NON-PUNITIVE "CLOSE CALLS" INCIDENT REPORTING - EVENT reporting!

Today, at EMS TODAY, noted public safety risk management expert Gordon Graham talked about learning from close calls - non-punitive close calls incident reporting. He cited the great experiences of the aviation industry and the fire service with event reporting and recommended that EMS "get with the program."

So that everybody knows - EMS already HAS a great close calls reporting system. Apparently we need to do a better job promoting it - so we will get started on that.

The EMS Voluntary Event Notification Tool (event.clirems.org) is a project of the Center for Leadership, Innovation, and Research (CLIR), a project of several American and Canadian EMS organizations, with sponsorship provided by the North Central EMS Institute (NCEMSI), the National EMS Management Association (NEMSMA), the Emergency Medical Services Chiefs of Canada (EMSCC), the National Association of Emergency Medical Technicians (NAEMT) and the National Association of State EMS Officials (NASEMSO).

E.V.E.N.T. is a tool designed to improve the safety, quality and consistent delivery of Emergency Medical Services (EMS). It collects data submitted anonymously by EMS practitioners. The data collected will be used to develop policies, procedures and training programs to improve the safe delivery of EMS. A similar system used by airline pilots has led to important airline system improvements based upon pilot reported "near miss" situations and errors.

Please do whatever you can to get the word out! We need to learn from the near-misses and close calls of our colleagues. Put YOUR events in to EVENT, and help us to make EMS a safer place to work!

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Permalink Reply by Skip Kirkwood on March 16, 2013 at 9:42am

Nobody interested? Perhaps a sign that something is not right in the EMS community?

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Permalink Reply by Chris Azevedo on March 16, 2013 at 4:46pm

How about some examples of when you would use this, versus the ingrained "protocol violation" policies that most EMS organizations already have?

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Permalink Reply by Matthew Hill on March 17, 2013 at 4:12pm

I am familiar with the EVENT reporting system and believe it is a valuable tool. The problem is our EMS culture. Clinical staff believes reporting events will lead to punitive action, and in a lot of cases they are right. Most organizations and leadership in EMS do not support a JUST Culture model or even know what it is for that matter. Generally, our leadership is made up of paramedics who were “most senior” rather than those who have demonstrated leadership. They often are not equipped with the skill set to apply concepts like JUST Culture and progressive performance improvement effectively. Our best and brightest potential leaders always seem to leave the profession to pursue other professions.

At our organization, we have a hard enough time getting staff to report events internally, which is critical for us to monitor system trends and evaluate our own processes. I agree that we need to be able to collect this data across a wide spectrum, but paramedics are not going to be consistent in doing this. Leadership (Managers, Quality Staff, Supervisors, etc.) will need to input this information as part of a process. Until we have a culture change in EMS towards a non-punitive structure of investigation such as JUST Culture, we will not see an optimal use of this tool. We have had JUST Culture in place for over 2 years now, and still find challenges in convincing staff that our role is the improve the care we provide as a system, and not to provide punitive action against clinical staff for making errors that we all can learn from.

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Permalink Reply by Skip Kirkwood on March 17, 2013 at 4:29pm

Actually, I'd hope that reporting in EVENT would be much more safe than local reporting - particularly since it is anonymous. It takes a lot of work to do just culture in an organization, particularly a small organization, but what is there to fear about retribution when the people receiving the data don't know your name or your agency?

So, Matthew, if "the best and brightest potential leaders always seem to leave the profession to pursue other professions," what can we do about it? We who try to provide leadership are often very frustrated, asking "How can you lead those who refuse to be led?" What can those at the point of the spear (the medics on the ambulances and QRVs) do to create an environment where leadership is possible?

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Permalink Reply by Matthew Hill on March 17, 2013 at 9:34pm

I think it is reasonable to think that reporting an error to an anonymous system like the EVENT system will not result in punitive action. The problem I believe lies in general perceptions in EMS on what exactly a reportable "event" is? I think most would agree that in EMS our view of what an adverse event differs from what other allied health professions view it as. Also, EMS staff tend to have a hard time in seeing the broader goal of "improving the safety, quality and consistent delivery of Emergency Medical Services"

In regards to "what we can do about it", I think some basic elements must exist within an organization's culture. They are:

1. Respect (mutual between front-line staff and leadership)

2. Accountability

3. Investment in talent.

Good organizations promote mutual respect. They expect accountability, but console and retrain in situations that are appropriate. They also recognize talent and develop it early. Realizing that a lot of leadership is aging in many organizations, there seems to be almost no investment internally. Additionally, we have created silos in EMS organizations that make recruiting leadership talent from outside the organization an unspeakable act. Nowhere doe this appear to be more common than the Fire Service, but it can just as easily be said for EMS as a whole.

Lastly, Quality, Risk Management, and Compliance as a whole seem to be the last areas where EMS organizations invests in. This is how Quality inevitably gets viewed as "punitive", because these roles end up falling on supervisors, whose role conflicts with training and development practices.

These of course are just my opinions and I will admit they are slightly off topic, but I believe we lack an accountability to our patients by our general culture which precludes us from understanding why a system like EVENT is so important. It is not intentional, but rather instilled in our culture.

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Permalink Reply by Skip Kirkwood on March 17, 2013 at 9:49pm

Oh, you are so on target. I agree that "we lack an accountability to our patients by our general culture which precludes us from understanding why a system like EVENT is so important." So many of our decisions are made based on short-sighted self-interest (like, "How do I avoid doing this little piece of work?"), rather than on the interests of the patient (which should come first), or the interests of making the profession a better one.

I am amazed at how little we are willing to invest, either in our employees or in our selves, for future betterment. I hear it all the time - "I'm not going to get a degree, because nobody pays you more if you have a degree!" True, but if you have a degree, a few years from now you might beat out the next guy for a promotion or some other opportunity.

So how do we blast this stuff out of our culture, and replace it with good stuff?

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Permalink Reply by Devin Nemec on March 21, 2013 at 8:37am

On that degree note, I just applied to an EMS job that a degree was a requirement for. There shouldn't be too much competition either because of that mindset of why should I get one. At the company I'm no longer with, I think out of about 300 EMTs and Paramedics MAYBE 2 had EMS degrees.