Monday, January 27, 2014

PI, What it means and how to achieve it.

Performance Improvement
What it means and how to achieve it
By Alan Perry
January 27, 2014

The concept of Performance Improvement (PI) requires little explanation to most; the term itself pretty well sums it up. We in Emergency Medical Services & Fire Services sometimes get hung up with its application since it is much more than just a concept, it requires awareness, measurement, analysis, communication, feedback, training, monitoring and goals to be effective. Performance improvement is not an officer, office, department or form, it is a process that the entire organization must be aware of and committed to.

Performance improvement is an organization-wide system for improving the quality of the products or services offered by that organization, it can also include recognition and development of new products or services that can fill demonstrated gaps which the organization is responsible for, or should reasonably provide. A true PI program goes far beyond simply addressing recognized shortcomings and failures; it will constantly monitor and seek the best possible solutions to an organization’s overall performance, identifying areas where improvement can occur before they become overtly apparent.

In the arena of Emergency Medical Services (EMS) and Fire Services (Fire), a performance Improvement program will affect the number of lives saved, the value of property loss prevented, the satisfaction of the customer, and the contentment of the employees. Far too often PI is given such a narrow focus that only one or none of these receive any benefit. Most organizations follow the “wack-a-mole” method of Performance Improvement out of respect for tradition or a narrow understanding of the value of PI when applied more proactively and globally. Some organizations do not have the resources to dedicate to it except in dealing with emergent or politically sensitive circumstances. The value of a well-designed PI program to an organization should make economic sense and justify the allocation of sufficient resources.

Regardless of the scope of the Performance Improvement program it must start with awareness that a circumstance, service or product may be in need of improvement. Looking at global & national statistics for high-performing EMS & Fire services can be a good place to start, or benchmarking your performance against similar organizations near you. You will need more than a hunch; you need data to support the need for a change and an idea of its potential benefit. If your data is incomplete or totally missing you will need to find a way to accurately and quickly capture it otherwise you will merely be guessing which is very risky. Only with a clear understanding of the exact nature and scope of the circumstances should you move to the next phase of PI.

Good communication plays a vital role in any successful PI program; the entire organization should be aware of their PI process and be involved with it. Most opportunities for improvement will be known to those involved with those processes, this is the best place to start looking for solutions. Many times the answer has already been discovered but not communicated. From a PI administrator’s point of view, consider that when an opportunity is discovered it can frequently be resolved by simply communicating that there is an opportunity for improvement and what the desired goal is; your personnel will respond by doing better on their own. At a minimum they will provide feedback about how to improve the outcomes and you can start developing a plan to address it. The other side of the communication process is feedback, once an opportunity is identified and being measured you must provide quantified feedback so your staff will know how they are doing; they all want to perform and need that information.

If your performance opportunity exceeds the ability of your staff to improve it on their own a plan must be put in place to modify the existing practice/policy/procedure/operation/training in a logical way so that it addresses the root cause of the performance problem and not the symptom. Spell out the nature of the performance challenge and what the desired goal is, develop a plan to correct it, measure it, provide feedback, modify it and repeat. Keep in mind that PI is an ongoing process the continually pushes the organization along the continuum of customer expectations, best practices and superior organization performance.

Be Safe,

Alan

Wednesday, January 15, 2014

Superman's view on Evidence Based Practices

Superman's view on Evidence Based Practices
January 15, 2014

By Alan Perry

Sometimes I feel like Superman in kryptonite turnout gear, I see all the great opportunities and ideas go buy, recognize them and try to get others interested, but utterly fail to make an impact. I point to stated organization mission & values statements, studies proving these “best practices” and identify ways to make them happen, and don’t even get a response. Perhaps it is my communication style, or perhaps I’m just not “allowed” to come up with those ideas, or make those types of decisions.

So now that I have vented, let me try (real hard) to say this in the way a chief officer should.

Our department and perhaps the fire service in general, have entered a new era in the provision of both Fire and EMS services. We are now regularly bombarded with new evidence based practices which are sometimes foreign to our existing way of thinking about and doing our job. Change in any large organization is usually difficult to manage and we are no different, the change must be managed in a controlled and thoughtful way. A real challenge at this point is managing these changes thoughtfully even though many of the changes themselves are undergoing refinements of their own, kind of like trying to hit a moving target. We are tempted to simply wait until the target stops moving, however I fear that may not be realistic and the fact of the matter is the longer we wait to begin making any real change the further we will be from meeting our obligation to our citizens.

EMS public education, Hands-Only CPR, Public Access Defibrillator programs and Community Paramedicine are all excellent examples of programs that both Fire and EMS agencies have yet to fully implement, if they have considered them at all. Many of these programs have been around for 10 years or more and have proven benefits with many working examples from which to draw information and implementation clues. Extensive new studies on these new practices are rarely warranted and merely waste time and money that could be used to get the stretcher rolling. Take a look at your organizations public messages like “progressive”, “responsive” and “caring”, are we truly living up to our billing?
The public may be happily ignorant of the circumstances we find ourselves in, it will only take one bad outcome, properly investigated and publicized, to educate the public and bring them to the intelligent conclusion that change is needed now. Questions will be asked, excuses may be given. Will you be able to say that we have done everything possible to equip our organization and staff to provide the best evidence based care possible?

Be safe,
Alan