5 Tips for an Effective QI Project for Your EMS Agency

Quality Improvement projects can make a big impact in your EMS agency operations, helping processes run more efficiently, lightening the load on your providers, and even promoting more positive patient outcomes. But how do you get started?

It can seem daunting: knowing which projects to tackle, how to judge whether you’re really making a difference with your efforts, and how to make the most of your resources in the shortest amount of time. At the annual ESO Wave conference held in Austin, TX, ESO Director of Clinical Operations Remle Crowe and Brooke Burton, QI/Controlled Substance Manager at United Fire Authority, presented a keynote presentation titled, “From Quality Assurance to Quality Improvement: Time to Pivot.”

Covering some of the most pressing aspects of quality improvement projects, Crowe and Burton presented several helpful guidelines to ensure your project starts out with the right scope, gains proper buy-in (or, better yet, commitment), stays on track, and can be easily rolled out with success.

To help lay the foundation for a successful QI project, EMS agencies should incorporate the following tips.

1. Start with the Right Questions

When creating your quality improvement project, you should begin by asking yourself three important questions from the Institute for Healthcare Improvement’s Model for Improvement:

• What are we trying to accomplish?
• How are we going to know that a change really happened?
• What can we change that might result in improvement?

Your project doesn’t have to be on a huge scale or involve giant, expensive changes. In fact, we recommend starting small and making fast tests of change with the goal of learning what works well and what doesn’t before you scale up to organization-wide implementation. Unlike research where the goal is to test a hypothesis in a very controlled setting, the goal of quality improvement is rapid learning to make meaningful change.

When it comes to a good QI project, you should also focus on a metric that already has an established Standard of Care, and that occurs enough within your agency to be able to see change. For example, a topic like Pediatric Stroke has high importance and high criticality, but perhaps in your community, very low frequency. If you only encounter a few cases of Pediatric Stroke a year, it would take us years to know whether any of our changes made a difference or not.

2. Establish a Strong Aim Statement

In quality improvement, an aim statement is a clear, explicit summary of what your team hopes to achieve in a specific amount of time, including a concise description of what success will look like. An aim statement is notably different from your project’s “problem statement,” which is a bigger-picture description of the overall issue your team is trying to solve.

To create an effective Aim statement, you’ll want to dig deep and ask yourself “Why?’ until you come to the core of the issue. For example, you may start with the goal of “decreasing on-scene times,” but when you ask yourself why this is important, you will come to the goal of “decreasing mortality rates.” You may then find other actionable measures that  have a larger impact on the same goal (e.g., thorough assessment, rapid initiation of appropriate interventions), rather than only looking at scene times.

An aim statement should also fit the S.M.A.R.T. criteria: Specific, Measurable, Attainable, Relevant, and Time-Bound. Being disciplined and taking the extra time at the beginning of a project to get the aim right actually saves your team hours of wasted effort and frustration down the line. Learn more about crafting an effective aim statement.

3. Brainstorm Your Change Theories

You also don’t need to come in with all the answers. When it comes to fixing a problem, spend some time brainstorming with a driver diagram and involve people from the front line who live the process. The whiteboarding stage of your quality improvement project can and should be the most inclusive and stimulating phase of the project.

Even though you probably have a good idea for how to fix the problem, open your mind to other possibilities (even ones that don’t seem feasible) in a brainstorming session. If you don’t have one already, create a Quality Improvement Committee with representatives from various sectors of your agency. Each one will bring a unique perspective and new ideas.

Other sources for change theories include patient feedback forms, PubMed, Google Scholar, and small focus groups. It’s important to create a culture where feedback can be offered freely without fear of punishment. Acting on feedback received or communicating why an action was not taken is a key part of creating a participatory environment.

4. Take into Account Variation

To make real change you need an accurate understanding of your data over time. Traditional summary measures, like averages, hide variation and make it harder to know whether you are dealing with any outliers. A certain amount of random variation is natural within any process.

Think about your drive to work: sometimes you hit a few red lights or stop for a coffee and sometimes you hit all green lights and go straight to the office. This is “common cause variation” in your commute time. But what if one day on your way to work, a giant sinkhole opens up just in front of you? Your time to work that day is likely to be unusually long. This is “special cause variation.”

In QI, we’re hoping that the changes we make result in better performance than any spike we see with random normal variation in the process. We’re looking to generate special cause variation (not catastrophic like a sink hole of course).

A run chart is a simple tool that can help you look for signals of special cause variation, while control charts are more sophisticated visualizations that can tell you whether special cause variation has occurred.

5. Use the Plan, Study, Act Cycle

As you are ready to begin trying out your first selected change idea, you’ll want to start with a small group that can provide you just enough information to see if the change is worth rolling out to a larger audience. Your goal is small, fast test of change to get to rapid learning.

This may mean just one crew and one shift; implement your change and track the results. At the end of each of these cycles, you then “adopt, adapt, or abandon” the change. If the change did not work at all as intended, abandon it and quickly move onto the next small test of change with a new idea. If the change mostly worked, but you learned something about how you might be able to make it better, adapt the change and test again with another slightly larger group.

If the change worked great, adopt it and scale up to five crews or five days, and then again to 25 crews or 25 days, to ensure you are still seeing results while avoiding any unintended consequences.

Implementing these steps and best practices can help ensure your team is working smarter – not just harder – to improve operations, ultimately benefitting your team members, your bottom line, and your community.

See how ESO tools simplify data gathering and allow you to focus on the changes you want to make, rather than spending all your time mining data. Video: See how EMS Agencies have implemented Quality Improvement in their agencies >>