannot be transferred to a second, third, or fourth choice on a list of communications centers, law enforcement agencies, ambulance providers, or fire departments. Contracts can be reassigned, but not in relation to the immediacy of the caller’s event. We must be committed to doing it right from the start to help guarantee the success of subsequent steps.
This leads me to the point I am trying to make. Quality management and quality performance are staples in the Academy’s philosophy; it’s the Academy’s culture. Brian can harp on the benefits of quality standards—and he will—but it’s your use and understanding of performance indicators that qualifies the strength of your link in the EMS chain. After all, no one wants to be considered the link that tangles the connection.