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Journey to 2050: Creating a Culture of Innovation

When the first iPhone was released in June 2007, its beautiful touchscreen and “apps” were a revelation. Today, just 12 years later, smartphones are so ubiquitous that “smartphone zombies” are a new menace at crosswalks. Smartphones have transformed our society and nearly every consumer experience, from how we navigate our cars to how we buy toilet paper to even how we raise our children. In 12 short years the world has dramatically transformed around us. 

When we embarked on EMS Agenda 2050, the vast span of time from now to 2050 was one of the most daunting challenges we faced. How will the technology advance over the next 30 years? How will the world change? Fortunately we were wise enough to know that any effort to predict the future is largely futile. Instead we focused on ways to create adaptable and innovative EMS systems that are prepared for whatever unimaginable technology and other changes the future holds. 

Indeed, among each of the six guiding principles anchoring EMS Agenda 2050’s vision of people-centered EMS systems, the principle of “adaptable and innovative” may be one of the most challenging. And yet it’s among the most important—to remain truly people-centered and stay true to their other guiding principles, EMS systems must continually evolve and grow to meet the changing needs of their communities. Over the next 30 years, we cannot fathom how the political landscape might change, what impact climate change may have, how payment structures will affect us, or what new technologies we will leverage—but there are concrete steps you can take to ensure your system evolves and thrives.

Recognize that innovation is a skill—Technology comes and goes. And eventually even the most stalwart giants become obsolete (see Kodak, Xerox, Blockbuster—the list goes on). The good news is that innovation is a practice—a culture, a discipline, and a skill set. Most important, leaders and innovators can study these traits and adopt them anywhere. Not sure where to start? Look for innovation, lean, or design-thinking classes or seminars in your community or take free online classes, like those from EdX. The truth is that most innovators are not Steve Jobs or Jeff Bezos; they are people who passionately believe in change, and all of us can learn ways to become more innovative and support innovators within our organizations. 

Fail fast and fail early—Possibly the biggest barrier to innovation is the fear of failure. We don’t like to make mistakes, and in EMS we often associate mistakes with bad outcomes. Add the demands of ethics and patient safety, and it seems like the barriers to risk-taking are ever higher. However, there are ways to safely test innovations and quickly know how successful they are—and quickly decide whether to build upon them. Start small, with specific goals that can be measured and evaluated. Experiment without ego. Use a model like the plan-do-study-act (PDSA) cycle. Test new ideas with one crew, one shift, or one division. Don’t be afraid to try new things, and don’t be afraid to say those new things didn’t work or need further tweaking. Learning from your first small experiment when the stakes are low is far preferable to learning when you have patient lives or hundreds of thousands of dollars on the line. 

Start small—Innovation doesn’t always mean spending more money or using new technology. In fact, sometimes it’s just the opposite. While many healthcare innovations require an investment in equipment, training, or other resources, sometimes the simplest innovations are those that reduce complexity or simply shed light on a problem. Consider collecting data on your quality or safety outcomes and comparing it with a nearby agency’s. Do your numbers meet the standards you have for your agency? Is there variation among agencies? Why? What could be done to reduce variation and improve outcomes? Step by step you’ll embark on a truth-seeking journey that identifies your key pain points and sparks ideas for practical solutions. 

Creating a culture of innovation takes work—Innovation often comes from the top, but it just as frequently comes from other sources—new employees who come without the biases veterans of an organization might have, or even patients or experts or students at local colleges. Perhaps the most obvious but most difficult way to create an innovative organization is to make sure leadership is open to new ideas. People within your agency should feel comfortable suggesting different ways of operating and know those ideas will be taken seriously, even if they are ultimately not adopted. Taking it a step further and holding innovation contests—sometimes with rewards such as cash prizes, uniform stipends, or an extra day of leave—are another way some departments foster a culture of innovation and adaptability. 

Form partnerships—Creating a culture of innovation is one thing—finding time to take a step back from the day-to-day realities and think about new ways to do business is a different story. Use your community as your resource. Other community organizations may have the skills and resources to partner with you (and vice versa) to tackle common problems. Local colleges and universities often want real-world projects for students and researchers to work on—students studying technology, engineering, statistics, or public health. For example, the EMS system in Austin, Tex., has developed fantastic local partnerships, collaborating with the University of Texas Design Institute for Health and working with UT students to perform an in-depth analysis of possible community health innovation projects. In addition to academic institutions, technology firms and incubators are other often-untapped resources filled with people who might be looking for projects that serve their communities. 

Like each of EMS Agenda 2050’s guiding principles, creating an adaptable and innovative EMS system starts with how we educate our workforce. Students in EMS programs must learn early that the industry will evolve—that research will change how we clinically treat our patients and technologies will create new ways of communicating with each other and our partners throughout public safety and healthcare, and more. 

In EMS we take pride in our ability to adapt on the scene of an incident, but we often struggle to adapt to broader changes in how we operate. Rather than resist change, we need to seek out ways to foster innovation and embrace new ideas. Only then can we truly achieve our goal of a people-centered EMS system that best serves our patients, communities, and profession.  

YiDing Yu, MD, is an internist at Atrius Health in Massachusetts and the creator of Twiage, a digital platform that enables the transmission of real-time data from ambulance to hospital.

Ernesto Rodriguez, MA, EMT-P, is the chief of Austin-Travis County EMS in Austin, Tex., and a certified improvement advisor with the Institute for Healthcare Improvement.

Kevin G. Munjal, MD, MPH, is a board-certified EMS physician and the medical director for community paramedicine at Mount Sinai Health System in New York. He is also founder and chair of the New York Mobile Integrated Healthcare Association. 

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