For years I wondered why despite being a confirmed urbanite, I love camping. Then I realized that camping gives me full permission to improvise—to make creative use of the limited materials I have to get the job done. Hence, shirt tails are fair game for wiping coffee grounds out of measuring spoons.
Similarly, I am inspired by people and groups that use the resources we have at our disposal in health care in creative new ways. Like the first explorers, these folks are testing approaches to provide care that are more effective than the status quo. Given the escalating health care costs, we need to be looking for ways to make the available financial resources work better for us. And, studies have shown that health care delivery includes a lot of wasted time, resources, and supplies, due in part to use of higher-priced services with no health benefits over less-expensive alternatives.
At a recent meeting on patient safety, I heard about a novel way of using a previously untapped resource—emergency medical technicians (EMTs), those courageous first responders to 911 calls. I followed up with Matt Zavadsky, MS-HSA, NREMT, who is the chief strategic integration officer at MedStar Mobile Healthcare, which provides emergency medical services (EMS) in the Fort Worth, Texas area, to learn more about it. Here’s what he told me.
For decades EMS units have been paid only to respond to emergency calls and transport people to the hospital. If they were to transport a person who needed less intense care to a lower acuity setting, like a walk in center or a clinic, they would not be paid—representing overuse of higher-priced services. In addition, EMTs, especially those based in fire departments, often spend a substantial portion of their shift waiting for emergency calls—representing underutilized human resources.
Why would a well-respected, venerable health care organization adopt a soft and squishy approach—tracking disrespect and other forms of emotional harm—to monitor its performance?
In 2007, Beth Israel Deaconess Medical Center (BIDMC), a 672-bed health system affiliated with Harvard Medical School, adopted the audacious aim of eliminating all preventable harm by January 1, 2012. According to Kenneth Sands, MD, chief quality officer of BIDMC, the organization has not yet achieved perfection in this area, but the bold goal has catalyzed substantial advancement in patient safety at the organization.
Sands and colleagues described this courageous approach and their patient safety efforts at a presentation at the Institute for Healthcare Improvement Annual Forum in December. BIDMC patient safety experts have developed a process by which serious events, such as medical errors, are sifted from the “noise” of the thousands of reports received each year, such as “near miss” events. High-level statistics regarding these events are included on the organization’s performance dashboard, portions of which are shared publicly. Since launching the initiative, BIDMC has seen a 70 percent drop in serious harm events, despite improved reporting mechanisms that likely increased the number of harms reported.
According to Sands, the bulk of the improvement was due to several initiatives to decrease specific harms (for example, decreasing cardiac arrest in med/surg units). Quality and safety leaders realized that the harms that remained would require a broader approach.