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Look before you leap

Editor's note: St. Petersburg, Fla., is considering breaking away from the county EMS system — a move a consultant says could bring in million for the city. Editorial Advisor Art Hsieh says even in times of financial hardships, money shouldn't be the only consideration to a system-wide change.

I'm not a strong advocate of the adage, "If it ain't broke, don't fix it." We should constantly be looking for ways to refine, revise and improve the delivery of care.

This cycle of quality improvement allows us to evolve and adapt to changing conditions. The questions that drive changes should revolve around the benefit to the patient, balanced with operational and financial factors. In my naive and perfect world, data and common sense would rule all changes.

The same goes for EMS systems. However, broad system changes are complex and require serious study. These articles reflect the challenges this system is facing.

On one hand, this large city is probably in the same financial difficulties as most governments, motivating it to find ways to capture revenue. On the other hand, the city's fire department is part of a well integrated county-wide system that is interdependent on its partners to operate effectively.

It's likely that the current configuration took a long time to develop and has been evaluated and reviewed extensively for its efficacy and efficiency.

A large scale and rapid change could have significant effect. I'm not necessarily saying that it should not be done; but finances should not be the primary driver of this debate.

Nor should the politics of providing the service. Absolutely there is a place when these factors should be considered carefully, but only in conjunction with considerable discussion about patient outcomes, organizational behavior and system culture. One suggestion — look at the history of other system design changes and find out what worked best, and what did not.

Evaluate the reasons why other systems changed their configurations, and look at the outcomes of such changes. Did patient care improve? Was any money saved? While no two systems are identical, most systems have many attributes in common. I'm hoping someone is looking at that.

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