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EMS quality improvement through clinical specialty teams

Harness a passion for care to identify improvement opportunities in clinical specialty areas and propose change

EMS quality programs commonly have bottleneck; the bulk of the clinical quality management work is often done by one staff member. That person will usually have “quality” in their job title, but it may also be something like the “clinical services manager.” They may even have a broader job title, particularly in smaller organizations.

The problem is that by the time this key person finishes gathering and cleaning up the raw clinical data, analyzing it and generating reports; addressing clinical incidents; maybe doing some clinical training development and delivery; and any other duties as assigned – there usually isn’t much time remaining to do actual clinical quality improvement projects. While the magnitude of this problem varies between agencies, it’s so pervasive that it signals a need to reconsider how our EMS quality management programs are designed.

One of the other key limitations in these key quality positions is that agencies don’t do much to adequately groom staff members for these positions or continue their professional development after they assume the role. A couple lectures, or even a pre-conference workshop, is not adequate.

Adapting quality circles from aerospace, tech sectors

In contrast to healthcare and EMS, some other industries have a much more evolved approach to quality, particularly in the high-tech manufacturing and aerospace sectors. One of the distinguishing characteristics in these industries is their use of team-based quality strategies. Over the years, the names for this participative management strategy have changed and the processes the teams use have been adapted and improved, but their legacy traces back to the idea of quality circles.

The basic premise of the quality circle is that front-line staff have deep insights into the processes they work within. Given appropriate coaching and support, those staff members could use those insights to generate great improvement project ideas, be directly involved in project implementation and help train their colleagues on any changes being made to the process.

Hospitals sometimes have structures akin to quality circles. They often have a committee of front-line staff members and subject matter experts in clinical service line or condition-specific standing committees. For example, cardiologists and cardiovascular clinical nurse specialists, cath lab nurses, cardiovascular technicians and cardiac ICU nurses will be on the hospital’s STEMI committee. The STEMI committee will usually include some members from the emergency department and it may also have external representation from EMS. It will monitor STEMI care performance in their hospital, work to correct process compliance issues (e.g., non-compliance with processes for timely triggering cath lab team activation), keep up with research and best practices, and generate ideas for changes in the overall STEMI processes to elevate performance (e.g., implementing a direct-to-cath-lab protocol for select EMS STEMI alert cases).

Applying team-based quality strategy to EMS

Translating this idea for EMS, consider the EMS specialty team model. These are standing committees of EMS staff members who share a passion for care in a particular clinical area and take responsibility for specific activities in order to move the quality and value forward.

Consider establishing specialty teams in these clinical areas:

  • Trauma
  • Stroke
  • Cardiac arrest
  • Sepsis
  • Opioid abuse
  • Chronic inebriates
  • Mental health
  • Emergency medical dispatch
  • Airway and ventilation
  • Pediatrics
  • HazMat
  • Tactical
  • Critical care transport

Clinical specialty team responsibilities include:

  • Advanced continuing education of team members in their clinical specialty area
  • Professional development of team members in quality, research, general management/leadership and adult education
  • Choose/define performance metrics and descriptive statistics that will monitor processes and outcomes
  • Gather raw clinical data and any relevant operational data
  • Analyze data to calculate performance metrics and descriptive statistics
  • Report performance measures and descriptive statistics to the organization and other stakeholders
  • Identify improvement opportunities and propose improvement projects to senior management team
  • Conduct journal club activities in scientific and trade literature for professional development and to monitor for innovation ideas and best practices
  • Identify improvement opportunities and present improvement project ideas to senior management team
  • Oversee ad hoc improvement project teams
  • Develop continuing education goals and then develop/deliver (in conjunction with training staff) and assess educational impact

The logistics of participation on a clinical specialty team can be handled in several ways. It desirable to have the team meet as a group monthly to review and plan. The routine tasks of the team can be handled quite well by individual members each completing their respective tasks separately. The whole team or smaller groups can meet synchronously via video or audio conference calls – or communicate asynchronously via email and virtual team workspaces. The key is a well-organized routine and clear task assignments.

One of the most important roles of each clinical specialty team is to identify improvement opportunities that lead to proposals to the senior management to commission an ad hoc improvement project team.

Mic Gunderson is the president of the Center for Systems Improvement – a consulting firm specializing in design and value improvement for high-risk time-sensitive care.

His prior positions include national director for clinical systems at the American Heart Association; EMS system director for Kent County EMS in Grand Rapids, Mich.; president at Integral Performance Solutions; national director for quality, education and research with the Rural/Metro Corporation; director of research and education with the Office of the Medical Director in the Pinellas County, Fla., EMS system.

Over the course of his career, he served as a field EMT, paramedic and firefighter, clinical manager and director with military, private and governmental EMS agencies. Mic has authored and edited a wide range of articles and textbooks, and has served on the boards of directors for several national EMS organizations.