Quality Corner: Part 2--The Quality Coordinator

No one in EMS has a more important job than the quality coordinator, and no one has a greater opportunity to make a positive difference on such a large scale. But it doesn't take a genius to be great at quality improvement. All it takes is a little dedication. Much of the work of the quality coordinator is tedious, unglamorous grunt work. But if you're willing to invest some time and effort, you can have a dramatic agencywide impact on patient care. Whether you got to where you are by promotion, demotion, light duty or blackmail, if you have the desire, you can make a difference.

In fact, you can make a difference more than one call at a time. Anyone who's been in EMS for any length of time knows the thrill of a successful resuscitation or turning the tide of impending death and delivering a patient to the hospital in better shape than they were found. That's an awesome achievement and the very reason most of us got into EMS. But that's one call, one fleeting moment. You may ride that high for a while, but by the next day it's ancient history. The quality coordinator has the rare opportunity to produce positive change on a scale much greater than just one call at a time.

Imagine being the first person to really look at how your agency is handling "routine" calls, instead of just the high-intensity, high-profile calls that typically get all the attention. Imagine uncovering instances of downgraded care based simply on a single set of stable vital signs taken as a snapshot in time and to the total exclusion of the history of events which, to the objective observer, clearly warns of potential disaster. Imagine discovering inefficient, inappropriate or possibly dangerous trends of several providers or perhaps an entire agency, which could easily be resolved with a simple memo alerting providers of the risk. Imagine providing feedback to providers on how to improve the quality of their patient care and coordinating training with actual identified needs based on a comprehensive review of calls. Maybe that's not as intense of a rush as saving an individual life in the field, but all in all it represents a much greater impact on a much larger scale.

Management vs. Leadership

A willingness to put the hard work into a change as massive and ongoing as developing a quality program is the difference between management and leadership. Management all too often has become the art of maintaining the status quo. And in the manager's defense, dealing with the day-to-day operations of an agency does have a strong tendency to draw you in, pull you down and keep you from moving ahead. Unlike the typical line officer, the quality coordinator has an opportunity to focus directly on improving the core business of EMS, patient care, and moving it forward.

There are many different EMS systems and agencies out there, all with their own histories, dogmas and bureaucracies. Some quality coordinators take the job to get off the street; others take it as a promotion; still others get it as a punishment. Despite the best of intentions, many quality coordinators are prisoners of their systems. They take over QI programs, and if they're lucky, they may receive a brief orientation by their predecessor on how to continue the failed or mediocre processes that came before them. Rarely are they offered any formalized training regarding administration of a quality improvement program.

Look to See

The first step to correcting any problem is to take a good, hard objective look at what's really going on below the surface and acknowledging that opportunities for improvement exist.

The three components of a comprehensive quality improvement program, as described last year by EMS World, are retrospective review, prospective review and concurrent review. Retrospective review is the component that first comes to the minds of most people when quality programs are mentioned. It's also the component most commonly performed. Retrospective review means the review of call documentation or patient care reports. Concurrent quality improvement is evaluating and monitoring what's going with patient care in real time. Prospective quality improvement is everything you do to improve the quality of patient care before calls come in, such as con-ed courses, in-service training, call feedback, counseling sessions, memos or bulletins, and any changes in equipment, medications or the physical setup of ambulances for purposes of increased safety or efficiency. For the most effective results, you should incorporate all three of these components into your quality improvement program.

If you're a quality coordinator who has discovered or developed a successful quality care initiative or program, write it up and share your brilliance with the rest of EMS as a guest columnist at Quality Corner. Submissions should be about 900 words; please also include a short biography and head shot. Remember, none of us are as smart as all of us.

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.