Improving EMS

Since our “birth”, EMS has been focused on doing good for the community.? Our training programs were first taught under the watchful eyes of doctors and nurses who made sure we did it as good as they did.? As our systems became more formal and scaled, the State stepped in with its oversight, and eventually accreditation for our education programs and our agencies formalized things to new levels. We transformed into something big and regulated and popular.

And, yet, somewhere along the way, quality got punted to the office at the end of the hallway.? We became bound to the runsheet.? Dot our i’s and cross our t’s.? Make Billing happy. Quality assurance became our endpoint.?

What if we were to bring quality out of the back office and into the front office?? What if it were pulled from the depth of runsheet reviews and given a new spot for everyone to see?? How could our agencies, and our communities, benefit?? How could we make this happen?

Focus on improvement.? Continuous improvement.? Wholistic continuous improvement.? The adage of being “1% better each day” is true.? When we seek to make things constantly better, we get to identify and address the pain points, the friction, and the barriers to a more enjoyable experience.? What about “the thing” adds value?? What about the thing is necessary?? What’s just plain waste?? This approach goes beyond our clinical practices—it’s all-encompassing; every bit of what we do.

Look at your agency’s application process.? Actually walk the steps needed to apply.? How many clicks does it take to get to the center of the application?? The questions asked on the application—are they integral to the process?? If you aren’t using the information for a reason, why are you asking it?? Keep going with the exercise and follow the application through the HR process: If the application is electronic, who gets it?? If it’s paper, how does it get to that person, and does everyone know this?? What does the person actually do with the application?

“Actually” is an important part of the improvement process.? Our SOPs/SOGs, protocols, etc., all expect things to be done a certain way.? But the design of a plan doesn’t always work with how things are truly done.? Your morning truck check?? Have you watched your crews do the check and complete the list?? When you counsel an employee after they violate policy, do you hear a reason why?? The clash between “work as designed” and “work as done” is fertile ground for improvement.?

When we look at what’s actually done, we get to understand the details of the process.? And, when we’re looking, we should be in the spot where the work is being done—this isn’t a conceptual exercise, it’s hands-on.? The only way to truly understand a thing is to experience it.? Stand there and watch.? What are the steps to the process?? What are the aggravating factors?? What’s valuable, and what’s waste?? When was the last time you spent any appreciable time where the people you are responsible for are doing what they do?

In a Lean process, there are eight “Wastes”, things that don’t add value to the customer: Defects, Over-processing, Waiting, Unused human talent, Transportation, Inventory, Motion, Over-production. The applicant is a customer.? Your HR people are customers.? Dispatch, Fleet, the floor nurse, case manager, law enforcement… What are their needs and how can you efficiently deliver their product?

When you go through a drive-thru, you’re a customer.?? After sitting in line (waiting), you place your order.? You might have to clarify it (defect).? You wait some more. Pay.? Wait. Receive your order. Carefully position your order in the seat so it doesn’t tip over in your car (motion).? Etc.

Our applicant wants a job—that’s the product they want.? Could your system have a scheduling feature, where the applicant chooses an interview slot, right from your website?? Can HR have an auto-generated email that gives the particulars to the candidate?? A confirmation step that ensures that the person received the email will help to close the loop.? A reminder email the day of the interview could help with no-shows or late arrivals.? And, all of this can be done with HR lifting only a few fingers.

When we look for improvements, we will see them.? Small things lead to big things. Take small wins and use them to propel you forward.? When we approach improvement from a wholistic viewpoint, we get to move it beyond runsheets and clinical practices and put it in the center of our organization.? What are the steps involved in getting an oil change and PM for the ambulance?? What is your onboarding? Developing new supervisors?? Vehicle swaps? ?What are the wastes that are sucking away your profits and the joy of your employees?

EMS started off as ambulance drivers in hearses.? Today, our communities expect much more from us; they may not understand the difference between an EMT and a Paramedic, but they understand they want high quality care at a good price.? We can improve the care we deliver by making quality an intentional part of everything we do.? When we know why we are doing what we are doing, we can be effective and efficient.? We can continue the improvement one person, one patient, one process at a time and transform us into what we truly desire to be.