Qmentum Quarterly, July 2010, Volume 2 Number 3
Qmentum Quarterly: Quality in Health Care is new publication produced by Accreditation Canada. This month’s issue (July 2010) is focused on Emergency Health Services in Canada, including pre-hospital and in-hospital care. I contributed a piece called “Enhancing Organizational Performance Through Process Improvement” (pp. 18-20).
Using an ST Myocardial Infarction (STEMI) cases as an example of a care process, the article discusses the importance of approaching improvement with Deming’s System of Profound Knowledge as your underlying theory and then provides guidance on several considerations important to any improvement project, including:
- selecting a project,
- choosing project sponsors,
- forming a good team,
- developing an aim statement,
- defining measures,
- learning in action, and
- spreading changes.
Unfortunately, the article is not available online for free. Copies can be purchased here.
After many years of always carrying around some earmarked textbook and a file folder of articles, of squeezing in writing around family and typing away in hotel rooms on client trips, and of wondering when it will ever end, I finally finished the doctoral journey. The dissertation is finished and approved, the defense is complete, and the administrative checkboxes are filled in. My research will soon be published in the ProQuest UMI Dissertation database and add to the learning about patient-centric systems. In the meantime, here is the official abstract. Thank you to all who have supported and encouraged me over the years. I really appreciated it. –Dr. Dave.
Abstract
THE INDIVIDUAL, ORGANIZATIONAL, AND SYSTEM OBSTACLES TO PATIENT-CENTRIC EMERGENCY MEDICAL SERVICES SYSTEM DESIGN
David M. Williams
Saybrook University
Research regarding emergency medical services systems design is inadequate and is largely focused on individual components or patient conditions (e.g., cardiac arrest) rather than on an interconnected system designed to serve the patient. In addition, patient demand has expanded from life-threatening illness and injury to include general medicine, which current EMSSs are not designed to serve. The purpose of this research was to examine the individual, organizational, and system obstacles to developing a more patient-centric EMSS design.
Fifteen factors potentially associated with patient-centric EMSSs were identified from clinical and systems literature. Using a multi-case study, five United States EMSSs, representing five major design models (fire department, hospital, private organization, public/third-service department, and public utility model), were studied. Data collection included four sources of evidence: (a) data metrics, (b) document review, (c) interviews (n=11), and (d) archival records. Data analysis involved coding 582 independent obstacles into 38 distinct categories and using a Pareto distribution to identify the leading obstacles to each patient-centric feature. Fifty percent of interview transcripts were externally reviewed for reliability. Results were presented in written narrative and displayed in Pareto charts.
The top five categories, representing 33.5% of the total obstacles identified, were cost/funding, data measurement, process/outcome focus, systems view/design, and public information/education. Six recommendations resulted from the findings, including quantifying a reasonable cost, changing the funding model, developing an EMS research consortium, initiating data measurement to improve, integrating quality improvement as an operational strategy, and documenting and sharing learning on practices that work and do not work.
This inquiry provided new insight into the current state of EMSS design, how it aligns with patient-centric factors, and what obstacles exist for medical directors, operational leaders, and policy makers in positions to transform future EMSS design and operations. The obstacles identified provide information for additional EMSS research and the results will further the vision of creating a more patient-centric EMSS design that better serves patients through prevention, reduction of morbidity and mortality, and facilitating access to the most appropriate care.
I’ve been catching up on my reading and am sifting through a stack of magazines on my office shelf. In the March 2010 issue of Fast Company is a great article about an ad agency based in Rochester, NY – Partners + Napier – that applied process improvement to their business and realized amazing results. They report being able to trim the time to complete a project from eight weeks to just three, save the client 40%, and increase productivity by 3.5%. The company has become much more nimble and billings have increased 300% in five years. Frequently slow adapters to the potential of applying process improvement claim that it doesn’t work in the service industry. Here’s one example where it has. To read the Fast Company article, click here.
Over the weekend, the NY Times reported that President Obama is expected to appoint Donald Berwick, MD, CEO of the Institute for Healthcare Improvement to lead the Centers for Medicare and Medicaid Services. Dr. Berwick has been one of the leading advocates and scholars in the area of improvement science and applying those principals to health care. He has long been a champion of reducing costs and improving outcomes through process improvement and evidence-based, standardized, reliable care. His leadership and expertise will be of great aid to the efforts toward US health care reform.
Read the NY Times story here.
Photo: alamosbasement
Today, I had the pleasure of speaking to a group at the University of Texas LBJ School’s Center for Health and Social Policy about prehospital emergency health services systems. As a former paramedic, EMS research, and organizational systems improvement advisor with my colleagues at Fitch & Associates, I was able to share a unique understanding of the history and evolution of EMS systems in America. The Institute of Medicine’s 2006 report Emergency Medical Services at the Crossroads served as a framework for the discussion. It’s not often I’m invited to present this information to audiences outside of the EMS and public safety industry and it was great to see people engaged in the topic and asking great questions about quality, performance, system design, and public policy. Copies of the slides should be available soon on the CHASP website here.
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