One of the biggest challenges in any business is changing employees’ behavior. Quality improvement in EMS is no exception. Hopefully you have identified the opportunities for improvement you’d like to see at your agency; if so, the next step is knowing how to effectively communicate those desired changes to your providers. Communication is the critical step in quality improvement and the most common stumbling block to progress. Here are some suggestions for communicating your ideas to the troops.
Newsletters and General Announcements
Identify an area in need of improvement, such as an inequity in how various medics treat cardiac chest pain. Write a one-page review of the assessment and treatment of ischemic chest pain. Emphasize the importance of early aspirin administration and 12-lead acquisition, if applicable to your service. Stress the importance of a thoughtful working diagnosis. Not all chest pain is ischemic in nature, and it should not all receive cardiac meds, but all chest pain patients should at a minimum receive cardiac monitoring and a 12-lead ECG if available. The goal of standardized care should be emphasized, so that every patient receives the same care no matter which medic they get.
When writing a newsletter article on patient care, reference multiple sources. Include interesting and meaningful tidbits of information, such as the Thrombolysis in Myocardial Infarction (TIMI) study group’s finding that early aspirin for the AMI patient, chewed for rapid absorption, has been linked to a survival rate comparable to that of tPA, the primary clot-busting drug used for thrombolysis by ERs. It is important to keep newsletter topics short, sweet and to the point--no more than one page, using medium to large print to increase the likelihood that providers will actually read it. Use bold face, italics and underlining to emphasize key points and increase the chance that providers who won’t read even one page might still walk away having learned something just by skimming it. If something bolded or underlined grabs a reader’s attention, they may even read the rest of article.
For providers who will read more than just one page, search the Internet for supportive literature. You might highlight the title and, if you really want to spoon-feed them, highlight key points as well. Then leave copies around the station.
Once you get established with the newsletters, invite other providers to produce or contribute to them. If you schmooze them just right, they may be flattered to be asked. I realized after doing several of these newsletters that I ended up learning quite a bit by researching and writing them. This validated the old adage that the best way to learn something is to teach it. So why not share the wealth? An especially good way of doing this is tapping a provider who has just had an interesting call or, better yet, a call where there were problems.
Simple, specific issues that require rapid correction may be handled by the general announcement method, which may be most effectively communicated by memo or posting. Examples of this might be if medical command is not being called for patient refusal authorizations for syncopes, aspirin is not being administered to acute cardiac syndrome patients or copies of ECGs are not being included with PCRs. As a rule, include no more than three issues or five or six sentences in a general announcement.
Display and distribution is critical, and you may opt to print the newsletter or announcement on the brightest paper you can find. I use the organizational colors of the agencies where I work…on steroids. For Bucks County Rescue Squad, where we use the traditional EMS colors of orange and blue, I ended up using international orange and electric blue. At Central Bucks Ambulance, I use lime green and screaming yellow. I alternate colors of the newsletter every other month. If nothing else, this should help draw attention, which is half the battle in quality improvement.
General announcements are placed in each provider’s mailbox to ensure all providers are notified. Just to leave nothing to chance, we additionally post them on all doors leading to the apparatus room floor, so they’re literally the last thing providers see before taking calls.
My most imaginative and effective measure by far was posting the newsletters over the urinal in the men’s room and on the back of the commode door in the ladies’ room. That took full advantage of a captive audience and exposed them to learning when they least expected it. I’ve had several people tell me they learned more going to the potty than they did in some con-ed classes they’d taken.
You can have a crystal-clear vision of how you’d like to improve patient care, but if you do not articulate it to the people who are actually performing the patient care, it’s not likely to be realized. Effective communication is the key to success.
If you’ve discovered a better way of doing things or developed a successful quality care initiative, why let the benefit end with just your agency? Share your insights with the rest of EMS as a guest columnist for Quality Corner. For more information, contact EMS World.
Joe Hayes, NREMT-P, is deputy chief of the Bucks County Rescue Squad in Bristol, PA, and a staff medic at Central Bucks Ambulance in Doylestown. He is the quality improvement coordinator for both of these midsize third-service agencies in northeastern Pennsylvania. He has 30 years' experience in EMS. Contact Joe at firstname.lastname@example.org.