EMS Innovations 2009: A Five-Part Series

Customer Service Key to FedEx Success

More than 35 years ago, Fred Smith launched the air-express industry with an idea forged during his college years at Yale. Legend has it that he received a C on his visionary paper that outlined what would make him and his company a leader in customer service and parcel delivery: management and quality values emphasizing people first, service second, and a belief that profit could ensue from those. Over the years, Smith's company achieved high levels of customer satisfaction and loyalty and experienced rapid growth. Annual revenues exceeded $1 billion within 10 years of the company's founding. FedEx became a standard in the air and ground delivery of America's packages and parcels. In 1990 it was the first service-based recipient of the coveted Malcolm Baldrige National Quality Award.

The company's growth led to various levels of services. Soon FedEx was providing international shipping and catering to the delivery needs of the world. With expansion and growth came the realization that ever-higher goals for quality performance and customer satisfaction had to be realized by enhancing and expanding service, investing in advanced technology and building on the company's reputation as an excellent employer.

Tradition Can Be a Hindrance

The fire service is notorious for being steeped in tradition. This affinity has sometimes been a hindrance in improving its quality of service and system issues in need of change to enhance service and productivity.

In the 1980s, I worked for a large metropolitan fire department that worked 24-hour-on/48-hour-off shifts—not so unusual, right? Well, the odd thing was that we began our shifts at 3:30 in the afternoon and ended them at the same time the next day. Then a new administration came in and added EMS to its list of responsibilities. Before long, the new EMS chief, seeing his busiest crews exhausted, asked why we had such odd hours. No one had an answer. He asked for the hours to be changed to something more standard: 0700 to 0700. This would allow a full 48 hours of off-duty normalcy for employees, making them more rested and productive. The fire chief was against the change because--are you ready?--"We've always done it this way."

A bet was made. If the fire chief could show, with written documentation, why maintaining these hours was beneficial, they would remain the same. If he could not, he would agree to change them, giving employees two "normal" days off. People were interviewed, news articles researched, log books and journals scanned, and there it was: Back in the 1800s, the oncoming shift tended to the horses at 3:30 p.m. each day. This was the only thing we found that seemed to account for the 3:30 shift change. The fire chief, losing the bet, then moved to an 0700-0700 schedule.

J. Harold "Jim" Logan, BS, EMT-P/IC, is a lieutenant firefighter/paramedic with the Memphis Fire Department, specializing in EMS consequence management and quality improvement. Contact him at jim.logan@memphistn.gov.

Part 4: Painkillers--North Memorial Medics Reducing the Hurt

Everybody hurts. Not everybody who calls 9-1-1 for pain gets the relief they could in the prehospital environment. One late-1990s study in Ohio found that of 1,073 patients with suspected extremity fractures, just 18 (1.7%) received analgesia from EMS providers.

EMS can do better at treating its patients' pain, and medics with Minnesota's North Memorial Ambulance Service are demonstrating how. By emphasizing this often-overlooked aspect of care and arming its crews to address it aggressively, the service reduces suffering and delivers patients to hospitals as pain-free as possible.

"What we're trying to do," says Associate Medical Director Marc Conterato, MD, FACEP, "is help people through a difficult time, and help them understand that while nothing will magically relieve their pain, we can do things that will help."