In a prior column on EMS clinical specialty teams, I introduced a team-based quality improvement model that consists of three main elements:
- Clinical specialty teams
- Ad hoc improvement teams
- The senior management team
EMS clinical specialty teams are standing committees of internal staff members who share a passion for care in a particular clinical area, and take responsibility for monitoring and improving care in that area.
As they monitor and analyze clinical performance, along with keeping abreast of the latest research and best practices, the clinical specialty team will come up with ideas for making improvements. The ideas are written up as improvement project proposals. An improvement project idea can be almost anything:
- A protocol change
- Using a different piece of equipment or technology
- An adjustment to an existing process
- A new training module
As EMS organizations need to prioritize their allocation of limited resources, the senior management team should have an opportunity to review and approve improvement project proposals. They need to consider the big picture of the organization’s overall goals and issues that need to be addressed at any particular point in time.
Therefore, the EMS clinical specialty teams submit proposals for improvement projects to obtain valuable feedback and senior management support, and allocate resources that may be needed to carry out the improvement project.
To help facilitate the senior management review, the improvement project proposals are written up in a project charter format. This format will help the senior management team make a better business decision by explaining the expected benefits versus the resources required. It also provides an explicit roadmap for the ad hoc improvement project team to follow.
Once the improvement project is approved by the senior management team, an ad hoc improvement project team is formed.
Forming an ad hoc improvement project team
Ad hoc improvement teams are temporary. They are formed for a specific project, complete its objectives and disband. They are accountable for making a sound effort to implement an improvement idea. They do their best to try out the idea out to see if it really makes a measurable difference in performance.
Ad hoc improvement teams typically consist of a small group of 5-7 people. They would typically be led by someone from the clinical specialty team, with the rest of the team comprised of other internal staff members that are not on the clinical specialty team. This strategy is intended to engage a larger portion of the workforce in the quality program and groom future clinical specialty team members. The ad hoc improvement project team might also include external personnel, depending on the nature and scope of the improvement project.
The ad hoc improvement project team is overseen by the EMS clinical specialty team that originally proposed the project. They will periodically report to the supervising clinical specialty team to ensure things are staying on track and to get coaching and support if the project team is running into issues they need help resolving. The supervising clinical specialty team can reach out to the senior management team as needed to help if necessary.
Quality improvement accountability
A crucial principle in this model is that the improvement project team is primarily accountable for the quality of execution of the improvement project idea. Regardless of the result, a well-executed improvement project idea should be celebrated as a success.
Celebrating well-executed projects that did not achieve the desired results is significant step forward in promoting a culture of improvement and innovation. This shows that the senior management team and the rest of the organization recognizes that failure is inherent to innovation. It helps everyone be more open to trying new ideas. It is a well-established principle of innovation that the more new ideas an organization thoughtfully tries out and executes well, the more the organization will learn and the more successes and innovations it will have.
If an improvement project does not produce the desired or expected results, the idea can be modified and tried again. Or, the ad hoc team might have gained some deeper insights along the way that leads to the consideration of an entirely new approach. This would be resubmitted as a modification to the project charter with review and approval from the supervising clinical specialty team and the senior management team.
