Putting It Into Practice

   In April 2009, EMS consultant Mike Taigman took a job as general manager at American Medical Response in Alameda County, CA. In the 1½ years since, Taigman has made significant inroads in improving the system. At the 2010 Pinnacle EMS leadership conference in San Diego, Taigman spoke about that progress and how it was achieved. Here he elaborates for EMS World.

One of your first tasks at Alameda County involved developing a new statement of purpose for the agency. What did that involve?

   When I got here, it didn't seem like the corporate mission statement had dialed in to the local folks, so we had some town hall meetings to chat about things and did an employee survey to ask questions like "Why are we here?" "What do you like about being in this business?" "What matters to you about what's here?" Out of that came a purpose statement that says: "Our purpose is to reduce suffering and improve health. Our vision is to measurably improve the health of our community." A lot of places have mission statements, but our folks have really embraced this as pretty much an everyday, moment-by-moment guiding principle.

One of your projects involved benchmarking. What does that mean?

   When it comes to quality management and performance improvement, most people study best practices and try to learn from them, so they can adapt things other places are doing for their own situation. When EMS people talk about benchmarking, they have this idea that we're all going to collect the same data and then compare it to see who's best. We did benchmarking in a few different areas. To look at cardiac arrest resuscitation, we made two trips to Seattle to visit the King County Medic One folks and see how they approach it. We went to Minneapolis and studied the Take Heart America/Take Heart Minnesota project so we could come back and incorporate their practices and principles into what we do. Also, we looked at the way Minnesota fire departments have researched and created their customer satisfaction measures, and used that as a framework for the ones we use. We also benchmarked the sepsis program coordinated by the folks out of Porter Adventist Hospital in Littleton, CO, and we looked at the Emed Health group at the University of Pittsburgh and what they're doing with asthma readmission prevention.

You referred to the "pit crew approach" to cardiac resuscitation. Explain what that means.

   That came out of our conversations with the Seattle Medic One folks. In a NASCAR race, one of the keys to a good performance is to have the fastest possible pit stop. Since our race is about unnecessary death in cardiac arrest, a pit stop is any time you pause compressions to make a diagnosis, do a defibrillation or manage the airway. The medics in Seattle allow 10 seconds for an ALS pit stop. If it takes 11 seconds, you have to explain why it took so long. We've been working on it in Alameda County, but the difference is that Seattle has two full-time data analysts who go second-by-second through the recordings of both the automatic defibrillators and the 12-leads so they can map each cardiac arrest and see what was going on. Their quality analysis is better than anybody else's on the planet. Our system doesn't quite have the resources to do that yet, but we're teaching the principles.

You've put a lot of emphasis on employee satisfaction and relationships. What improvements have been made since you took over?

   One of the first things I did was an employee satisfaction survey, using a series of questions that are predictive of employee dissatisfaction and turnover. I've worked with a lot of organizations, and I wouldn't say the AMR employees were more disgruntled than any other group I've been around, but there were several sources of frustration and some challenging interactions with supervisors. We've made good progress on some things, and progress has been slow in other areas, like getting people off on time at the end of their shifts. We do town hall meetings, and I spend a lot of time in the field trying to be open and available to people. I'm also Facebook friends with most of my employees. I know there's controversy about that, but I really like the folks I work with and don't find a need to have some of the boundaries some managers do. We don't talk about work on Facebook; it's a way to stay in touch and build community. I don't approach it like I'm the boss and they're the employees. It's a social network and designed to be personal.

Your agency is heavily involved in the community. Who are some of the groups you're working with?

   When I took over here, it quickly became obvious there are a lot of people already working on issues like asthma and diabetes, and it seemed better for us to just partner with those organizations and help them execute their missions more effectively than to try to invent something of our own. When the Ethnic Health Institute—which has managed to bring all the hospitals, medical schools, clinics and the health department together to improve the community's health—invited us to sit at the table with them, they thought it was so cool that 450 EMTs and paramedics wanted to collaborate. Because of the high asthma rate in West Oakland, we've worked with the institute and the Alameda County Public Health Department to train EMTs and paramedics as asthma self-care educators who can teach people how to use their medications and clean their homes of asthma triggers, so they don't need to go back to the ED. Related to that, we've partnered with a group called Urban Releaf, a forestry group that plants trees in urban areas of Oakland and Richmond to rid the air of diesel pollution. When diesel-polluted air passes through the leaves of certain deciduous trees, it is purified of 60%-70% of the pollution, so the goal is to plant trees in an attempt to decrease asthma rates in certain neighborhoods.

   Finally, we've partnered with the faith-based community and taught CPR to pastors and some of their congregations. We also participated in Hypertension Sunday, where paramedics, EMTs, doctors and nursing students went to 29 churches in North Oakland and took blood pressures as people came out of services. Out of 1,200 blood pressures, only 40% were normal; 60% of people had hypertension, and about half of those didn't know they had it. A physician at each location referred those people to see their physicians or go to free clinics, and we followed up to make sure everyone we identified was treated.

What do you see for the future?

   Unfortunately, we've lost the contract with Alameda County, and they will be transitioning to a new provider. As a corporation, AMR has been totally supportive of all my crazy ideas. They have been encouraging and supported me financially and with resources to work on making this all happen.