Perspectives can be helpful. They provide a lens through which you view the world and seek understanding. It’s important to recognize that there are lots of possible perspectives. I’d like to offer what may be a different perspective on how quality and performance might be considered from those on the front-lines of the EMS system.
Back in the ’80s, I watched a story on a television news magazine (maybe it was 60 Minutes , but I’m not sure) about a particular cab driver in New York City. It was at a time when NYC had a much grittier reputation that it enjoys today. Think crime and grime. The expectation for “customer experience” in a cab at that time was not very high. It was a definite plus to find a cab without puke on the floor or seat.
Getting around by cab in NYC was and remains quite common, and they tended to be seen as a commodity–they’re all basically the same. The rates are regulated, so there’s not a difference there either. But one cab driver and his cab stood out–dramatically. The cabbie realized that a ride in his cab did not have to be the same as every other cab. As long as he complied with the minimum requirements, there was a great deal of latitude in how he crafted the experience his passengers could have. His cab was meticulously clean. The air was fresh. There was a small tasteful vase with fresh cut flowers. There was a bottle of water for each guest. The cab driver dressed in accord with the exceptional level of service he was seeking to provide. While he could not charge more on the meter, his guests showed their appreciation with generous tips and asking for his cab specifically from the dispatcher (pre-cellphone days). He did very well. He had a handsome return on his slightly higher costs invested in cleaning, flowers, water and his own appearance. He perceived himself and his cab from the perspective we associate with being a consummate professional.
I was dumbstruck by the story. It gave me an entirely different perspective on what EMS could be like. What would the guest experience be like if a frontline crew took that approach to create a guest experience for the patients cared for in their ambulance? What could it be like if a frontline crew held the perspective that the quality of care they provide is primarily their responsibility? What if the frontline crew created its own clinical quality program or continuing education and professional development program? I saw parallels to the way I thought a chicken restaurant franchise works. You have to operate your franchise using the designated recipes, uniforms and general policies and procedures. Beyond that, you have latitude to operate the franchise as well or as poorly as you choose. Get too bad, and you risk losing the franchise, but there are no bounds on how well you run it.
Imagine the crew doing to their ambulance what that driver did to his cab. They do not have to depend on the cleaning job of the off-going crew. Imagine crews setting up their own clinical performance metrics because their managers and medical directors have put a functional process in place to do so. Imagine crews taking responsibility for their own continuing education because the offerings from their employer is only of marginal quality and primarily geared to the lowest common denominator among their co-workers. They track their own clinical performance and follow-up as best they can on their own patients. Their system has failed to provide a reasonable way to get them the feedback they crave to know about the accuracy of their field diagnostic impressions and the outcomes of their patients. Their example influences like-minded colleagues and they begin to collaborate in efforts to further improve their respective offerings for the best possible patient experience and clinical quality. The actions spur the managers to step up. The mangers become the providers of support services for the consummate professionals who work on the frontline.
Is this pure fantasy? Perhaps. Sometimes, the perspectives we have locked ourselves into, both as managers and field clinicians, keeps us from considering the full scope of possibilities for ways to improve the patient experience and clinical quality. It may be possible for intrinsically motivated field staff members who view themselves as professionals to raise the bar to provide the support services and culture needed to achieve high levels of clinical and service excellence.
I suspect that there are not many frontline providers who read EMS Insider . But the kind of frontline provider that does may have just the right stuff to take this idea and run with it.
