Today, EMS agencies face many complex challenges and are constantly under scrutiny for performance issues across all aspects of their service delivery, including response times, staffing shortages and care quality. Even in an ideal scenario where EMS systems operate with minimal deficiencies, the focus should remain on improving system and provider performance. Improvement initiatives may arise from noticeable inefficiencies within the system or key performance indicators derived from the agency’s formal strategic plan. Either way, it is time to implement improvement initiatives when inefficiencies are identified.
This raises critical questions for EMS leaders: Does our system operate efficiently? If not, why? As we delve into the benefits and examples of implementing a systematic approach to problem-solving, it’s crucial to reflect on your agency’s method for addressing service-level performance issues. Do you rely on traditional brainstorming, where ideas are thrown against the proverbial wall to see if they stick, or do you employ a systematic, data-driven approach?
Team development and composition
Consider who is involved in the improvement process — is it solely a leadership activity?
Performance improvement is a collective responsibility that impacts all stakeholders accountable to an organization’s policies, procedures and protocols. Engaging internal and external stakeholders throughout the performance improvement process offers dual benefits:
- It positively impacts morale by involving participants in identifying root causes, problem-solving and solution development.
- It also encourages buy-in and creates performance improvement advocates within the organization.
Employees who are included in the problem-solving process are more likely to support solutions derived from improvement activities.
A diverse team of knowledgeable, dedicated employees is essential for effective performance improvement. The team should include individuals directly impacted by potential improvements, with executive leadership providing top-down support and resources rather than injecting themselves into the decision-making process. This approach helps prevent low morale and directly impacts team productivity and employee buy-in.
The team should include subject matter experts, support staff, mid-level management and technology/data analysts. This diverse makeup minimizes knowledge gaps and provides valuable insights into day-to-day operations and policy execution challenges that top-level leaders may not be aware of.
Sructured team meetings
Team meetings should be structured to ensure productivity and focus. Here are some key recommendations for structuring a meeting:
- Assign a team leader to guide the meeting
- Respect the team members’ time with a clear agenda and a timekeeper
- Provide training on data gathering, analysis and problem-solving techniques that will be used in the improvement process
- Establish ground rules, including a no-talking-over-people policy
- Ensure adequate time for all team members to share their input
Implementing these strategies within an organization can create a more inclusive and effective performance improvement process that leverages the expertise and perspectives of all stakeholders.
PDCA (Plan-Do-Check-Act)
PDCA (Plan-Do-Check-Act) is a systematic approach to problem-solving that offers an efficient, straightforward method for continuous improvement. This cyclical process combines inductive and deductive problem-solving techniques, ensuring a comprehensive analysis of issues and their solutions. While less rigorous than other performance improvement strategies, PDCA provides a simple, yet effective tool for teams to organize their efforts and drive meaningful change.
- The PDCA cycle begins with the Plan phase, where teams gather and analyze data to identify problems or opportunities for improvement. This crucial step involves determining root causes and developing clear, SMART (Specific, Measurable, Attainable, Relevant and Timely) goals and objectives. Teams also create a detailed implementation plan that aligns with the organization’s strategic vision.
- In the Do phase, teams implement their changes on a small scale to test the solution’s effectiveness. This stage involves collecting data and observations, and evaluating any deviations or unexpected results during implementation. The small-scale approach allows for quick adjustments and minimizes risks associated with large-scale changes.
- The Check phase focuses on analyzing the results of the implemented changes. Teams compare outcomes to the objectives established in the Plan phase, gather stakeholder feedback, and examine qualitative and quantitative data. This thorough analysis helps determine whether the changes produced the expected results and effectively addressed the identified problem.
- Finally, the Act phase involves making decisions based on the analysis from the Check phase. If results are not desirable, teams analyze failures and identify areas for improvement. Successful changes are adopted, adapted or abandoned as necessary, and implementation can occur on a broader scale. Standardization of effective changes ensures the long-term sustainability of improvements.
Implementing a systematic performance improvement process, like the PDCA cycle, assists organizations in fostering a culture of continuous performance improvement by encouraging teams to test ideas, analyze results objectively, and make data-driven decisions. Consistently applying PDCA, organizations can create sustainable system efficiencies that benefit all stakeholders, including improved financial performance, enhanced patient care quality, increased provider safety and optimized support services.
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Ultimately, the PDCA approach helps agency leadership become better stewards of shareholders’ or taxpayer funds by creating cost-saving efficiencies and operational improvements. Continuous monitoring of key performance indicators (KPIs) ensures continued efficiency and sustained progress in the organization’s performance improvement journey. This process helps to change workplace culture to focus on continuous learning and improvement.
