February 28, 2019
Mike Thompson and Mike Taigman
Have you ever stayed in the guest bedroom at a friend’s house? Maybe in a country house in one of those bedrooms that was converted from a garage where they have a shower that was clearly installed as an afterthought? Stepping groggily into the shower to clean up before breakfast you reach in and turn the hot water knob a lot and the cold up a little. After a few seconds you stick your hand in to find that the water is arctic cold. You reach in and turn the hot water all the way up and wait for what feels like an hour, but is only seconds, and try it again. The water is still cold enough for a frozen daiquiri. So you reach in and turn the cold all the way off and make sure that the hot water is turned all the way up. It’s still freezing cold. Figuring that the hot water must be broken you take a deep breath, brave the cold water, and go for the gold in the world’s fastest shower competition.
Then, like a light switch, the water turns scalding hot. Leaping from the shower hoping to keep it to only second-degree burns you reach back in through the cloud of steam and turn the hot water down halfway and the cold water back up. It’s still as hot as a ghost pepper so you crank the hot all the way off. Then it switches from scalding to freezing again. Have you had a shower experience like this?
When we’ve described this to audiences full of EMS and fire leaders most of them raise their hands when we ask if this has ever happened to them. What makes it difficult to get the right water temperature in some showers is that the hot water heater is located on the other side of the house—a long way from your guest room. When you take an action, like turning on the faucet, it takes a long time for the message to be sent across the house, for the hot water heater to receive the message, and to respond by sending hot water all the way back across the house to your shower. This delay between action and feedback makes it very difficult to fine-tune a warm, comfortable shower.
Leadership author Ken Blanchard said, “Feedback is the breakfast of champions.” Here are a few things to consider when thinking about feedback systems for you and your team.
Measure what you want more of
One school of thought says, “What gets measured gets done.” So if you measure mistakes you’ll get more mistakes; if you measure successes you’ll get more successes. For example, it may be more effective to measure the percentage of cardiac arrests identified by arriving EMS crews that were recognized as cardiac arrest by the EMD than it would be to track the percentage where the arrest was missed.
Focus on improvement rather than judgment
Having a communication center culture where people use feedback to shorten their total time in ProQA® is healthier than a culture where people are afraid that they will get in trouble if their time is too long. Accountability to the people you serve and to each other is different than accountability to arbitrary goals. A goal of the fastest possible hands-on-chest time for cardiac arrest cases is more powerful than if we want hands-on-chest in 35 seconds or less. There is a delicate balance between looking at your actual performance and working to improve and focusing on goals. The benefit of an improvement focus is that it deals with actual performance and allows for quantum improvement that might be better than the number stated in a goal. The advantage of having a goal is that people like to have a target to shoot for. The most effective approach may be a blend of both.
Faster is usually better
Near real time individual, shift, and system performance feedback can be a powerful tool for fine-tuning individual performance. For example, an EMD finishing a CPR call gets instant feedback on the dashboard for how long it took to get hands-on-chest. This allows the EMD to reflect on the call and make micro adjustments to improve the next one.
Faster is better except when it isn’t
Often when making a change to improve a practice, policy, protocol, or procedure it’s important to “let the data run” for a while before assessing the effectiveness of the improvement. If you’ve added EpiPen assistance to your Pre-Arrival Instructions and the first case or two cause frustration for the EMD, it would not be helpful to rewrite the instructions without having more experience with the new approach. We will talk more in a future column about the value of tracking improvement data/feedback over time.
Clarity of purpose
It’s important for leaders to make it clear what they hope followers will do with the performance feedback they provide. An ambulance service was hoping to decrease hospital turnaround times for their crews. They decided to provide performance feedback by publishing average weekly turn times by crew names with the longest at the bottom of the list and the shortest at the top of the list. A line in magic marker was drawn across the list one-third of the way down. In green ink a big “Thank You, Well Done” was written in the top third. On the bottom two-thirds, written in red ink, was a big, “If you’re down here, try to be up here next week” with a big red arrow pointing up.
A few crews were arriving at the hospital, finding any open bed, and dropping their patient without a report just to get a short turnaround time. Clearly this is not what their leaders hoped would happen. It’s important to be clear why the feedback is being provided and what you hope people will do, feel, or think when they see it.
Be careful with comparison
There’s a natural tendency that lives deep in the DNA of many emergency communication center leaders. It’s the impulse to use data for comparison-based feedback. In the quality improvement world this is referred to as benchmarking. If you’re using comparison feedback for genuine improvement that’s great. If it is being used as some kind of crazy competition or to make people feel bad for not being up to snuff, it’s time to rethink your strategy.
Effective leadership involves a blend of art and science. Using accurate and helpful improvement systems yourself and providing them for your team delivers the best opportunity to optimize performance. Academy Analytics was created to make feedback fast, easy, and effective. Go to https://www.academyanalytics.info for more information.
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