Over the coming year EMS World, in conjunction with the National Association of EMTs, will provide detailed implementation strategies for key recommendations of the Promoting Innovation in EMS (PIE) project. The PIE project utilized broad stakeholder involvement over four years to identify and develop guidance to overcome common barriers to innovation at the local and state levels and foster development of new, innovative models of healthcare delivery within EMS. Each month we will focus on one recommendation and highlight the document’s actionable strategies to continue the EMS transformation.
Innovation is hard! It involves taking risks, pushing the envelope, and in some cases venturing into uncharted waters that can be treacherous, or at least murky. Agencies nationwide have learned firsthand the risks and benefits of trying something new.
You’ve read about these agencies in EMS World, heard them speak at national conferences, or perhaps even read about their innovations in national media outlets. On the surface it seems easy. But ask the leaders in these innovative EMS agencies, and they will often readily share the scars they’ve incurred from taking risks.
Why is innovation so difficult? What are the lessons we can learn from some of the EMS agencies recognized for implementing innovative approaches to service delivery and patient care?
Innovation begins with a visionary leader—someone who can see something new, something better than the status quo. It requires a telescopic (or at least a binocular) view of the horizon. Many people do great work day to day leading teams to improve the way they operate or deliver patient care. Often these improvements are simply transactional, such as testing a more effective way of call-taking to reduce call processing times, finding ways to reduce activation times for responses, or implementing best practices for airway management procedures to improve patient outcomes. These things are valuable, but again they are generally transactional, not transformational.
Let’s take the call processing example: A transactional enhancement might be using address flags in a computer-aided dispatch (CAD) system to add notes about patients with special needs who live at that address. Address flags in CADs are not new, but using them to add clinical information about people who live there is a transactional improvement (let’s avoid the potential HIPAA issues for the sake of the discussion).
The visionary leader may look at this in a more transformative way: People don’t stay home. They go to the store, they go to work, they visit neighbors and family. What happens if a medical emergency occurs when the patient is not in their residence but, say, at the local Walmart? In this scenario the residence address flag is meaningless. The transformational leader may look for flagging solutions that follow the patient, regardless of where they may be at the time of an emergency medical need. This would require the implementation of a call-taking process and CAD software that can flag people, not addresses.
Yes, this would likely mean investing in a totally different CAD, one not tied to an incident location but instead to the person experiencing the medical emergency. It would also require a transformation of the emergency call-taking process to ask the patient’s name, primary phone number, and date of birth to see whether this patient is registered in the CAD as likely benefiting from a specialized response plan.
This type of transformational innovation sets the stage for the EMS agency to move away from the transaction of always transporting patients to emergency rooms to making patient-centric, clinically appropriate recommendations based on factors such as clinical assessment, medical history, and perhaps even health insurance type. That allows the agency to dramatically change the economic model for providing medical care.
The participants in the Promoting Innovation in EMS (PIE) project fit the profile of transformational leaders because they envisioned a desired state for EMS and worked collaboratively with virtually every EMS stakeholder to painstakingly craft consensus-based innovation recommendations, then articulate barriers to achieving them.
Innovation is messy. There’s likely a chance an innovation could fail. It’s often said that failure is only a failure if you fail to learn, and if you are not failing, you’re not innovating.
The story is often retold that it took Thomas Edison 1,000 tries to develop the light bulb. When asked what it felt like to fail 1,000 times, it’s reported that Edison answered that he did not fail 1,000 times, he learned 1,000 ways how not to make a light bulb. More recently Elon Musk’s SpaceX rockets underwent many “rapid unscheduled disassembly events” before successfully landing back on earth for the first time.
Innovation involves risk—financial risk, reputational risk, and organizational risk. While it can be mitigated through thorough planning, execution, small-cycle testing, and pilots, not everything is going to work perfectly. Innovators must develop a tolerance for risk with which they’re comfortable.
A preliminary review of data from the 2017 NAEMT MIH-CP survey seems to indicate that some of the MIH-CP innovations implemented just a few short years ago are no longer operating. If the final analysis reveals this to be true, some might look at that as a failure. Perhaps instead we should find out from the innovators why the programs were not sustainable and learn how to avoid those challenges in future innovations.
We often hear about a typical example of “failed” innovation. A new project is developed with grant funding. The seed money is used to develop and implement the innovation, but leaders may not look at the horizon and plan for what will happen when the grant funding runs out. Collaborating with these payers before the grant even starts will help determine and report the metrics necessary to demonstrate value.
Some organizations are renowned for being nimble and embracing innovation, while others have reputations for being slow to adapt. Google, Apple, and Amazon are perhaps examples of the former, while Kodak, Blockbuster, and Polaroid could be considered examples of the latter. Assessing organizational readiness for innovation requires an honest assessment of visionary leadership and risk tolerance of the organization’s internal and external stakeholders.
Alan Brunacini, former chief of the Phoenix Fire Department, had a reputation as an exceptionally visionary and innovative fire chief. He created a culture that sought out and implemented change and improvement. However, it may have been nearly impossible for Brunacini to lead the Phoenix Fire Department to becoming one of the most respected departments in the country without the support of his frontline staff, his executive team, or the city’s leadership team.
Commitment to innovation must be bidirectional. Leaders should be willing to envision transformation, while those who will actually implement the transformation need to be willing and able to do so. Some of the best innovations come from those who do the work every day. Consequently leaders should be willing to accept and try ideas brought to them from the field.
Once again we turn to participants in the PIE project for further examples of organizational readiness. Drs. Kevin Munjal and James Dunford sought out visionary leaders from multiple stakeholder groups and created an environment that encouraged consensus-building based on innovative thinking. The PIE team was “change-ready,” willing to not only imagine a desired state for EMS but invest the time, energy, and resources to identify and articulate the barriers to achieving it, whether perceived or real.
Perhaps one reason the group was ready to embrace change was that individuals came from organizations that were themselves implementing innovation—organizations such as Kaiser Permanente, Northwell Health, the Alliance for Home Health Quality and Innovation, MedStar, Medlert, Eagle County Paramedics, the Institute for Healthcare Improvement, and the Center for Emergency Medicine of Western Pennsylvania.
The EMS field has adapted well in the past, but the change occurring now in healthcare is unlike the changes we’ve experienced before. Managing this hyperturbulent environment will not only require visionary leaders who are risk-tolerant and organizationally ready, but strategies to remove barriers through partnerships with groups we’ve not typically partnered with.
In our next column we will begin to explore specific recommendations prioritized by the NAEMT EMS 3.0 Committee and strategies for implementation.
Matt Zavadsky, MS-HSA, NREMT, is chief strategic integration officer at MedStar Mobile Healthcare, the exclusive emergency and nonemergency EMS/MIH provider for Fort Worth and 14 other cities in North Texas. He is a featured speaker at EMS World Expo 2018, to be held Oct. 29–Nov. 2 in Nashville.