Responsibility and Quality Improvement

Taken from 911 Magazine, August 2006
Written by Brett Patterson, Academics and Standards Associate for the National Academies of Emergency Dispatch, involved with training, curriculum, protocol standards, quality improvement, and research


Recent headlines regarding 911 and EMS failures are disturbing reminders of just how fragmented and inconsistent public safety can be in the United States. While the vast majority of EMS calls are handled in a professional and competent manner, acts of simple negligence are far too common for a profession that relies on public trust not only for funding, but also for the ability to function effectively. Without the public's trust, 911 callers are less forthright and patients are less likely to welcome strangers into the most intimate aspects of their lives. Trust is earned, and it is our responsibility to maintain it through honesty, integrity, and a vigilant effort to improve our services.

Quality improvement in EMS seems a daunting task when we consider the nature of the problems we read about in the headlines. It seems that after decades of EMS evolution we would be well beyond the negligent care of a patient based on the assumption of alcohol intoxication. How can a trained emergency dispatcher refuse service to a child based on the mere suspicion of ill intent? Such errors in judgment seem so rudimentary; this is the stuff we were warned about in basic training, it's not rocket science! So what's the problem, and how can we fix it?

The responsibility for the quality of any service is twofold: personal and organizational. Countless Academy reviews of negligent acts by EMDs have revealed several common denominators of personal responsibility. Emotion is at the top of the list because it tends to affect judgment. Basic EMD curriculum teaches us that: "As emotion escalates, judgment deteriorates."

The most common forms of detrimental emotion in emergency dispatch are anger and apathy. We know from psychology that our emotions are the direct result of our thoughts, and that our thoughts are within our control. Therefore, it is possible to control our emotions if we take control of our thought process. For example: while this author cannot presume to know the thoughts of the calltaker who refused to dispatch aid to the Detroit child cited in recent headlines, one might assume that her thoughts were influenced by previous experiences with prank calls. This is actually quite common and, in many cases, very beneficial. We learn from previous experiences and, therefore, think and act appropriately when the same situation arises again. However, problems develop when we fail to obtain the facts and make assumptions about a given situation, assumptions that are often influenced by an inaccurate thought process. This is especially easy to do in the non-visual environment of EMD.

The best way to take control of our thoughts, and therefore our emotions, is to practice. In particular, situational "dispatch danger zones" should be rehearsed; calls that raise our suspicions, calls made by angry or hysterical people, or any call that, in past experience, has produced a less-than-optimal result. The process is relatively simple. Think back to such a situation and recall the events and accompanying thoughts. Write them down. Then take some time and create reasonable and productive replacement thoughts. Run through the situation several times, replacing the bad thoughts with the good ones. With minimal practice, the next time you encounter a similar situation, you will be cognizant of your thoughts and, eventually, the new ones will become second nature.

While individuals are ultimately responsible for their own thoughts, emotions, and actions, organizations can do a lot to promote responsible behavior in the workplace. Obvious efforts include prudent selection of employees, a lengthy and complete orientation, and adequate training. However, an intangible factor that is too often overlooked involves the emotional wellbeing of employees. If anger and apathy are common factors in dispatch negligence lawsuits, then common sense tells us that such emotions should be managed at the administrative level.

Fact: Happy employees are more productive and less likely to make errors in judgment. This is because constant learning and a sense of accomplishment foster happiness, and such individual growth and success leads to confidence and pride in workmanship. Employers can enable happiness in the workplace in two fundamental ways. First, provide a perpetual, learning environment. Turn big stick supervisors into teachers and mentors. Create educational opportunities, work related or not, wherever and whenever possible. Encourage non-fictional reading of peer reviewed and professional journals. Take advantage of the Internet and multimedia presentations. Take field trips to other communication centers. Promote higher education. Do everything possible to ensure that every employee learns something every day. While continuing education is considered by many managers to be little more than an expense, perpetual learning enables productivity not only through work-related knowledge, but also via happiness and fulfillment, intangible qualities that simply cannot be bought.

The second essential factor in fostering happy employees is feedback. Apathy is likely the most detrimental emotion encountered in the workplace and, in the case of public safety, its effects can be devestating. A caring attitude is essential in our profession. It's what separates the cream from the curd. Apathy is our enemy, and the way to eliminate it is simple: feedback.

While the act of providing positive feedback to employees is relatively simple, most managers and supervisors avoid it. This is likely because human beings tend to seek out the negative, not unlike the press of late. While the process of random sampling of performance data and accurate analysis and interpretation of such data is too complex to explain in the space remaining, actual feedback, especially positive, verbal feedback, can be improved in the same way thought processes can: practice.

Managers and supervisors should set feedback goals, and then follow through. Find something good to say about as many employees as possible each day. While this may seem awkward at first, practice will make it second nature.

Like any employee, managers and supervisors thrive on learning. Study quality improvement principles. Read, ask questions, join a quality-minded listserv or club. The National EMS Managers Association is a great place to start (http://www.nemsma.org). Pay attention fo the attitudes of your employees and help them to help themselves by providing an enviornment of learning through education and feedback. Doing so will improve the quality of life for everyone involved in our business of caring.