PULSE Magazine | May 2019 Issue

By Ernesto Rodriguez | Wednesday, April 17, 2019

Creating an Emergency Medical Services Improvement Culture

Chief Ernesto Rodriguez - Austin-Travis County EMS was recently featured in an article for the Institute for Healthcare Improvement (IHI).

The IHI uses improvement science to advance and sustain better outcomes in health and health care across the world. They bring awareness of safety and quality to millions, accelerate learning and the systematic improvement of care, develop solutions to previously intractable challenges, and mobilize health systems, communities, regions, and nations to reduce harm and deaths. Working in collaboration with the growing IHI community they work to spark bold, inventive ways to improve the health of individuals and populations.

They generate optimism, harvest fresh ideas, and support anyone, anywhere who wants to profoundly change health and health care for the better.

Emergency Medical Services (EMS) professionals don’t typically take part in health care quality improvement trainings, but Ernesto Rodriguez, the Chief of Emergency Medical Services in Austin, Texas, USA, believes that needs to change. A graduate of the Improvement Advisor (IA) pro- gram , Chief Rodriguez describes how creating an improvement culture in his organization has helped his team work more efficiently, communicate more effectively (including with elected officials), and saved their community money. I’ve been very interested in quality improvement for a long time. One of the improvement advisors (IAs) I met on my journey was [IHI Senior Lead, Improvement Science & Methods] Dave Williams. He did a training in our agency and I believe it was Dave who first introduced me to The Improvement Guide . I started reading it and ended up thorough- ly confused! I decided I needed someone to help me understand improvement, so I enrolled in Wave 34 of IHI’s Improvement Advisor (IA) pro- gram ed my world has never been the same. EMS does a lot of critical things in a very short amount of time with very little room for error. When you operate in an environment where every- thing you do matters, and you don’t have redo op- tions, you’ve got to get it right. It’s important to find ways to simplify and standardize some of what we do and to provide the tools and the information so that people can make good and wise choices as they perform critical interventions. There is a lot to be learned [from health care quality improvement] and the exposure to many On his interest in learning more about quality improvement On why more EMS agencies should learn about health care quality improvement

different facets of health care is eye-opening. It’s good to learn with professionals from a variety of disciplines about how we can do what we do better. On why he started investing in building the improvement capability of his staff After I went through the IA program, one of the first things I learned was that I couldn’t do what I wanted to do by myself because we didn’t just need to improve the organization — we had to transform it. We had to go to the root of who we are to change our culture and come out the other end being different. That’s not something that a single person can do by themselves. I decided to identify individuals with some skills and interest and sign them up for improvement training. When I looked into IHI’s Improvement Coach program , I found that it provides all of the essentials we need, so I sent three individuals to participate. The key result was that we sent them as individuals, and they came back as a team. That propelled us going forward. An example of how improvement thinking reduced waste and saved thousands of dollars We buy ambulances and they cost around $200,000 each. We buy them year after year, replacing old ones with new ones, and we continuously got complaints about the work space in the ambulances from our medics. The cabinets aren’t designed properly. Our equipment doesn’t fit. The flow is wrong. So, we had been spending all this money trying to buy better ambulances, but we failed at it over and over. After coming back from an IA training, I had the idea to use PDSA cycles and see what we can learn using an ambulance prototype. I talked

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