Senior management’s role in the team-based clinical quality model

EMS leaders triage improvement projects, remove roadblocks and celebrate well-executed projects

The team-based clinical quality model for EMS has several key elements – including EMS clinical specialty teams and ad hoc improvement project teams. To maximize the success of these teams, they need the direct and visible support of the senior management team.

Senior management teams vary considerably between EMS provider organizations but typically consist of the administrator/chief, their direct reports and the medical director. At the senior management team level, the big picture issues can be considered in the context of the impact on the overall organization and how they may impact the various functional areas that the direct reports oversee. This group should also be most familiar with the organization’s core operational and financial obligations, the current strategic plan, its associated priorities for the current year and the status of the budget.

That big picture perspective is invaluable when triaging potential quality improvement projects. A great proposal for a quality improvement project may be presented to the senior management team, but the timing may be wrong and thereby lead to a decision to postpone it. The funds required for that great QI project may not justify the potential benefits compared to other QI projects or other organization needs. There may be several pending proposals for QI projects, but the bandwidth limitations of the organization may necessitate spreading them out over time with a decision on which projects to do in what sequence. All of these scenarios are most appropriate to decide at a senior management team level.

Celebrating projects that have good execution but did not get great results, the organization signals that making a good try is just as important as a project's success.
Celebrating projects that have good execution but did not get great results, the organization signals that making a good try is just as important as a project's success. (Photo/Wikimedia Commons)

Another role of the senior management team is to review and comment on QI project proposals. The collective experience and expertise of the senior management team can be used to provide constructive feedback on the design of the project and the proposed methods for its execution.

Removing quality improvement roadblocks

As a project progresses, each of the ad hoc quality improvement project teams should be required to provide to provide regular project status updates. More in-depth reviews of the project are commonly conducted when the major milestones of project are reached. These are sometimes referred to in the quality literature as tollgate reviews, particularly if the QI project is using the Six Sigma project model. The project team needs to convince the senior management team in the tollgate review that the tasks and objectives leading up to the milestone have all been satisfactorily completed before they are allowed to move on to the next milestone.

One of the most important roles of the senior management team is roadblock removal. QI project teams commonly run into problems that can significantly slow down or bring the projects to a complete stop. Removing those roadblocks can be outside the power or influence of the QI team itself. At the time of project team updates or tollgate reviews, the team can explain the more problematic roadblocks and seek the advice of the senior management team in resolving them. When needed, members of the senior management team may get directly involved in assisting the team to remove a roadblock. That may be as simple as one of the direct reports reaching out to one of their staff members to get them to cooperate with the ad hoc QI project team’s request. It may be more complex, like having the administrator or medical director working with a hospital’s medical records, legal and QI departments to get access to hospital patient data.

Building a culture of innovation

One of the best responsibilities of the senior management team is celebrating the accomplishments of an ad hoc quality improvement team when a project ends. Regardless of the project outcome, the team members should be publicly congratulated for stepping up to participate. The story of the project – from idea, to proposal, to execution and results – can be told in a way that helps everyone better understand the processes that QI projects use and to encourage others to step up and cooperate with future projects.

The senior management celebration of a completed project also provides an opportunity to significantly influence the culture of the organization to support innovation. Innovation depends on people willing to step up to propose a project idea and see it through to completion, particularly when the project might not succeed. By celebrating projects that have good execution but did not get great results, the organization signals that making a good try is just as important as a project's success.

Innovation typically has more failures than successes. If no one is willing to try out an idea because of fear of negative consequences if it does not turn out to be successful, few will ever step up and try – brining the changes of making a meaningful innovation in the organization to almost zero.

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