Quality Corner--Part 7: CQI as a Career Path

One of my favorite quotes by Drina Reed is, "If you want something you've never had, you have to do something you've never done."

In my former life, I was a software consultant where I performed computer programming, systems analysis and design duties. The analysis and design was mainly small components of businesses like accounts receivable, customer complaints and return goods etc. But, like FEMA's ICS (incident command system), systems analysis and design is size-adaptable. Whether you perform analysis and design for an entire business or a portion of it, the skills and tools required are the same--only the scale is different. Once you learn the basic concepts of systems analysis and design, you never see the world in quite the same way again. As you view any process, you immediately notice the flaws and opportunities for improvement. System analysts may retire, but they never stop analyzing.

The whole time I was learning my trade as a system analyst, I was also involved in an alternative enterprise known as EMS. In the beginning, EMS was all volunteer, but it eventually grew into a part-time job. Then, in 2003, the bottom of the software consulting market dropped out for me. Fortunately, I had enough money and investments to pay off my house. With that financial burden lifted, I had the freedom to do whatever I wanted, and it wasn't going to be business. I earned a great living and learned some skills that would serve me well for the rest of my life, but business wasn't nearly as rewarding or satisfying as EMS. I was a wage slave, doing a job I'd grown to really dislike and many times even dreaded.

In business, the pressure is frequently unbearable, unlike EMS. That may sound ridiculous, but it's the absolute truth. Business is all about making money, and the conventional corporate mentality is that you can never make enough. No profits are ever big enough to satisfy the beast. Nor does it matter what obstacles stand in the way of achieving those profits. The economy is bad? No excuse, where's our profit? The new software is going in late because of a power outage? No excuse, where's our profit? It's the worst kind of stress imaginable, because while you have no control over all those "uncontrollable" circumstances, it never alters the expectation, demands or unrelenting greed.

Conversely, EMS, and medicine in general, is simply life and death, but with reasonable expectations. Everyone knows some patients are going to die regardless of your best efforts. And, despite suffering the most devastating loss possible, family members will still thank you for doing all you did for their loved one. In business, if a project is delayed by even one hour due to any unavoidable circumstance, you rarely hear a kind, appreciative or encouraging word.

Having lived these two parallel yet radically different lives for 20 years, when given the choice, I opted to abandon the much higher paying job for the nobler, more meaningful and appreciated profession of EMS and never once looked back.

Those 20 years in business were not without their advantages. I did learn the skills which have helped me to transform quality improvement at my agency from one of moribund inertia to imaginative progression with measurable results; most notably, a 20% increase in the ALS treatment rate. Now, having thrown that number out, let me immediately follow with the caveat that there is nothing magical about any number for the number's sake. I remain as suspicious as ever about statistics. A statistic only has actual, factual meaning when verified with the detail data. In this case, this statistic was verified by review of 100% of our call volume and validated by the final arbiter of patient care--the unit's medical director. This dramatic increase in the level of patient care confirmed by the medical director, along with other improvements initiated, made me look like a genius and catapulted me to deputy chief.

Although sometimes forgotten, patient care is the core business of EMS. At many EMS agencies throughout the country, quality assurance/improvement has forever been nothing more than the perpetuation of an unimaginative moribund process, which is there by law because it has to be, but which lies dormant until harm is done or a complaint is filed.

If you are the person who has been promoted, demoted or blackmailed into taking the quality coordinator position, and you are willing to think outside the box and break free from doing things the same old way for no other reason than that's the way you've always done them, you can dramatically improve the standard of your patient care.

One of the quickest, easiest and most effective ways to do this is being willing to utilize external resources and networking. Those external resources are for the first time now available at EMS World via this Quality Corner column, the Quality Corner online forum and, coming in July, the first book written by an EMS quality coordinator for EMS quality coordinators--CQI for EMS--a practical manual for QUICK results. When you dramatically improve your agency's patient care with the help of these external resources, you don't have to tell anyone where you got your ideas if you so choose. As the author of the Quality Corner column and the CQI for EMS book, I'm perfectly okay with anyone borrowing my ideas and leaving your colleagues to believe that it was all you, especially if this could help advance your career. But, in the final analysis, most people won't care whether you improved patient care as a result of all your own original ideas or because you were resourceful enough to seek out good ideas wherever they could be found. Because, while business and EMS are very different enterprises, they do share one similarity: When it comes to results, most people don't care so much how you did it as much as that you did it.

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 EMS agencies in northeastern Pennsylvania. He has 30 years' experience in EMS. Contact Joe at jhayes763@yahoo.com.