Great EMS agencies are never good enough

The best EMS organizations follow these four steps to continually improve personal and organizational performance


EMS agencies that are considered the very best by their peers, customers, and stakeholders are also the ones that keep trying new things. That is not a coincidence. If you think you’re doing everything right and stop trying to improve, it won’t take long before you’re no longer the best.

We recently worked with a hospital EMS system that had an old, tired ambulance fleet. We made the case for replacing the fleet during the annual budget meeting. The hospital’s new CEO commented: "It’s good enough, you’ll just have to make due until next year. We have other priorities." 

In addition to the aging fleet, this service used a patch, repair and replace parts plan rather than a preventive maintenance program. It should be no surprise that the service’s cost per mile, critical breakdown rate and ambulance out-of-service time from routinely changing from one beat-up truck to another were sky high.

The choice of priorities directly impacts patients. The status quo wasn’t good enough for the STEMI patient waiting on the side of the interstate for 25 minutes for a unit from a distant district to arrive when the primary transport truck broke down.

The status quo is a killer; not only can it harm patients, it halts progress while providing the illusion of comfort and success. Implementing a scheduled preventive maintenance approach instead of a patch, repair and replace parts plan, even with an aging fleet, clearly would have enhanced service, reduced costs and improved patient care.

Discover and improve
If you are part of a service that has a "good enough" or "we’ve always done it that way" mentality, your agency is destined to become dinosaur in the near future — even if your service currently outperforms its neighbors or competitors. A good question to ask is: "How can we do it better?"

No matter what your level of leadership (from front-line provider to field supervisor to chief or CEO), always look for ways to improve service. You have to constantly innovate, perform better and faster, and add value in the process. Whatever you do, don’t stop improving.

Examples of details going unchecked in EMS abound. If you’re like most leaders, you can find a shortcoming or two in your own EMS operation. And that’s exactly what you should strive to do: break out the white gloves and closely critique your operation. Then take these four steps to address what you discover:

1. Write it down
Take note of everything that needs to be done, no matter how large or small. Don’t worry if the list is long. Think of each item as an opportunity to improve your operation. If you can get 1 percent better every day, you will be 100 percent better in 100 days!

2. Formulate a plan
Once you’ve finished the list of areas for improvement, prioritize the tasks. Determine deadlines for each item and spread them out over several days, weeks or months, depending on the magnitude of what needs to be done. Not everything can be addressed immediately. Successful EMS leadership takes perseverance.

3. Get your team involved
Don’t lecture caregivers or send the impression that you’re not pleased with the work they’ve been doing. Be positive and upbeat. Emphasize the importance of managing the details, using concrete examples and anecdotes from your own experience. Give the people who need to be involved specific tasks. Follow up and for ongoing tasks set interim checkpoints that will help you monitor progress.

4. Recognize accomplishments
Identify the resources you’ll need to meet the deadlines. As tasks are completed, praise the appropriate crew members and managers both in private and in public. What gets rewarded gets completed.

Emergency service leaders can also glean important lessons from other industries and businesses. Author and psychologist Russell Bishop tells the classic story about Debbie Fields, founder of Mrs. Fields cookies. Early on she made a surprise visit to one of the first stores in her chain. She noticed the cookies that were coming out of the ovens were overcooked. When she asked the manager to taste them, he told her that they were "good enough." Legend has it that, having more than a little pride in her products and her name, she replied "Good enough never is" and "Good enough never is" became the watchwords for the Mrs. Fields brand.

Whether you are thinking about response time, fleet maintenance, training or any other aspect of our profession, remember: The status quo — or good enough —never is.

Jay Fitch is the founding partner at Fitch & Associates, which has provided leadership development and consulting for emergency services for more than three decades.

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