Quality Improvement
...rs to review. In -4- exceptional cases, the supervisor should review calls with individual EMS workers. Trends in documentation should be reviewed at EMS drills. Early on, it should be decided that every member of the department would participate in run report review, a move that would improve teamwork and mutual understanding. The entire department should quickly become familiar with the data elements that made for a quality report. Within a year, the documentation of EMS calls should go from mediocre to exceptional and remain that way. Second, the department should decide to conduct detailed event reviews of every cardiac arrest call. Cardiac arrests are high-risk incidents that warrant individual analysis. The reviews should focus your attention on scene performance benchmarked by data obtained from neighboring EMS departments. Through drills and in-service education, as well as changes in equipment configuration, the department should reduce its arrival to first shock time by an average of 20 seconds. Third, the department should begin mailing a patient satisfaction survey after each EMS call. When 80% of the surveys are returned completed, these should be posted at each EMS station. The results of these surveys would be helpful in improving morale. Maybe even customers would send donations with the -5- completed surveys. An issue identified by these surveys would help the department recognize a need to more clearly differentiate its EMS workers. Without a doubt, it is important for taxpayers to see their EMS department at work. QUALITY IMPROVEMENT could help the department recognize and fix problems. Fourth, the department should undertake a review of all EMS equipment and staffing. EMS workers should keep current with developments in medical equipment and technology. County and state EMS mandates minimum equipment and staffing for each piece of apparatus responding to an EMS call. The department should be committed to ensuring that all its vehicles exceed these minimum standards. To monitor this, the department should develop an EMS equipment checklist in conjunction with standards for maintenance, service, and equipment repair. A computer database should be created to track EMS certifications and a printout of certification levels and expiration dates should be routinely generated. The supervisor should work with members to assist in keeping EMS certifications current. Fifth, a job description should be written for the supervisor that includes providing medical oversight. This ensures that only qualified people answer EMS calls, that continuing medical education is available, and that EMS training and -6- certification records are maintained. Periodically, the supervisor should evaluate the skills of EMS providers, often by observation and on the scene of EMS calls. This EMS QUALITY IMPROVEMENT program would be simple yet comprehensive. It would be designed to help EMS workers provide the best possible care to patients and prepare the best possible documentation of their actions on calls. From the start, the program should be endeavored to be not a source of stress but rather a positive and helpful influence to EMS workers. The efforts should not only demonstrate improved patient care and better documentation but have also develop greater confidence and provided a good deal of positive feedback from customers directly to the EMS workers who cared for them. Another important benefit (somewhat hidden from frontline personnel) is the greater legal protection that improved care and documentation has afforded the department. The EMS agency or system mission statement describes the fundamental reason for the existence of the organization. It should describe all the essential components of the organization, such as identification of the system's customers; geographic service area; major services provided; economic goals; and organizational strengths. The vision statement declares where the organization -7- wants to be in the future and serves as a major focal point of strategic quality planning. The values statement identifies the basic tenets and principles of how people will work together. The values statement covers issues of fairness, honesty, commitment, dependability and expectations. • Mission: Purpose of the organization • Vision: Desired future status • Values: Beliefs and principles • Goals: Proposed accomplishments Operational goals and objectives are defined within the strategic quality planning process and provide day-to-day direction for system progress. Continuous QUALITY IMPROVEMENT is a vital component of an EMS system. Patients must receive high-quality emergency medical care in the field. The leadership of the medical director and the medical community is crucial in realizing this goal. High-quality patient care requires a comprehensive, up-to-date knowledge base; access to the tools necessary to do the job; and strong motivation. -8- The QUALITY IMPROVEMENT team should constantly scrutinize system performance and patient care provided to determine areas needing improvement. When a goal is not met, the following process should be implemented: • Identify the problem. • Establish a corrective plan of action. • Execute the plan. • Measure the outcome. More often than not, the problem is the result of a system deficiency. The system is improved by refining standards and providing appropriate equipment. Providing ongoing education to personnel on use of equipment and specifics of the standards and protocols is essential to providing quality patient care. Quality is a building block of the EMS service. A good QUALITY IMPROVEMENT program needs to be at least a stepping stone. The following is terms that will help you understand quality improvement and terms that I used in my report: -9- bench marking: The practice of setting operating targets for a particular function by selecting the top performance levels, either within or outside a company's own industry. In a broader sense, bench marking involves searching for and copying new ideas and best practices for the improvement of processes, products and services. brainstorming: A technique to generate as many thoughts and ideas as possible within a defined time (e.g., 10 - 15 minutes). cause: The reason for a problem or defect. common cause: A reason for a problem or defect that is inherent in the production process. consumer: The recipient of the service provided. (See "customer"). critical indicator: clearly defined measurements that compare various input and process characteristics. cross-functional teams: Teams composed of workforce members from several different work units. -10- customer: In the broadest sense, the recipient of the service provided or the purchaser of the services. Generally, however, the term refers to the purchaser of the service. (See "consumer"). cycle time: The amount of time it takes to complete a defined task. defect: Non-conformance to requirements; the lack of a necessary characteristic. effectiveness: Conformity to requirements; the degree to which the service is performed in the correct and desired manner. external customers: Individuals, entities and organizations who are outside of the actual operation of the EMS system and who receive services provided by t...