Administration and Leadership, EMS Insider, Operations

The Importance of Testing Systems and Processes for Improvement…Literally

It was around 10:30pm on May 17th 2017 while attending the JEMS EMS Today 2018 Curriculum Committee meeting in Charlotte, NC, while entering an elevator that I went unconscious and into cardiac arrest…

We had just finished dinner and luckily I was with a large EMS contingent from around the country consisting of all EMS system delivery types (fire, private, government) and provider types (EMT and Paramedic) who all came together with a previously untested nor coordinated, yet unified mission to provide care to a patient in need.

The process went like clockwork (according to those who witnessed the event and participated in the resuscitation efforts)…as soon as I was off the elevator, my limp body was extricated and laid down on the ground for a primary assessment….no pulse…not breathing…someone call 9-1-1/get an AED, start CPR…after one round of compressions, I began to awake hearing the sounds of a Federal Queue in the background from the first responder engine from Charlotte Fire Department.  Within minutes of my event, I was receiving oxygen and having vital signs taken, minutes later, the MEDIC EMS team arrived with ALS care and performed a 12 lead, packaged me up, and quickly and safely transported me to the ED while providing ALS care en route to a tertiary care facility designated to address my particular clinical need.

While my situation clearly scared the crap out of everyone involved and I am grateful to everyone involved in my care, there is a great lesson to be learned here, and that is that properly designed systems and processes work.  While luck played a part in my situation given my proximity to immediate medical care providers, it became clear to me that the EMS system as designed in Charlotte works.

The best way I have ever found to assess and improve upon a system and/or process is to literally become the focus of that system or process.  Whether it be patient care, a billing process, a resupply process, a deployment process, a response process, a training process and so on, sitting in the seat of focus (what the process or system is designed to address) provides you with a rather unique perspective, and to the trained / observant eye, will surface both challenges and successes within that process or system.  While lean, six sigma, TQM and other systems used to improve processes are great, I have found that the only way to really understand the inner workings of any system or process is to partake in it.

This approach has been at the foundation of my improvement work over the years and is something I brought to the table early on as I learned about High Performance EMS Systems of care from Jack Stout.  My approach was always to test something out myself, be the guinea pig, go out and touch it, feel it, walk it, be a part of it…it was visceral for me and an important part at the nucleus of my work that is then supplemented by data, statistical analysis and process mapping functions used in systems / process improvement science.

In this particular instance, being a real patient allowed me to see what worked and what didn’t.  In this case, everything in the EMS system worked and worked well and the outcome was desirable.  My experience in the hospital was not as quite as effective nor efficient as it could be, and I will save these observations for another article as I believe healthcare can learn a lot from EMS in terms of processes and operations management.  I also see this as a larger success for the EMS industry as a whole in that care providers from different backgrounds, differing systems of care delivery and different levels of clinical capability, whom never worked together clinically nor operationally before, were able to collectively and in a coordinated fashion know what to do, how to do it, and in what sequence.  This speaks to the importance of systems and process standardization, specifically in this case, BCLS and ACLS algorithms and the training programs that accompany these processes.  This also speaks to the importance of an evidence based approach used to identify the best in class processes and systems of care and speaks to the importance of research in EMS.

While I am not advocating to literally become a patient in order to determine if your particular system of care works, it doesn’t hurt to find ways to experience it, even if it is as an observer or bystander.  The important piece is to watch with your eyes wide open, assessing not only the situation at hand at face value, but asking yourself deeper questions like: why are we doing this the way we are, does this make sense, could it be done better, did we achieve our goal in an effective and efficient way, was everyone / everything involved in the system / process properly addressed, where there any gaps, did we have to do any rework…another way to think about it is being constantly inquisitive or having what is now being called in leadership science as having a high curiosity quotient…or always asking why.

With these simple yet effective techniques, I bet you will find new opportunities to improve your systems and processes within your organization.  Constant improvement and course correction is an important and fundamental organizational and leadership variable found in successful EMS systems and careers.  In closing this chapter of EMSOLOGY, I highlight the insightful proverb “doing the same thing over and over and expecting different results is the definition of insanity”.


EMSology: The Art & Science of EMS

This is the second article in Jonathan Washko’s EMSology series, which aims to share the wealth of knowledge and wisdom that Jonathan has gathered in his 30-plus years in EMS. 

He’s worked with countless EMS agencies at both the bottom and top of their games from around the U.S. and other countries.  This series covers a variety of topics, along with best practices learned from other leaders in the industry. 

EMSology includes commentary on a variety of important topics, including: 

  • Healthcare models and policy changes;
  • Leadership and mentoring; 
  • Process improvement; and
  • High-performing teams.

To learn more about how you can integrate your EMS system into a coordinated healthcare system, look to NAEMT and AIMHI on the web for resources, follow @EMSOLOGY or @JonathanWashko on Twitter for for quick insights and links to other resources.