The Secret of a Successful EMS CQI Coach: Understanding the “Why”
If you want to up your CQI game, perhaps a change in strategy is in order. Many, if not most, CQI professionals spend most of their time trying to understand what went wrong on a call. That is a good thing, but if you want to take your game from good to great perhaps it’s time to change your point of view.
Understanding what went wrong on a call is an important aspect of determining if errors occurred so they can be addressed. The problem is it does not always address the “Why”.
Understanding Why things went wrong gives you critical insight into the mindset of the provider at the time of the call, so you can understand what thought processes they were employing when making decisions.
Understanding how people think, that may have contributed to the problem in patient care may set you on a whole different path in helping the provider understand their error, and more importantly, help them understand what they need to do to fix it.
Seek to Understand the Why
For example, I once met with a provider of an agency concerning several calls over a 3-month period where the provider was clearly cutting corners. Some patients who should have received ALS did not. The ones that did were routinely not getting 12 leads, blood glucose monitoring or in some cases even full treatments.
During our first couple of sessions the provider would give me clinical reasons he felt the patients did not need the level of assessment or care the CQI audit identified. A common refrain from the provider was, “the patient wasn’t that sick and did not need the extra efforts” the CQI auditors were recommending to properly complete the patient care experience.
From that point, the discussion went off in the direction of us discussing the nuances of the patient’s presentation that would have necessitated the additional efforts. Not an uncommon CQI feedback experience.
After a couple of these discussions, I remarked to the provider that these issues were not normally issues we needed to address with him, and it seemed out of character for the provider to be so “loose” with his assessments and care.
It was only after we got to this point in the discussion that the provider revealed the real reasons for his lack of detail in providing care. The medic agreed that he normally would not be so laid back in his approach but felt that given the current EMS climate, he (and others in the agency) needed to do something to preserve his sanity.
As it turned out, this agency, like so many others in EMS in recent years, had been having trouble hiring and maintaining employees. At the same time, the call volume had risen dramatically resulting in providers working double and triple shifts just to keep the trucks on the road.
After several months of this, fatigue was setting in. All of the providers were talking amongst themselves that they felt like an assembly line where the main focus of their job was to just get the patient to the hospital quickly and turn the truck around to handle the next call. Patient care had fallen victim to the situation the providers felt themselves in.
Think about this for a minute.
In the first few conversations, the discussion was directed into a typical discussion about the need for more thorough assessments and ALS procedures. The provider was willing to take the hit on that but had no plan for addressing the real issue that was concerning him and many others in the organization. I was not able to help him with his real problem as the real problem didn’t even come up in the conversation.
Once the conversation turned to the Why of the call, namely organizational stressors, the conversation became very different.
Understanding the Why Allows You to Address the Real Problem
We spent quite a bit of time simply discussing the state of affairs in EMS today and how many providers are feeling the same way. We also discussed that while trying to get more calls done quickly is admirable on his part, it would not serve the patient, him, or his agency well when something went wrong. The likelihood of something going wrong is also increased significantly utilizing a scoop and run approach to patient care.
The reason these calls were not being managed appropriately was not because of a lazy medic or a provider who didn’t understand protocol or basic ALS theory (all requiring different approaches to solve the problem). It was due to the stress being placed upon him by the system. The approach to “fixing” all these issues is completely different when you understand the Why of the call, sometimes referred to as the “root cause” in CQI terms (for a more detailed look at the various root causes check out our article, The 13 Necessary Elements for High Quality Patient Care).
This problem required a systems fix, not a provider fix. As a result of the conversation the provider agreed to slow down a bit and take care of the patient in his presence instead of worrying about potential future patients. Getting additional resources to handle the agency’s volume is a dispatch and management resource allocation issue. Had we not spent time understanding and addressing the Why of the issue, the
provider likely would have felt the CQI process was an added stress that he would need to avoid or contend with as opposed to a resource to help him get changes enacted at a higher level.
You Are Their Advocate
CQI officer as advocate, can be a powerful tool in helping providers to buy into the CQI process and should be used whenever possible to help establish the legitimacy of the CQI process. Otherwise, providers may feel CQI is a tool of management to get people in trouble instead of helping them improve.
In this case, the provider felt “heard”, as opposed to feeling he was being accused of bad patient care and it made all the difference to his mental state. It also allowed him to reorganize his thoughts and priorities coming in to work each day. The added benefit is he was able to spread this message to others in the organization who were experiencing the same problem. Those others also felt more comfortable bringing their own concerns up regarding the real problems affecting them.
All in all, a much more successful outcome than simply getting the medic to comply with protocols.
If you want to take your EMS CQI game to the next level, always consider getting to the root cause of the issue (the Why) and you will likely never look at the CQI feedback loop the same way again.
For more information on this topic or other EMS CQI topics, visit us at www.girardassoc.com or contact Paul directly at paul.girard@girardassoc.com.
