By The Center for Patient Safety
Leaders at the EMS agency scratched their heads in puzzlement and frustration. The investigation of a serious clinical error identified significant process failures that led to a patient’s death. They also found patterns of behavior by frontline crews that contributed to the error. They had hired good people, trained them well, utilized the best equipment, and implemented progressive protocols. So how could this happen?
Further investigation revealed that middle managers had allowed crews to take shortcuts and workarounds, bypassing established protocols. The managers hoped to keep everyone “happy.” As long as things got done, no harm no foul – right? The shortcuts meant some performance metrics were improving, reflecting well on the managers. But as time passed, the shortcuts were normalized and became hardwired into agency practices. Workaround acceptance became part of the organization’s culture, ultimately leading to unsafe practices that caused the patient’s death.
Safe care should be the first objective in EMS safety
Patient harm in healthcare – including EMS – happens every day. Clinical errors can have many causes, and no event is the same. Leaders need to encourage clinicians to recognize and report errors; crews can’t be afraid to report a mistake for fear of punitive actions. This culture shift requires leaders who are actively engaged in promoting safe care, not just relying on staff to do the right things. While unfortunate, errors shouldn’t be a surprise. A strong safety culture promotes efforts to find, investigate and learn from the unfortunate events that happen.
EMS has made significant strides in provider safety. However, many leaders haven’t made similar progress with patient safety in the clinical setting. The reasons for this discrepancy include:
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A lack of awareness of clinical risks
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Assuming somebody else (the medical director, perhaps) should ensure patient safety
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Assuming the crews alone can support patient safety
The culture pivot to patient safety requires specific leadership action within an organization, including steps to address the silos that separate clinical and workforce safety; one is not more important than the other. The key components of a strong safety culture can address both.
How can EMS leaders, already weighed down with projects and deadlines, find time to work on safety culture? Or maybe the question is, “How can they not find the time?” Good leaders understand how defining the vision, helping their crews support it, creating urgency and removing barriers will move their team to a safer experience.
‘The Road to High Reliability’ webinar series
Reducing patient harm must be a priority for all EMS leaders and clinicians, but how do you do it? Today, the phrase “high reliability” is used to describe aspects of safety and trustworthiness. While high reliability should be every leader’s goal, there are many foundational, or preparatory, steps required long before attainment.
The Center for Patient Safety will host a webinar series called “The Road to High Reliability,” dedicated to informing and educating the foundations’ steps required to start on the road towards high reliability.
The CPS will present the first webinar in the series on January 15, 2020 at 1 p.m. CT, during which industry experts will share ways to reduce clinical errors by cultivating a robust safety culture for staff.
This webinar is for EMS leaders and others who want to learn essential and practical steps to move their agency towards a model of high reliability by creating a strong safety culture, aligned with their mission, vision and values.
Speakers include:
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Brian Froelke, MD. Dr. Froelke is an assistant professor of emergency medicine at Washington University School of Medicine. He is board certified in Emergency Medicine and holds a subspecialty certification in EMS. He is the medical director for EMS as well as the Community Health Access Program at Christian Hospital. He has served as the regional EMS medical director for the East Central Region since 2007 and served as the state EMS medical director for Missouri from 2013-1016. He is the president of the Interstate Disaster Medical Collaborative. Dr. Froelke has been the EMS medical advisor to the Center for Patient Safety since 2017.
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Brian LaCroix. Brian LaCroix is recently retired as president and EMS chief of Allina Health Emergency Medical Services, St. Paul, Minnesota. He has worked as a volunteer firefighter, emergency medical technician, paramedic, educator, author, peer counselor, manager and executive officer. LaCroix is a fellow in the American College of Paramedic Executives, holds a paramedic degree, a bachelor’s degree in business and has completed post-graduate studies in business administration. He is the current president of the National EMS Management Association and serves as the liaison to the Paramedic Chiefs of Canada.
Visit the CPS’s “The Road to High Reliability” for additional information and to register
[Listen for more: Inside EMS Podcast: How important is developing a culture of safety in EMS?]
Learn more about creating an EMS culture of safety
Learn more about creating a safety culture in EMS with these resources:
