Spare Some Change?

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With EMS Today right around the corner, I got thinking the other day about the past conferences that I have been to.  This year’s gathering in Washington, DC marks my ninth consecutive major conference that I have attended.  I’ve been to Baltimore three times, this will be my second appearance in DC, Las Vegas twice, New Orleans, and the first conference that I attended back in 2010 in Dallas.

That year in Dallas, Had quite the opportunity drop in my lap.  One morning, I had the chance to sit down and interview a person who I very quickly came to admire because of his involvement in the National EMS Management Association, Skip Kirkwood, who at the time was the chief of Wake County EMS.  Even before I had a chance to meet Skip the words “Well, in Wake County. . . ” were a constantly used phrase in my vocabulary.  I admired the changes and strides that they had made in their quest to provide the best possible patient care for the residents of Wake County.

More than that though, I admired Skip’s approaches to problem solving.  For years to follow, presentations that I have given have involved little pearls of wisdom that I have obtained at the hands (and fingers) of skip over the years from e-mails and posts that I have received from him, so while I had a long standing admiration for Skip, having the chance to sit down with him as a captive audience and pick his brain was quite the opportunity for me.

One thing that stood out to me was how he approached change and progression in Wake County.  As I read about his service it was clear that things always seemed to progress quickly there.  Skip’s answer to me was that he always promotes an environment that is comfortable and welcoming to change.  He wanted his people to be ready to walk in one day and find a new piece of equipment, or a new policy change.  By doing this, when major changes were rolled out his staff was more welcoming and willing to adapt.

I cannot tell you how much that stuck with me.  Far too often, I have seen paramedics, EMTs and even services becoming complacent with the “norm.”  They get themselves into a rut, and allow life to just carry on day to day in their same routine.  Response becomes automatic, treatment becomes automatic, and then when someone suggests doing something differently there is significant pushback.  I have seen it through my own experiences as a supervisor, I have seen it as a street medic both from myself and from my peers, and I have seen it through my friends in other services.  It is a consistent trend.

It goes without saying, and has been stated repeatedly in the virtual pages of my blog that we are at a major crossroads in EMS.  The care that we provide is slowly moving away from simply providing emergency care, and we are evolving into what MedStar and Matt Zavadsky are calling “Mobile Healthcare.”  We are being asked to relearn the EMS alphabet, and but “C” before “A” and “B” all in the name of saving more lives.  It’s change, and for most people who have adapted their own way of doing things and their own rhythm, it’s is terrifying.

Every service and every manager has their own challenges for how to promote and allow their people to become comfortable with change.  For example, one of the major ones that I dealt with at my former employer was having a diverse work force that was around 40% part-time and per-diem employees.  Getting the word out to these people and getting them proficient to the point where they could just seamlessly transition into the workforce was difficult.  Dispatchers had to be convinced that no, that crew is not dogging it at the hospital, they’re learning our new computer system.  Managers had to learn that we might have to put an extra truck or two on to let our people adapt, and give them a chance to apply what they learned in a classroom (or on a memo) hands on.

The important thing to remember though is that while fresh ideas can be born at any level from the newest EMT right on up to the medical director, the key to how that new treatment or policy is received is up to the leadership team.  Implementations need to be methodical.  No one should ever say, “Just do it, make the change.”  Memos should not be rushed out.  Rollouts on major changes need timelines.  With every new policy fails, is not followed, or is simply imposed with an iron fist on a work force, you can expect the next one to be that much more difficult.  While I am certainly guilty of contributing to the problem as well as the solution, all that I can do is learn from my mistakes, and more importantly, embrace Chief Kirkwood’s ideas and values.

Promote the change, embrace the change, and be a champion of the evolution of EMS.

To read my full interview with Chief Skip Kirkwood, check out Part 1 and Part 2.