Debilitating Decision Delays

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

Hidden Fire

Hidden Fire

Unseen threats to Emergency Services

By Alan Perry

February 11, 2015

Many a life and countless millions in losses can be attributed to the effects of hidden fire. These fires spread undetected, concealed in walls, floors and utility chases, destroying the structure and spreading to remote locations with catastrophic consequences. It is a threat every firefighter should know well and aggressively seek to identify, locate and extinguish before declaring a fire under control. This principal is an easy one to understand but also easy to overlook in the heat of battle. Many emergency services have similar threats to their ability to achieve their primary purpose and mission due to hidden threats within and outside the organization. Many appear well on the outside only to collapse under pressure when the underlying structure fails due to these “hidden fires”.

 The structural integrity of your organization can be compromised by inadequate training, poor morale, lack of public or political support, overextended resources, poor communication or any number of other threats and weaknesses you can name. The critical needs of the organization can be overlooked while distracted by ancillary programs, new services and trying to keep up with new trends. Some organizations seek out new responsibilities, programs and stature, enticed by State or Federal funding, setting up new services at the expense of those critical needs. I will argue that emergency services should do more to prepare for large scale events, integrate with more effective healthcare or cultivate needed specialized resources. These are all part of the public expectation and our mission just as the core services we provide are, there must be a balance between these “nice to haves” versus the “must haves”.

Identifying the threat or existence of the hidden damage is not difficult if you are in-tune with your organization. Objective quality control monitoring of your resources, human and physical, will give you the best and quantifiable evidence. Structural collapse rarely occurs without giving some evidence or clues to a developing problem, that’s why we sound floors and look for smoke and heat where it should not be. Similarly, problems within your organization will reveal themselves if we use common management tools to evaluate failures in our equipment, processes and personnel. Long standing problems will compound and accelerate the damage, like a hidden fire in a structure already weakened by termites.

To locate the source of this insidious damage we have to look at data, ask questions, and sincerely want to improve the situation without fear, or presumption, of what will be found. How effective are your firefighting operations? How reliable is your apparatus? How frequently do your providers deviate from operational or EMS protocols and SOP’s? Are there training issues? Funding issues? Do your personnel have the right tools and resources? Do they function well as a team? Are all concerns heard without reproach? These questions may reveal the symptoms; the cause may be well removed and must be located before it can be corrected and the damage stopped.

Stopping the destruction will require correction of the identified fault. It may also involve correcting other faults propagated elsewhere secondary to the origin. As with hidden fires, there will likely be extension to other parts of your organization. Your organizational culture can help you manage these shortcomings, or it may be decayed and damaged by the process itself. As with structures that are hopelessly corrupted by fire, the only solution may be demolishing it and rebuilding.  That would be an extreme outcome that will permanently alter the persona of the organization, but it would certainly give it the opportunity to rebuild the organization as it should be and on a solid foundation. An alternative that may be more appealing would be targeted restoration of affected components, like remodeling a kitchen, retaining the existing structure while upgrading the area in need, taking care to carefully examine other parts of the organization for weakness. So what kind of "house" do you want to inhabit? One with a solid structure, but perhaps without the fancy kitchen and showers, or a showplace that has cracked walls and creaking floors. Choose wisely.

Be Safe,

Alan