Critically Examine Your Agency to Succeed in Reform Environment

Measure twice, cut once. This old adage holds true for many things: carpentry, sewing and health care–especially in the context of health-care reform. No matter how many words we interject into the conversation about quality, we’ll never have enough to fully describe the important role it should and will play in health care–now and in the future. Health-care reform is ultimately about changing the way health-care organizations are reimbursed, and the only real way to change reimbursements is to address access, cost and quality.

Know Thy System
Achieving quality has to begin with the recognition that regardless of how well we do things today, there’s most likely a better way. And, if it can be done better, chances are it can also be measured and compared.

The first step to measuring quality is to know your system. If you’re not already tracking data, choose a few elements you believe could use improvement and start tracking that data today. This data can help you better use your resources and vastly improve patient care.

After you have your data, measure it against other systems and current national standards, review the literature, and consult with other EMS systems, hospitals or health-care organizations. Look for model systems in which changes are being made with a clear understanding of how and why those changes are making a difference.

If there’s no data standard or model system, then up the ante and design pilot projects to solve a specific issue. If you’re diligent in tracking information, it’s possible your system or program could one day become a national benchmark.

Science of EMS
As we’ve learned with CPR over its 50 years, there’s no constant. Science will always refine and redefine what really works. Think of how things have changed with close-chest cardiac resuscitation methods since CPR’s initial introduction in 1960.

Those of us who have been in EMS for a while have learned each new generation of CPR guidelines, incorporating new techniques, medications and devices into daily care to help ensure patients have the best possible outcome. We can’t be afraid to examine our systems with a scientific eye like researchers continue to do with CPR.

Specific guidelines dictate when every nut, bolt and screw needs to be replaced on a helicopter. Engine rebuilds are also completed on a strict fly-time schedule. Similarly, every state requires EMS systems to revise protocols annually or biannually. We must each devise a maintenance schedule similar to those we use for our helicopters and ambulances.

Maintenance will ensure your EMS systems run cleanly, efficiently and with purpose. This is sometimes painful, but necessary. Guidelines rarely tell us how or when to review system policies, procedures, staffing or the culture in general.

In Wake County, N.C., we’re lucky to have a data-driven EMS medical director, JEMS Editorial Board member Brent Myers, MD, MPH, FACEP. He’s consistently applauded for not being satisfied with being only good or even really good. He pulls apart the data and always looks for new solutions to go from good to best.

He has pushed Wake County EMS to be transparent and measure success in terms of patient outcomes. This is the place we all need to be, because we’re all here for the patient, and because this is how our organizations will succeed as health-care reform changes occur.

Stickler for Statistics
We typically repeat the same procedures in different settings on different patients, time and time again. Look at those procedures. Ask yourself, where do inefficiencies occur? Then, get innovative. Talk about ways to fix the processes to improve patient care and make your team more efficient.

Realize, too, that mistakes can and will happen, especially under pressure. To err is human, right? In a report of the same name released in 1999, the Institute of Medicine discussed the fact that errors can and do happen in health care, but that you can build safety and quality into your culture.

The report concluded that many of the errors in health care are due to system failures. The best thing we can do for our patients and our ongoing operation is to make sure staff have systems and tools in place to help providers do their jobs correctly.

In today’s world, a growing array of academic knowledge, research capabilities and workforce development opportunities can contribute to a higher quality health-care system and significantly reduce the number of medical errors.

To make these solutions effective, we must seek them out and take advantage of the information and opportunities. Remember, getting it right the first time is better for the patient. It can help reduce costs across the health-care system, and it will help make you successful in a reform environment. JEMS

This article originally appeared in September 2010 JEMS as “National Health-Care Update: Getting it right the first time.”

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