If you’re an EMS Quality Assurance manager and “discipline” is in your standard vocabulary here is a hint. You are doing it wrong.

I’ve often heard so called EMS educators and QA managers talk almost gleefully about how they were able to “pull” someone’s authorization to practice or “credentials” because that provider made a mistake.  They’ll crow about how they taught them  lesson.

They use the term “taught them a lesson”, but I don’t think it means what they think it means.

In addition to teaching the wayward medic a lesson, they also taught their co workers a lesson. The lesson is that they should cover up their mistakes, even if they have to lie to do that.

Wrong lesson.

I was fortunate enough to work in a system, which except for a short period of time where we were lead by a complete asshole with MD after his name, we used the same system that medicine uses for catching and remediating medical errors.

Note that I say errors. This system did not cover malfeasance, it covered honest medical mistakes.

The key to that system is honesty. The key to honesty is confidence by the providers that reporting their mistakes would result not in discipline, but in re-education and remediation.

If you teach someone that reporting their mistakes will result in discipline of any sort, then human nature dictates that they will try to hide their mistakes.

That doesn’t help anyone, not the provider, not future patients, and not the agency. What you get is a bunch of providers who are afraid to admit when they might have made an error, will default to doing the bare minimum on a call to limit their exposure, and overall you’ll get a crappy meets minimum standards (barely) EMS system.

Often when I’m working with a provider who made a mistake by either under, over, or incorrectly treating a patient, the first thing that they ask is if I am going to tell their boss. Unless the mistake puts the organization at risk for violations of law, regulation, or liability for harm to the patient the answer to that is a flat “No.” The organization I work for also does not notify regulatory agencies of mistakes. We do inform the service that they should look at the issue very carefully and make their own determination.

A good Quality Assurance person will not develop a reputation for reporting providers to anyone for discipline. The key to having providers be honest with you and heed your advice and recommendations is trust. If there is no trust in the confidentiality of the process, there can be no process.

Here is my last bit of advice on this topic. At least for now.

The best QA person I ever had wasn’t a QA person, he was a superb physician. Had he even a hint of arrogance in him, his IQ that could easily have intimidated the crap out of me and any other medic who worked for him. He didn’t, which made him an excellent teacher. In my 35 years of EMS experience he is the only person who could take 10 minutes to explain to me in detail how I screwed up then say “Good job.” and make me feel good about screwing up. I still remember things he taught me 20 years ago.

I’m not that good, but that’s the ideal that I try to achieve. If every QA person did that and sorted out the serious errors from “Chicken shit” the process would be a lot more enjoyable for everyone involved.

Not that I expect that to happen, but it should.