Quality Corner--Part 7: CQI as a Career Path

One of my favorite quotes by Drina Reed is, "If you want something you've never had, you have to do something you've never done."

In my former life, I was a software consultant where I performed computer programming, systems analysis and design duties. The analysis and design was mainly small components of businesses like accounts receivable, customer complaints and return goods etc. But, like FEMA's ICS (incident command system), systems analysis and design is size-adaptable. Whether you perform analysis and design for an entire business or a portion of it, the skills and tools required are the same--only the scale is different. Once you learn the basic concepts of systems analysis and design, you never see the world in quite the same way again. As you view any process, you immediately notice the flaws and opportunities for improvement. System analysts may retire, but they never stop analyzing.

The whole time I was learning my trade as a system analyst, I was also involved in an alternative enterprise known as EMS. In the beginning, EMS was all volunteer, but it eventually grew into a part-time job. Then, in 2003, the bottom of the software consulting market dropped out for me. Fortunately, I had enough money and investments to pay off my house. With that financial burden lifted, I had the freedom to do whatever I wanted, and it wasn't going to be business. I earned a great living and learned some skills that would serve me well for the rest of my life, but business wasn't nearly as rewarding or satisfying as EMS. I was a wage slave, doing a job I'd grown to really dislike and many times even dreaded.

In business, the pressure is frequently unbearable, unlike EMS. That may sound ridiculous, but it's the absolute truth. Business is all about making money, and the conventional corporate mentality is that you can never make enough. No profits are ever big enough to satisfy the beast. Nor does it matter what obstacles stand in the way of achieving those profits. The economy is bad? No excuse, where's our profit? The new software is going in late because of a power outage? No excuse, where's our profit? It's the worst kind of stress imaginable, because while you have no control over all those "uncontrollable" circumstances, it never alters the expectation, demands or unrelenting greed.

Conversely, EMS, and medicine in general, is simply life and death, but with reasonable expectations. Everyone knows some patients are going to die regardless of your best efforts. And, despite suffering the most devastating loss possible, family members will still thank you for doing all you did for their loved one. In business, if a project is delayed by even one hour due to any unavoidable circumstance, you rarely hear a kind, appreciative or encouraging word.

Having lived these two parallel yet radically different lives for 20 years, when given the choice, I opted to abandon the much higher paying job for the nobler, more meaningful and appreciated profession of EMS and never once looked back.

Those 20 years in business were not without their advantages. I did learn the skills which have helped me to transform quality improvement at my agency from one of moribund inertia to imaginative progression with measurable results; most notably, a 20% increase in the ALS treatment rate. Now, having thrown that number out, let me immediately follow with the caveat that there is nothing magical about any number for the number's sake. I remain as suspicious as ever about statistics. A statistic only has actual, factual meaning when verified with the detail data. In this case, this statistic was verified by review of 100% of our call volume and validated by the final arbiter of patient care--the unit's medical director. This dramatic increase in the level of patient care confirmed by the medical director, along with other improvements initiated, made me look like a genius and catapulted me to deputy chief.