Starting an Improvement Effort


Have you recognized a problem in your system that needs to be addressed? Whether you're dealing with a local issue or a global issue the idea of organizing an improvement effort can feel overwhelming, but knowing the basic components that need to be in place can make it easier.


1. A Focused Goal

A focused goal is essential to a successful improvement effort. In the beginning you may not have articulated a plan of action, but a focused goal is essential at this point.

To help focus your goal, ask yourself questions such as these:

  • Is your goal specific and tangible?

    We cannot demand things such as "respect." Our request must be definite, for example, "we need safety helmets," or "the transporting agency must have medical control." Things such as respect and esteem will be earned as the community sees that we are acting in its best interest.

  • Is your goal based on valid facts or research?

    We must educate ourselves and understand the subject we are delving into. We must be able to provide data to support the validity of our claims and requests. In the absence of legitimate research we must make sure there is sound logic behind our efforts.

    • With EMS being a young field, paramedics and EMTs are in an excellent position to initiate or participate in research or pilot programs pertaining to EMS. Stay tuned for a tutorial on starting research programs or pilot programs.

  • Is your goal reasonable and attainable?

    Change takes time and effort. Anticipating this will help us avoid frustration and help us make reasonable goals. For example, if you would like to see multiple drugs added to your protocols, you may have to tackle these one at a time. A medical director may not take a paramedic association seriously if the requests are overwhelming or unsafe.

EMS improvement, even in small steps, will impact the profession as a whole. No one has the expertise to execute a "one fell swoop" plan that will instantly fix EMS. The accomplishment of professionalization will only come step by step, as we put forth deliberate and patient actions.

Communication

Your next step is to set up a means of communication and collaboration. These days we have a multitude of tools to help us. Web 2.0 tools and social platforms are an excellent resource to help us organize and mobilize improvement efforts, being careful that we so not base our efforts entirely on internet based tools.


Recruitment-Ongoing and Member Involved


After setting up a communication plan you must find a way to recruit your colleagues. This will prove to be difficult for a number of reasons:

  • Fatalistic Resignation - The attitude that there is no hope because we don't have the power to change our circumstances.
  • Forgetfullness-Our recruitment attempt has been mistaken for usual venting or gossip. By the time you leave they have forgotten your effort.
  • Apathy - The thought that other people are making sufficient effort, and don't feel the need to be involved.

An important aspect of your effort will be the continuation of recruitment. Don't get comfortable in your organization and stop recruitment. Recruitment should always perpetuate, and you should instil recruitment into mindset of all members.

The following story emphasizes the importance of member involved recruitment.

No Magic Turnout


"A new organizer was working to turn out people for a citywide hearing on increased water and sewer rates. He passed out thousands of flyers. He put the announcement on cable TV. He called lots of people who had signed a petition on a door-to-door canvass. He was signing up hundreds of people to come to the meeting. He enthusiastically told me he expected 100 people at the hearing. Only a dozen showed up, all people he knew personally. He was disappointed, forgetting that flyers and media won't bring pepople. People bring people." 1

While we have illustrated the point of people bringing people, we still need to provide literature in most cases. Printing professional looking literature will not only serve as a reminder, but will also let them know that your efforts are serious, rather than usual "venting" between colleagues.


Collaboration and Delegation

Collaboration may or may not begin naturally in group communication. If you find that your collaboration is non-existent or ineffective you may have to initiate organized collaboration.

  • Ask questions in the form of interviews, polls or forum topics- Ask them things such as: What is the underlying problem from your perspective? Do you know of anyone else making this effort? Who do you think stands in the way of accomplishing our goal? Who are our allies?

  • Delegate- Delegation will be important, not to just reduce your workload, but to gain new perspective. People who have been assigned certain tasks may also bring new people to the cause as they gain support from their friends and family.

  • Find the resources within your group- Who are the artists? The business majors? The motivators? The planners? We have use for many skills and should learn to embrace and encourage their diversity.

Identify your plan of action

There is no iron clad method of developing a plan of action. A plan of action will be dictated by your goal. Examples of improvement methods are:

  1. Advocacy- Trained experts (in this case, paramedics and EMTs) acting on behalf of people in need

  2. Mobilizing- Such as marches, vigils and rallies

  3. Political Involvement- Endorsing candidates or requesting representative attention

  4. Education- Educating the public for prevention or correct actions in an emergency

  5. Study-Becoming more knowledgable about subjects to expand a scope of practice for the good of the community.

If your problems lie in working conditions you may have to employ different measures. The collective knowledge of your colleagues will prove to be valuable in these circumstances.

Member Education

Education is priceless in activism. When you delegate tasks to your leadership and members you must also delegate the necessary reading or education that will help them carry out the task, if necessary.

Retaining Involved Members

There are a few rules to remember to retain active members:

  • Accept people's time limitations- Remember to respect people's personal lives, and remember that many people will not be as motivated as you. Be happy with the amount of time people contribute to your cause.

  • Allow people to take ownership of their duties- Don't micromanage. People must have the freedom to execute their projects according to their own judgment (as long as it is in line with the community goal). By not allowing people to exercise judgement, you rob them of practical knowledge that EMS personnel need to sustain professional self-sufficiency. You may also cause them to withdraw their support.

  • Treat your members kindly- You will loose support if you treat your colleagues badly or place excessive burden on them.

Contributing to a Knowledge Base

Prehospital Providers would like to hear about your successes and failures. Submitting your experience as a research case study will help us in our collaboration as a response community. Ultimately our goal is to gain wisdom, practical knowledge and skills of change as a community. Any amount of effort to improve EMS, even if labeled a failure, is not wasted if we use it to contribute to our knowledge base.

Please email ajensen(at)prehospitalproviders.com for details.