Paramedic Chief Q&A: Offering cutting-edge clinical care is an operational commitment
Allina Health EMS leaders discuss the importance of a strong relationship between operational leaders and the medical director
Brian LaCroix, president and EMS chief at Allina Health EMS (and president elect of NEMSMA), will lead a high-energy, informal and candid discussion about how EMS chiefs and medical directors can build positive working relationships at the Pinnacle EMS Leadership Forum. This year’s conference will be held at the Boca Raton Resort near Fort Lauderdale, Fla., August 7-11 and will attract EMS leaders from all service models and every size system, for educational sessions, networking and special meetings.
By EMS1 Staff
Brian LaCroix and Charles Lick, MD, have worked together at Allina Health EMS for two decades. They credit their longstanding positive relationship to trust, respect, longevity and a track record of success. We asked them about working with each other and what advice they have to help agencies develop and maintain smooth relationships between clinical and operational staff.
Paramedic Chief: What is one issue that you think a lot of EMS organizations struggle with from an operations and clinical perspective?
Brian LaCroix: One of the issues that I am acutely aware that other agencies struggle with is finding medical direction for rural volunteers. In Minnesota, for example, there are 300 ambulance services. Six of these agencies do 80 percent of all the calls, which means there are a boatload of EMS agencies out there that are doing just a few hundred or a thousand calls a year.
Those smaller agencies often really struggle with finding a medical director. One of the things that I think would be of service to the nation would be helping smaller agencies develop relationships with medical directors.
What are some ideas for how small or rural agencies can find a medical director?
LaCroix: Historically, they might work with a family practice doctor in the community, who is just trying to help out. Often, they don’t really know what is expected of them, though. Often, a service can’t pay them so they offer other things like recognition.
Charles Lick: In Minnesota, the EMS Regulatory Board reports to Department of Health, and they’ve come up with a medical directors’ course for new medical directors, which they offer for free at their annual conference. It can be a great way for people who just don’t have any background or experience in EMS to get some of the knowledge they need. And in our case, Allina Health EMS provides medical direction for a number of smaller, volunteer services and first responder agencies as well as a local community college paramedic/EMT program, which can be another model for smaller agencies.
At Allina Health EMS, how do you find a balance between clinical and operation priorities?
LaCroix: My initial answer would be I didn’t go to medical school. Charlie is the physician, and I’m not, so when it comes to the clinical decisions, Charlie has the final word. Operationally, I think Charlie respects my opinion, but again we collaborate a lot. Over time, I feel that we have gotten pretty comfortable about where we have our respected areas of expertise.
Lick: I would say I’m not an operations guy and I’m not a paramedic, but I have a pretty good understanding of this organization and how things work from an operations standpoint. I know, for example, if I want to put a new medication in but it’s very expensive and we just can’t afford it, we need to look for a reasonable clinical alternative that is more cost effective.
Allina Health EMS is a service that prides itself on offering high-quality patient care. Can you give some examples of when the organization puts its operational efforts behind rolling out cutting edge clinical care?
Lick: Yes, we were early adopters of the LUCAS device, a mechanical CPR device. Initially, we had 30 or so and that was a lot of money; they are $15,000 each. That was a big investment in clinical care that we made before there were large studies on it, but clinically, it just made sense to me. We made a decision as an organization to do it.
The ResQpod is another one we pursued before there were big studies on it. I had seen the value of it in the animal lab, where the research was done. I was convinced it was going to carry over to humans, and it certainly has.
We were also early adopters of 12-lead EKG, and now that’s standard of care for just about everybody. We started doing CPAP way back before there were a lot of prehospital studies on that. The first year we did that, we cut our intubation rates by about 90 percent. Intubated patients have a 30 percent chance of ventilator-associated pneumonia with a 30 percent mortality rate. We were able to cut a lot of that out by making some investments in CPAP.
LaCroix: If there’s one thing I know about Charlie, it’s that when he is convinced of the efficacy of a clinical practice, he wants to get it on the street. Allina Health EMS is not the biggest ambulance company in the country, but we are pretty big, and we are geographically spread out. Over the years, we have given a lot of thought to how to roll out new clinical interventions. We know it’s not just a matter of the medical director making a decision to add a clinical piece of equipment; it involves thinking through all of the touchpoints that are involved in making it real on the street.
Rolling out new clinical interventions can also be an operational challenge. How do you handle this at Allina Health EMS?
Lick: We have fine-tuned an educational process for rolling out new stuff. Many years ago, we started doing care improvement goals. We’d pick a care improvement goal and go after it. We have been systematic in how we’ve done that, rolled out new care goals, trained people, and given feedback in a very consistent fashion. I think that process has been part of that success. Our employees know what to expect, know what’s coming, they know they are getting feedback.
LaCroix: In some cases, we have introduced things in one service area to try it out. Other times, we have introduced things system-wide. We’ve just taken things on a case-by-case basis. We’ve also invested in some communications tools, which allow us to record short videos on educational information or about new equipment. We put those in an email and send it out to the 600 people in our system.
How do you handle any human resources concerns from a clinical and operational standpoint?
LaCroix: For the most part, we have a pretty firm firewall between our clinical and operational evaluation processes. On the medical side, if there is a person having clinical performance issues, that is dealt with using remediation, additional training and a connection with a clinical outreach person, who might be tasked with riding on shifts with that person. For the other side of it, things like I don’t show up to work on time, I am out of uniform, we have left that largely to the operations leaders to deal with from a performance management standpoint.
In my opinion, though, there are definitely times when it is appropriate for the medical director to be present for a conversation with a crew about performance. For example, if we get a complaint that a crew was rude or they didn’t explain things very well. I really thinking having a medical director sit down and talk to someone about their bedside manner can be really powerful.
How can EMS leaders build stronger relationships between operational leaders and the medical director?
LaCroix: I believe the key to strong relationships between the operational and clinical teams is frequent and open communication. At Allina Health EMS, we have worked hard to develop those open lines of communication. Although Charlie and I have a good working relationship, we don’t have all the answers.
I would invite all agency leaders join the conversation at our session at the Pinnacle EMS Leadership Forum about the opportunities and challenges of building strong relationships at the leadership level and how those relationships can influence the entire organizations. If you have ideas or questions you would like to see addressed during the session, please email me directly at Brian.Lacroix@allina.com.