Can you hit a moving target?
Alan E. Perry
November 17, 2013
Anyone can tell you that in order to hit a moving target you
must compensate for the motion of the target and the trajectory of the object
you intend to hit in with. It can be tricky enough when you know the values for
these variables, compensating for them, leading your target and adjusting for
elevation, windage, air density and gravity. It is nearly impossible, except
for dumb luck, to accomplish a hit if one or more of these is not known, or
worse is constantly changing. This is the circumstance EMS leaders are finding
themselves in as they try to grasp concepts like community paramedicine, mobile
integrated healthcare and all of their variations being explored throughout
this country and elsewhere.
EMS is no stranger to change; it began in 1967 with an
article titled Death in a Ditch, our
growth as a viable public safety essential service, the 1996 EMS Agenda for the Future, its follow-up
implementation guide and the 2007 EMS at
the Crossroads describing the future of healthcare. We can’t say we didn’t see
the changes coming; many organizations have been quietly and productively
working at solving problems, filling service gaps and improving the quality of
their services for many years. The rest of us are now staring at the ambulance
barreling down on us and trying to decide which way to run.
The Patient Privacy and Affordable Care Act (ACA) is not
new, it has been around and its consequences known for several years. This is
the latest variable added to the changing world of EMS, many of its objectives are
compatible with the needed changes to EMS that were recognized in 1996, yet we
have still not acted on the majority of them. These were once stationary goals
that EMS alone sought to achieve, we are now so far behind that the change is
now being pushed down on us from the Federal Government! What has happened to
us? We are so worried about studies, stakeholders, regulations and politics
that we can’t even do the simple and easy things we have known we need to do
for decades.
So, about that target, what is it? Do you want to just look
good, or actually do good? We know
that better patient outcomes are at the top of the list closely followed by
greater healthcare system integration and lower costs, all identified in 1996
but now also required to obtain the objectives of the ACA. We have now lost the
initiative; hospitals are improving readmission rates on their own, hospice and
home health care organizations are filling the gaps between primary care and
the hospital more fully, both are reducing costs and improving the quality of
care for the patient. It may be that EMS will not play much of a role in this
new system as we had hoped despite finally coming up with innovative ways of
delivering care.
Let’s not forget the taxpayer, citizen’s and city managers
out there, will they support increased services and increased expenses for EMS
systems to duplicate services they have until now thought to unimportant to
develop on their own? Will you be able to convince hospital administrators that
you can do a better job than they of reducing readmission rates? Will your
regulatory bodies allow you to expand your roles in the face of all the other
changes going on in healthcare at the moment? Can all this be done quickly
enough to even make a difference, or will you be driven to provide whatever
services all these other parties decide you are competent to perform? As you
can see we are not just trying to hit a moving target, we are trying to hit
multiple moving targets that are rapidly changing direction, as it sits I think
we will go home empty handed unless we change our way of thinking and our
tactics.
I suggest that we go back to basics, clean up our house, and
begin working on developing real and meaningful strategies that will improve
the quality and value of our services whether or not we can develop new ways of
delivering that service. Work on developing your staff, cultivate your leaders,
and train your providers with the best programs available. Educate your public, policy makers and
stakeholders. The true value of public education is severely underappreciated
by EMS, look at the outcome, and resources, dedicated to public education in
fire prevention, why is EMS any different. This is a target we can hit.
Be Safe,
Alan
