SAN DIEGO 鈥� The 2020 National Association of EMS Physicians (NAEMSP) Annual Meeting started off with a keynote address by Dr. Dave Williams.
, an internationally renowned improvement science expert as well as a self-described 鈥渞ecovering paramedic,鈥� set the stage for a conference that highlighted quality improvement and patient safety throughout the three-day program.
Dr. Williams began his talk by reminding the crowd of the Martin Scorsese classic 鈥淏ringing Out the Dead,鈥� starring Nicolas Cage as a burned-out paramedic in New York City.
While many of his colleagues found the portrayal of EMS disturbing, Dr. Williams felt the opposite, heavily identifying with many of the major themes in both the book and movie as they related to the high levels of variation across the industry.
Dr. Williams highlighted the international reception of the which focuses on three dimensions: improving the patient experience of care, improving the health of populations, and reducing per capita cost. He pointed out that while EMS is happy to discuss the Triple Aim, there is little evidence of 鈥渨hat good looks like鈥� within our industry 鈥� something that is easily shown by the wide variation in cardiac arrest survival across different communities.
After setting the stage with the basics of why quality improvement matters, Dr. Williams invited Nikki Little, quality and patient safety officer with Winnipeg Fire Paramedic Service; Brooke Burton, division chief for quality for Falk in Alameda County, California; and Dr. Ian Medero, the medical director of Albuquerque Ambulance Service to join him at the podium.
All three had participated in in the past few years, so Dr. Williams used their individual journeys to act as perfect examples of just how messy quality improvement really is. He didn鈥檛 focus on the actual change his co-panelists were trying to create, but rather walked through the process of going from idea to action to (hopefully) change.
Dr. Williams finished the keynote by asking what one thing from the course had changed the way each of the three think about quality improvement.
Little was most impressed by how impactful examining data over time could be to operations and clinical efforts.
Burton reminded the crowd that you learn as much from failure as you do success and that change often happens incrementally.
Dr. Medero was struck by the difference between quality improvement and quality assurance and the role each plays in an overall system of quality management.
Memorable quotes on quality improvement
Here are some memorable quotes from Dr. Williams that stood out.
鈥淭he system that we have can be influenced by the things that we do.鈥�
鈥淚f you don鈥檛 like the results that you get, you have to change the system to produce a different set of results.鈥�
鈥淥ne of the reactions, whenever you鈥檙e confronted with data that doesn鈥檛 match your personal experience or how you鈥檙e feeling, is to want to question the data or resist what it says.鈥�
鈥淭he difference between those that are making an impact, and those that are not, is the focus of attention on the results.鈥�
鈥淚t鈥檚 very common to find people doing activities, but it doesn鈥檛 change the results for patients.鈥�
鈥淲e all know there鈥檚 a gap between where we are today and the opportunity we have for patients and communities; we know there must be an opportunity to do better.鈥�
Key takeaways on EMS quality improvement
Here are the top takeaways from the NAEMSP keynote address.
1. Every system is perfectly designed to get the results that it gets
One of Dr. Williams鈥� biggest points was that in order to change the outcomes of a given process, you must first change the structure. This point, originally championed by , recognizes that the biggest driver to outcomes is the structure of a system. Processes will naturally revert back to their former flow if the corresponding structure of a system isn鈥檛 changed which is while re-education interventions rarely work in the long term.
2. Not all action is created equal
Organizations that continuously show improvement aren鈥檛 just doing something to do it, they are relentlessly pursuing better results. They think critically about what changes could be instituted to lead to definitive improvements and recognize that it鈥檚 an iterative process. They know that improvements happen 1% at a time.
3. Improvement is messy
If it were easy, everyone would be doing it. Quality improvement is not a one and done effort. It is not a flashy new technology or a nifty gadget that somehow does a preexisting process better than before. Quality improvement is only successful when practitioners get in the weeds of the data, the processes and the organizational structure.
4. NAEMSP is committed to the growing focus of quality improvement within EMS
Whether it鈥檚 their yearlong course, their preconference, or the growing number of sessions within the annual meeting that highlight the constructs of quality and patient safety, it鈥檚 nice to see a national organization recognize how important these ideals are to moving our industry forward.
Additional quality improvement resources
Learn more about quality improvement with these resources from SA国际传媒:
- Improve EMS quality with a model that works
- EMS quality improvement through clinical specialty teams
- EMS chiefs: Listen for theories
- How to make improvement in EMS automatic thinking
- Quality improvement in action: Cutting opioid overdose deaths in half
- EMS QI: Focus on what matters to patients
- How EMS should benchmark for improvement
