Deliberating
Decision Delays
The performance pitfall perils of procrastinating
for proof
By Alan Perry
3/8/15
In the era of evidence based best practices for the EMS
and Fire services, we are beginning to accept that this ideal as the norm
rather than the exception. Those holding the purse strings and writing policy are
more often compelled to act based on evidence and proof of value before
allocating resources. This is of course the most responsible and practical
thing to do, but should this rule be applied to every decision we make? Is there still value in making decisions based
on reasonable expectations? Does every project have to have some specific,
measurable and obtainable outcome to have merit? If we are bound by this dictum
we would all be hemmed up in a hopeless feedback loop of indecision every time
we tried to do something new and unproven for which no “proof” exists. Someone
actually has to do something before any proof or positive results can be found,
and occasionally the outcome is not what we expect even if it is a positive
one.
A perfect example is public education; fire
prevention programs have a proven and documented history of success as
declining fire events and related injuries can attest. Why then, do we have to
prove that an injury/illness prevention program will work and establish a set
of metrics to analyze it? The benefits of education and prevention programs go
far beyond reducing injuries and illness, although those would be primary
goals. The benefits generally translate into greater public support, better reactions
to emergencies and participation in community health and safety, things that
can be difficult to measure but can have a profound impact on the community’s
resistance to emergencies of all types.
The same logic can be applied to integrating
healthcare services and incorporating EMS systems into the patient care
continuum. Start where you stand, do not be blinded by the wide array of
possibilities. I assure you, that while you are doing your research and
developing evaluation methods to measure your success, someone will be acting.
EMS is not alone in this arena, hospitals, public health, health care systems
and insurers are all looking for ways to improve their bottom lines while
improving the quality of care for patients as mandated by the Affordable Care
Act. Most traditional Fire and EMS systems are ill prepared to step into this
fast paced arena using old management philosophies and insufficient resources
compared to the other players.
In areas where diversity in delivery models is
significant, consensus is the enemy. I’m not saying cooperation isn’t desirable
or even preferred, I’m merely pointing out that while trying to mesh too many
disparities it will be difficult if not impossible to reach a decision that
will enable all parties to benefit and maximize the use of the resources they
have. I have seen such attempts last for months if not years with no tangible
results or even progress. Sometimes you have to take the tools you have, the
resources you have, and use them to start pushing the ball forward.
The word I’m looking for is responsibility; as
public safety professionals we have a responsibility to the citizen taxpayers
to provide responsive and caring service, keep up with the state of EMS &
Fire sciences, adopt and develop the most effective care and delivery
practices, dedicate sufficient and appropriate resources to training and
equiping our providers, and act with purpose when we know our system needs
work. We can ill afford to attend another unproductive meeting or continue to
conduct business as usual when that is not producing the change our services
desperately need.
We have known for several years that routine
back-boarding of patients is of no benefit, and can actually be harmful, why do
we still do it? Narcan, in the hands of a first responders or bystanders saves
lives, why don’t we permit it? Fire and EMS personnel are injured every week in
vehicle accidents even though the evidence indicates priority responses have no
proven relationship to patient outcomes, why do we run two, three or four
vehicles lights and sirens to any EMS call? We know integration of healthcare
and EMS benefits patients and the EMS systems involved, why have we not yet
acted? These are just some examples of best practices that are delayed by our
traditional decision making process. It is broken, it may be time to
re-evaluate our command structures and seek a leaner more responsive model that
is made possible by using modern communication tools.
As a test, try asking one of those questions of the
person next in your chain of command. If you have a responsive and nimble
organization that person should be able to answer the question directly and
have the ability to effect an immediate change if needed. If you do not have a responsive
nimble organization you will have to wait for an answer from the ivory tower,
if you ever get a reply at all, it will likely not result in any change or
further discussion of the matter. You can’t hold an individual responsible for
that type of problem, it is cultural in nature, it is no wonder that when
leaders of such organizations gather to address the need for change and new
challenges facing them, they are hopelessly mired in the apparatus of consensus
and “chain of command” decision making.
I don’t like putting stuff like this out there
without trying to point us in the right direction for solving it, so here it
goes;
· - Flatten
the command structure.
· - Use
the freed-up resources to allocate sufficient personnel to training and
organization development.
· -Spread
out authority and accountability for decision making.
· - Don’t
be afraid to do the right thing.
· -Do
it now
