This month we continue our discussion of professional behavior in EMS by examining the concept of commitment to excellence. To begin, we return to Dr. Herbert Swick's 2000 article "Toward a Normative Definition of Medical Professionalism." Swick said, "Physicians demonstrate a continued commitment to excellence."1 As we have done each month, let's define the terms in Swick's statement so we can begin our discussion on firm footing and then consider how this concept applies to EMS practice.
The two key terms in Swick's statement are commitment and excellence. How would you define commitment? Take a minute to think about it. One online definition describes commitment as "a pledge or promise to do something" and "dedication to a long-term course of action; engagement; involvement."2 Another says it is "the state of being bound emotionally or intellectually to a course of action."3
What is excellence? It seems like a simple idea: the very best, high quality, high performance. How would you define it? One definition includes "the quality of being excellent; state of possessing good qualities in an eminent degree; exalted merit; superiority in virtue."4
What Excellence Looks Like
"The quality of a person's life is in direct proportion to their commitment to excellence, regardless of their chosen field of endeavor." --Vince Lombardi5
How should we as EMS practitioners demonstrate our continued commitment to excellence? I believe we all should promise to serve, respond and provide the best care we can. We also should follow the ideal to "do no harm." There is an echo of core values here.
Each of us, to be the best we can be, must continually strive to keep up with changes and advances in medicine and apply them to our prehospital practice. How many times has the methodology of CPR changed? Several times in my career. Do any of you remember "four staircase ventilations"? We will likely see more changes later this year with the next update.
Why does CPR continue to change and evolve? Because research--scientific inquiry and analysis--shows us what works and what doesn't. We adapt how we do CPR to continuously improve effectiveness. In turn, we hope to improve a person's chance of surviving sudden cardiac arrest. We are pursuing excellence.
How else might this pursuit of excellence manifest? I hear discussions about developing a "culture of safety" in emergency services. This may include always wearing a seat belt, and ensuring everyone else in the vehicle is wearing theirs as well. Do you always wear your seat belt in the ambulance? How about in your personal vehicle?
Pursuit of excellence in safety may mean changing the way ambulances are designed, demanding better configuration before purchasing one. It also means constantly working to be safe drivers. Pursuing personal excellence might include attending conferences, joining professional associations, and political activity such as participating in the development and review of EMS legislation.
The Emotional Bond
"Desire is the key to motivation, but it's determination and commitment to an unrelenting pursuit of your goal--a commitment to excellence--that will enable you to attain the success you seek." --Mario Andretti6
The other night I was thinking about excellence and commitment and how they apply to EMS practice. It occurred to me that it was really about emotion, and how we feel about what we do. Although I have heard discussions about attitude and EMS instructors and educators trying to address the affective domain of performance--the educational domain concerning emotion--we almost never talk about emotions. The work we do is stressful and can have enormous emotional impacts, yet in my opinion we do very little to prepare EMS practitioners for this critical aspect of working in EMS.