The 5 P's

Bryon Schultz and Rich Lindfors


*To take the corresponding CDE quiz, visit the College of Emergency Dispatch.*

Greetings, all of you outstanding Q’s. At NAVIGATOR 2023, we did a session on quality improvement (QI). We discussed different aspects of being a Q that can help you be successful and begin your journey to QI.

There are many danger zones you must navigate to provide constructive feedback while maintaining morale, keeping your team focused on the issue, and correcting any identified problems. This is where the 5 P’s come in.

The 5 P’s

Proper preparation prevents poor performance

These words are profound for quality assurance/quality improvement officers. For a Q to be successful, we must plan every aspect of the review process. This includes what happens before and during a case review and the conversation, follow-up discussions, and resolution. Remember, we are emotional creatures too. It’s easy for us to get caught up in the minutiae of a case. We may have preconceived notions about a team member and dread listening to their calls and going through the feedback process with them. Perhaps we are just in a mood and want to say, “Not today.”

Using the 5 P’s helps you handle the successes or difficulties in performance reviews. Emotion is part of the calltaking and review process. After all, you are listening to a past recording of two humans having a difficult conversation under extreme circumstances. Maybe it’s a call brought to you with a preconceived impression that you must decide how to handle. Perhaps a team member comes to you and says, “Protocol 1 is so wrong and broken!” How should a Q handle these different circumstances?

Prepare and plan for the emotional aspects of case review. While it’s easy to say a Q shouldn’t bring any emotional baggage into case reviews, we know that evaluating performance objectively takes practice and discipline. We have performed case reviews for years and occasionally get caught up in the emotional baggage or start a case with a negative impression. There are a couple of best practices to help avoid mixing human emotion in with objective questions and answers.

First, always remain open about behavior. Ask yourself if their behavior was reasonable, and if so, if they are following established standards from the IAED and local policies and procedures. This can be problematic when reviewing the case of a team member who has had previous issues with compliance or receiving feedback. It can be easy to think, “Here we go again.” Instead, step back and take a break before composing your feedback and plan before giving it face-to-face.

Know your audience and keep that in mind when preparing for face-to-face feedback. Your verbal feedback will likely differ for a team member with 10 years of experience versus one with six months. Stay out of the weeds by not letting the conversation get off topic. It can be easy to get off topic with a team member you have known for a long time because of the need to overexplain irrelevant details. They might get off topic to deflect the conversation from their behavior to someone else’s.

So, what should you do? During your discussion, use the tools readily available to you: ProQA®, IPR, QA Guide/Pilot Guide, and Performance Standards. Show them the Q standard and explain it. Since the Q standards are available in PDF, we suggest copying and pasting right into the comments section in AQUA®.

Sometimes, especially with a new team member, use ProQA to demonstrate how to process that call so they’ll be prepared for the next time they take one like it. This is a great tool for showing any mistakes and where and how to meet expectations next time. A more seasoned team member may benefit from this right after a protocol update. We know that calltakers get into habits and have muscle memory so when the protocols change, they may be the ones who struggle until they reprogram their practices.

Utilize the Additional Information section of the protocols to reinforce the “whys” behind the expectations, whether it is a definition, Rule, or Axiom. Since this information is available in AQUA, copying and pasting it into the comment section can be very beneficial.

Team preparation
Has anyone ever brought you a case to review, giving you incomplete information or preconceived notions about a call? If so, there goes objectivity; now you also have those thoughts. The only way to avoid this danger zone is to have no information about the case before you review it. These cases must be reviewed the same as any random case imported into AQUA.

One way to accomplish this is to have a reporting mechanism in place. Rich did this in his former center with a simple email signature that directed personnel to ONLY include the incident number when reporting a case. After the review, face-to-face discussions would commence and any action taken would be complete.

Calltaker frustration
Can the protocols specifically cover infinitely different scenarios all the time? No, it’s not conceivably possible. The protocols do a great job of identifying critical, time-sensitive complaints and situations. Sometimes a caller will complain about an odd or downright strange situation. Protocol knowledge and understanding will prepare the calltaker to make solid decisions to ensure the correct response. Most of the time, the frustration felt by the calltaker can be diminished after talking with them about how the protocols function, spending time working through scenarios with them, and offering best practices for handling frustrating situations.

QA/QI mastery
As a Q, one must have a mastery of protocol, process, policy, and all things 911. For Emergency Dispatchers to fully understand and follow protocol, they must know why they need to perform this way. Simply telling them “Because I said so” will not suffice in today’s modern call center. Explanations are key.

For example, Protocol 21: Hemorrhage (Bleeding)/Lacerations has this Key Question: “Is this following a C-section?” Many EMDs have never seen this question. When they see it for the first time, they may be confused about why it exists. You are responsible for knowing the “whys” behind the questions included in protocol and being at the ready to explain. A successful Q must understand and master the protocols in the QA Guide/Pilot Guide and ProQA, as much as understand and learn the Performance Standards and AQUA.

Please don’t make the job of being a Q harder than it needs to be. As a Q, you work to set the tone in your center. Not using the 5 P’s can destroy all of the good work you’ve done through one negative conversation or interaction. Remember the human element to calltaking and protocol management and plan for all exchanges.

The best chances for you and your team to be successful and stay out of the deep weeds are to remain focused, control the conversation with preparation, and utilize the tools and information available to reinforce the expectations. And lastly, be a master of the protocols using the QA Guide/Pilot Guide, ED-Q Performance Standards, and AQUA.