Catalyzed by issues like combative patients, exposure to bloodborne pathogens, and responding to mass casualty incidents, improving EMS provider safety has been increasingly prioritized in the last couple decades. The lackadaisical approach to workplace safety transitioned to one of greater urgency. In the meantime, focusing on patient safety seems to have fallen to the wayside.
“Many still believe that patient safety isn’t really part of our EMS vocabulary. We don’t get a lot of educational training around it in our EMS education or formative process as other healthcare providers do,” says Lee Varner, MSEMS, CPPS, EMT-P.
As the patient safety director of EMS Services at the Center for Patient Safety (CPS), Varner, a veteran paramedic of over 20 years, aims to change that lack of training. The nonprofit organization works across the continuum of healthcare to help organizations find creative solutions for reducing preventable harm.
“On the provider safety side of things, we began to understand we needed to start doing things differently. We needed to institute greater workforce safety, whether it’s BSI, scene safety and injuries, staging on unknown EMS calls—that wasn’t common years ago,” says Varner. “It took leaders and stakeholders in our industry to realize we need to be doing things differently to protect our providers and in a similar way we’re in the same place with patient safety.”
When CPS started working with EMS about five years ago, the main goal was to improve the overall safety culture by shifting each organization’s current model to one of a ‘just culture,’ or a model of shared accountability. After teaming up with the Missouri Ambulance Association and other EMS medical directors, the project flourished.
“We talk about patient safety as really being a journey. We all see the destination or the goal of what we want to ultimately end up with—safer care for our patients and a safer place for providers,” says Varner. “It doesn’t matter where you’re at. It’s more important to have the willingness and the desire to be moving along that journey.”
CPS offers a number of avenues to begin that journey. Its most popular avenue is Patient Safety Boot Camp, an 8-hour workshop composed of topic presentations and small group discussions. The workshop highlights the basic philosophies of patient safety, covering topics like leadership’s role in patient safety and near-miss events. Most importantly, attendees are asked to reflect on four fundamental questions: what are they doing now that’s working, what do they need to improve, what do they need to start doing, and what is a goal to keep in mind for the future that’s not currently plausible for their organization.
“We want our attendees to leave there with a patient safety plan in hand, as well as an understanding of ‘What should I do when I get back home to my organization?’ So, we walk them through a prioritization matrix to understand ‘This is where I should begin when I get back to my organization,’” Varner says.
There’s a disparity in the way EMS handles patient safety compared to the rest of the healthcare continuum, Varner says, due to the oversight of establishing regulations in the industry, contributing to the lacking education. The formative years of training teaches providers that following protocols to the T automatically equates to safe, good quality care, he says. Mistakes happen, though, and it’s important to understand why they happen.
“We need to understand why mistakes occur, how we can build resiliency into our work, into the systems and processes, and adopt a culture within our industry where we are learning from our mistakes,” says Varner. “So, a lot of our work at the Center is focused around developing the culture that supports patient safety and preventable harm.”
It’s in these terms, he says, that patient safety needs to be discussed. It’s important to have a solid grasp on the meaning of preventable harm since it is so often overlooked in education.
“We want to do the best that we can, but unfortunately, we're human. And since we're human, we're prone to errors and we make mistakes,” Varner says. “Unfortunately, a lot of those mistakes reach our patients, and they can also reach the public or providers.”
Aside from the detriment of mistakes affecting patients and providers, Varner understands the hesitance to openly discuss the topic of patient safety, especially when it comes to reporting mistakes made on the job.
“In EMS, we’re not really taught that we should report things. We’re also working in that culture where we’re fearful to report things because of the punitive environment,” says Varner.
Another hindrance to reporting is the simple lack of understanding of key terms like ‘near-miss’ or ‘adverse event’ from a clinical standpoint, Varner says. Even if providers do want to report an event, most EMS organizations don’t have structured reporting platforms, resulting in a lack of collected data. This is a major obstruction to improving patient safety in EMS.
“It’s really shifting that culture from being reactive to proactive,” says Varner. “We should want that data. We should want to understand why things are occurring, what those causal factors are so we can address those areas. So, we’re looking at it in a learning environment, not one as a punitive environment.”
One way CPS helps to gather this type of data is being a federally listed Patient Safety Organization (PSO). As a PSO, they collect healthcare providers’ data about unsafe conditions, near-misses, and adverse events to identify and analyze trends around issues like airway events or medication errors. The information is then shared through watches and safety alerts.
CPS also shares these trends via social media and their website so EMS personnel are aware of them. Providers can learn more about these topics through CPS’s #EMSForward page, where they identify key issues and provide questions that prompt providers to assess their organizations’ approaches to these topics.
EMS organizations’ goal should be working towards becoming a “high reliability organization,” which is “an organization that has a preoccupation with failure,” Varner says. Due to the unpredictable and often chaotic nature of EMS combined with the potential for human error, it’s imperative that organizations are mindful of their quality of safety practices.
“Look at this work as a journey. Realize there are probably many places to begin but to understand [an organization’s] destination—and that’s safer care for their patients and a safer place for their workforce,” Varner says. “It really begins with the culture of the organization and that means measuring their culture—looking at their strengths, their opportunities, and being able to come back and re-measure that culture like we see other healthcare providers doing. Find somebody within the organization to be the champion for this work.”
CPS welcomes providers to call them to learn more about assessing their organizations’ safety culture and how to improve it, and they will even visit them on site. “We help people work through process improvements, develop action plans, look at what’s happening at the provider level, management level, the senior leadership level and help them develop a comprehensive plan,” says Varner.
Varner believes this process will help EMS be considered equal to other healthcare sectors. “I think it’s time that our profession takes action,” he says. “Mistakes occur every day and our leaders and stakeholders need to be addressing this topic. It’s part of the maturation process that we would see any industry move towards. We need to move away from viewing what we do in EMS as ‘rescue only;’ that we really are healthcare providers. That’s what we’re doing—we’re taking care of people.”