Closing the gap between EMS and inherent safety
A framework to quality improvement initiatives to solve your safety challenges
One of the pillars of EMS Agenda 2050 is that in the future “EMS will be inherently safe.” The gap between where we are today and inherently safe could be described as a canyon:
- We know that EMS providers frequently suffer shoulder, back and other injuries
- The number of healthcare professionals, including EMS providers, who are suffering and dying from COVID-19 is too high
- Ambulances involved crashes often involve monitors, radios, suction units, etc. flying around the patient compartment
- Running red lights and sirens results in a higher number of crashes and other cars crash as a result of the traffic disruption or wake effect
- We continue to have patients jump out of moving ambulances, crews get assaulted by violent patients, and administer the wrong medication or the wrong dose
Hoping things will get better is not likely to result in improvement. The key to improvement is for us to identify specific safety issues; charter improvement projects; and then do the work needed to make measurable, meaningful improvements.
The model for improvement popularized by the Institute for Healthcare Improvement is a simple framework to guide us in making meaningful improvements.
To begin, start by identifying a safety issue in your own system, such as vehicle crashes. Chartering an improvement project starts by answering the question, “What are we trying to accomplish?” The answer is most useful if stated in the form of an aim statement that includes how much improvement by when. For example, “Our aim is to decrease crashes in our system from one a month to zero by October 2021.”
The next step is to answer the question, “How will we know that change is an improvement?” This focuses on data and measures. Most safety improvement projects have outcome and process measures, and many have balancing measures:
- Outcome measures focus on the results you’re hoping to produce (e.g., the number of vehicle crashes of any severity each month)
- Process measures are those things that, if done well, are very likely to produce the desired outcome. In this case, you might measure the percentage of employees who pass the driver safety program every 6 months, or the percentage of fleet miles driven in the non-emergency mode
- Balancing measures usually focus on areas where the performance could decrease because of changes you make to address the primary safety issue (for this sample project, you might track response time performance a defined by the county contract)
The next step in this process is to answer the question, “What changes can we make that will result in improvement?” It helps at this stage to involve people who work on the front lines in your brainstorming process. It’s also useful to carefully analyze the data you have to see if there are patterns or anything else you can learn about the cause of crashes. Then think of changes that you could make to systems or processes that are likely to result in improvement. For example, you could:
- Quit running red lights and siren
- Limit the number of consecutive hours employees work to decrease fatigue
- Require everyone to pass a driver’s safety check-up every two months
- Install driver safety monitoring and feedback equipment in your fleet
It helps to articulate the theory you have as to why a particular change will produce the improvement you’re hoping for. One theory is that running red lights and siren greatly increases the likelihood of crashes and research shows that very few patients receive a clinical benefit to the few minutes of time savings. Therefore, if we decrease the amount of red light and siren driving, we will decrease crashes and maintain good quality clinical care for patients.
Once you have a list of ideas, the next step is to test your most promising ideas on the smallest possible scale to see what works, what does not, and what modifications you might make as you learn. As you learn about the effectiveness of your ideas with small tests, expand until you are confident that the ideas that survive your testing really produce the desired improvement. Then you implement them across your system. Monitor your data to track improvement. Continue to monitor performance to maintain your gains.
As leaders, we have a responsibility to protect the safety of the patients we care for, our employees that provide care, and the community. We’ve got some work to do to close the safety gap in EMS. It’s doable and worth doing.
CPS ‘Road to reliability’ webinar series
As part of its “Road to Reliability” learning series, the Center for Patient Safety is offering a webinar on Jan. 20, 2021, at 1 p.m. CST, “Basic QI and process improvement,” during which Mike Taigman will show you how to eliminate weak points or bottlenecks in your operations. Attendees will learn:
- The Model for Improvement framework for healthcare and safety performance improvement
- The importance of tracking safety data and events over time
- The value of and strategy for small scale testing of theories prior to implementation
About the speaker
Mike Taigman uses more than four decades of experience to help EMS leaders and field personnel improve the care/service they provide to patients and their communities. Mike is the Improvement Guide for FirstWatch, a company which provides near-real time monitoring and analysis of data along with performance improvement coaching for EMS agencies.
He teaches Improvement Science in the Master’s in Healthcare Administration and Interprofessional Leadership at the University of California San Francisco and the Emergency Health Services Management Graduate Program at the University of Maryland Baltimore County. He’s the author of "Super-Charge Your Stress Management in the Age of COVID-19."
Learn more about quality improvement
Learn more about how to institute and measure quality improvement initiatives with these resources: