The Live Music Capitol of the World – Austin, Texas – has a different buzz downtown today. The convention center is filled with Texas’ volunteer and career emergency medical services caregivers. Held annually, the Texas EMS Conference rivals many national EMS conference events and draws industry leading faculty from across the country and caregivers from across the state.

Ernie Rodriquez, Director of EMS for Austin/Travis County EMS, has been a leader in advancing professional development for EMS leaders in the State. This year, he is joined by EMS leaders who strive to push EMS operations to the next level in a dedicated administration track. Dr. Dave Williams was invited to introduce the Model for Improvement – used throughout health care for process improvement – and share his experiences using the model with organizations across North America and Europe. The conference is always a great event and we welcome the opportunity to contribute.

American Medical Responses (AMR) is the largest private ambulance service in North America. Responding to more than 8,600 requests for service per day and with a staff of 17,000, AMR serves 2,100 communities in 38 states. It is also one of the first organizations Dr. Williams worked with as a paramedic back in Springfield, MA.

AMR sees more patients than any other pre-hospital care and transportation organization in North America. The organization’s leadership has committed strongly to improving clinical quality. They aspire to develop needed improvement skills and strive to achieve the results witnessed throughout health care.

As part of this pursuit, AMR is embarking on an improvement journey modeled after the IHI Breakthrough Series Improvement Collaborative Model used around the world and throughout health care. More than a dozen operations, from across North America, will test changes in two work streams, including sudden cardiac arrest and portfolio of clinical areas. The sudden cardiac arrest work is part of the the HeartRescue initiative sponsored by the Medtronic Foundation and the portfolio of clinical areas is directly connected with AMR Clinical’s strategic plan. This is the first patient care improvement collaborative in this segment of health care or public safety.

Dr. Williams is pleased to support AMR’s work as improvement advisors coaching on testing and measurement.

More than a 100 people convened in Austin, TX at the Austin Convention Center for Wave 2011. Sponsored by ESO Solutions, a technology company developing solutions for emergency medical services organizations, Wave 2011 is a 2-day conference produced for its clients. It brings industry leaders and ESO’s deep pool of talented staff together to provide timely and pragmatic sessions on using patient data to improve care.

Dr. Dave Williams has had the pleasure of presenting at several of ESO Solutions’ national and regional education venues. ESO Solutions’ CEO – Chris Dillie – was Dr. Williams’s paramedic partner when they worked together at Austin EMS.

Today, he presented a session on using data for improvement and learning. With so much data, it’s easy for people to struggle with were to begin. Dr. Williams focused on identifying important metrics and measuring data over time to understand process variation and improvement. The audience included many innovative, local people striving to improve the reliability and quality of care in their communities. It’s always rewarding to see people really interested in improvement and change.

For the last few weeks, I have been testing an experiential exercise to quickly train large groups to use rapid cycle, small tests of change (i.e., PDSA cycles). The exercise involves teams learning through testing how to assemble a toy Mr. Potato Head. I modified the exercise after working with with Dr. Eric Dickson on the faculty for the Instituite for Healthcare Improvement (IHI) Impacting Cost & Quality collaborative. Dr. Dickson is the Senior Associate Dean and President, University of Massachusetts Memorial Medical Group in Worcester, Massachusetts. He uses Mr. Potato Head to teach emergency physicians and medical students about lean principles. You can read a description of a session he did for the American College of Emergency Physicians here.

The modified exercise I am testing includes teams developing theories, making predictions, carrying out tests, and measuring results on run charts. In addition, participants learn how to share knowledge across teams and harness the power of the collaborative learning process. I’ve now tested the exercise half a dozen times in public safety, health care, and education audiences and  each session has improved upon the last. And, I have received lots of positive feedback from participants. IHI even bought seven Mr. Potato Heads for the home office for use in the Patient Safety Officer Course and to teach internal staff about PDSA testing.

While the use of a toy produces an element of fun, this exercise, more than many I have used, really enables participants to discover the power of making predictions, using small PDSAs to test theories, and tracking data in real time using time series charts. It’s amazing how sometimes small experiential learning exercises can really connect people with the concepts and facilitate applying them to their improvement work.

Quality Health Care by Robert Lloyd, PhD

This week, I have been reading a great book by my colleague Robert Lloyd, PhD, Executive Director of Performance Improvement at the Institute for Healthcare Improvement. Published in 2004, Quality Health Care: Developing and Using Indicators is a great resource for learning about process improvement in health care.

Last night, as I finished a chapter (Ch.3), I caught mention of a great little story Bob includes in the chapter notes (p.119). The origin is unknown, but his discovery of it comes from his mother. Reflecting on it, the story really describes what I witness, and many teams encounter in trying to plan, launch, and participate in improvement work.

The Facts of Life

The story that follows is about four (4) people named Everybody, Somebody, Anybody, and Nobody. There was an important job to be done and Everybody was asked to do it. Anybody could have done it, but Nobody did it. Somebody got angry about that because it was Everybody’s job. Everybody thought Anybody could do it, but Nobody realized that Everybody blamed Somebody when Nobody accused Anybody.

In the same chapter (Ch. 3), there is a great quote attributed to one of Bob’s graduate school professors – Dr. Bob Bealer – and how they would respond the the question about sampling, “How much data should we collect for our dissertation research?” Dr. Bealer would reply, “As much as you must and as little as you dare” (p.79). I can remember my own dissertation chair – Dr. John Adams – providing very similar sage advice.

I am very much enjoying Bob’s book. I’m only 1/4 of the way through it, so do not be surprised if other great snippets emerge later.

On April 7th, Dave Williams had the pleasure of opening the annual meeting of the Texas Medical Group Management Association (MGMA) in San Antonio, Texas with a plenary talk on the Science for Improvement (see link below). More than 200 members came together for a mutli-day conference with a focus on accelerating performance. The Texas MGMA is a professional association representing medical practice administrators across Texas with over 400 members.

Dave spoke to the attendees about how they can apply the science of improvement to enhance quality, reduce costs, and improve patient safety. The talk was rooted in the work he is doing as an improvement advisor with the Institute for Healthcare Improvement.

For many, quality improvement and patient safety is mainly viewed as an in-hospital pursuit, but risks of harm and improvement opportunities exist in out-patient settings as well. For example, a project in Massachusetts funded by the Agency for Healthcare Research & Quality (AHRQ) called PROMISES (Proactive Reduction in Outpatient Malpractice: Improving Safety Efficiency and Satisfaction) is a three year, state-wide malpractice and patient safety initiative in the primary care setting. In addition, the Coalition of Advanced Emergency Medical Systems (CAEMS) has partnered with Positive Eye Consulting on a improvement and patient safety collaborative in the ambulance sector.

Interested in the talk, download a PDF of the slides here.

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.

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.