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What Makes a Good Quality Improvement Program?


As value-based purchasing continues to transform the healthcare environment and EMS shifts from an episodic healthcare model to a community-based/primary care model, proving the quality of the services your EMS agency delivers will be vital for future reimbursement.

Just thinking you have a quality organization is not enough—you have to prove it. For EMS to be successful as healthcare providers, our quality improvement (QI) programs have to be the driving force in proving not only that we are meeting our customers’ needs, but also that they are receiving positive outcomes and we are being financially responsible.

What Is Quality Improvement?

QI is a formal approach to analyzing an organization’s performance and developing systematic plans to improve it. Strong QI programs measure where you are, determine where you want to be and figure out the best way to get there.

A successful QI program should address the following areas:

1. Operational systems and processes—It is not possible to make improvements in your organization without having an understanding of your delivery system and key processes. At a minimum your QI programs should focus on the four Ps of an EMS system:

• People;

• Place;

• Performance;

• Patients.

2. Delivery and outcome of patient care—A vital measure of quality is our ability to meet the patient’s needs and expectations. When considering the best ways to meet the patient’s expectations, look at the following:

• Improving the processes that affect patient access to care;

• Providing care that is evidence-based;

• Making patient safety a priority;

• Creating a process for patient engagement;

• Integrating with other resources in the healthcare system.

3. A team process—At times we are focused on the one or two individuals who fall short of meeting quality measures. Embracing a team approach allows providers to harness the knowledge, skills, experience and perspectives to ensure lasting improvements. A positive team approach is most effective when it includes the following components:

• A complex process or system that spans across department responsibilities;

• Solutions and understanding that require brainstorming and creativity;

• Staff commitment to success in meeting the metric.

4. Data collection and utilization—Data is the cornerstone of your QI program and will show how well the system or processes are working. It’s extremely important that data systems are created to measure the essential elements of how your organization meets expectations. Using data will help determine:

• What you think is happening vs. what is really happening;

• What the baseline should be;

• How changes implemented led to improvements;

• Comparisons of performance.

Performance Measures in EMS

Healthcare today is taking some very interesting twists and turns. Hospital administrators are kept awake at night determining how to maximize profits to their bottom line. EMS will soon be in the same boat and need to meet the Institute for Healthcare Improvement’s Triple Aim objectives of better patient experience, better health for populations, and lower per-capita costs. Many EMS agencies are moving to meet these objectives today. When thinking about performance measures, even before we pick the appropriate key performance indicators (KPIs) to follow, we need to have an instrument that can assist with measuring our outcomes. This instrument should allow for the following:

• Assistance with establishing baseline data;

• Help establishing goals based on current performance;

• Determining how to bridge the gap between current performance and desired goals;

• The ability to track process;

• The ability to benchmark and compare results.

Once you’ve determined the best way to gather, measure and interpret the data, you can determine which KPIs best meet your organization’s goals.

The EMS Leader’s Role

The success or failure of your department’s QI program begins and ends with you. Your responsibility to create an environment that allows the QI process to function with the needs of internal and external stakeholders in mind is vital.

A majority of organizations have vision, mission and value statements, but can you recite these foundational documents? If you, as the leader of the organization, do not know these foundational principles, why should the workforce know or support them? It is your responsibility to demonstrate a strong commitment to the above principles and set expectations that not only promote quality, but also performance excellence. As the leader, you not only set the standards for your leadership team to follow, but you also create the passion that drives others in the organization to ensure success of the program.

When you think of what your QI program looks like, ensure it achieves a high level of performance and customer service and has a strategic plan to meet the metrics of your KPIs. The QI program’s strategic plan should focus on delivering safe and high-quality care. This should be a plan that is used regularly and not gathering dust on the shelf. Your QI team should also make needed changes and updates on an annual basis, ensuring your KPIs are still meeting the goals of the organization.

With the transformation of our career field, we must now, more than ever, prove our value to the customers we serve. Having high patient satisfaction, positive patient outcomes and getting patients where they need to go is paramount to the future and sustainability of EMS. The continued success of your QI program solidifies your organization’s journey toward excellence.

Chris Cebollero, NREMT-P, is chief of EMS for Christian Hospital in St Louis, MO. He is host of the "EMS Leadership" podcast, host of EMS World's "The World of EMS" podcast and a member of the EMS World editorial advisory board.


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