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Accreditation and Quality Assurance PART 2
Author: Cory Friend, PowerPhone, Inc.
Copyright: 9-1-1 Magazine, Feature Content
PART 2: Encourage Continuous Improvement with a Quality Assurance Program
The second of a two-part series on Accreditation and Quality Assurance, Cory Friend, Accreditation Coordinator at PowerPhone, Inc., discusses the importance of Quality Assurance to the Accreditation process and the steps necessary to implement an effective QA program. Friend’s first article detailed the Accreditation process, including the agency self-evaluation, the components of a successful Accreditation process and the benefits to be derived.
Would it surprise you to learn that most employees view Quality Assurance programs as a negative process that only looks for problems and assigns fault? Does this describe your QA process? QA is a continuing process of self-evaluation and improvement. An effective QA process uses a balance of recognition and acknowledgment to encourage and reinforce good performance and training and guidance to correct poor performance.
In 1982 Edward Deming, the father of modern Quality Assurance, wrote a book entitled Out of the Crisis. In his book he lists several points important to the establishment of an effective Quality Assurance program:
- Create constancy of purpose toward improvement.
- Improve constantly and forever. Constantly strive to reduce variation.
- Institute training on the job. If people are inadequately trained, they will not all work the same way, and this will introduce variation.
- Break down barriers between departments. Each department serves not the management, but the other departments that use its services.
- It is not people who make most mistakes – it is the process they are working within. Harassing the workforce without improving the processes they use is counterproductive.
- Institute education and self-improvement.
- The transformation is everyone’s job.
Instituting a Quality Assurance program will provide an agency with the means to:
- Increase customer and employee confidence.
- Increase an agency’s credibility.
- Improve work processes and efficiency.
- Enable an agency/department to compete with others.
Now more than ever, our communication centers have to compete on many levels. Centers are facing consolidation. Sometimes, it is to reduce the costs associated with funding multiple centers. All too often, it is a result of government leaders being frustrated with the problems of poor performance in the center. It is easier to contract the services and turn the headaches over to someone else. Leadership is less likely to give up a center with an effective QA process in place. They are more likely to stand behind an agency that has a plan for improvement with written documentation and measurable criteria that demonstrates they are committed to upgrading call handling standards and personnel practices and procedures on a continual basis.
Centers compete with other departments in the town, county or state for funds. A center with a QA process in place is able to justify its needs with thorough documentation output from the QA process.
Often call handlers are the only contact the public has with its government. The way they are treated by the call handler shapes their perception of the government. When tax or mill levy increases are requested, the public is much more likely to support the initiative if they feel they were treated respectfully and received good service from the call handler. A QA process will have a defined standard of care in place and will hold call handlers accountable for delivering that standard of care.
Creating an effective QA process starts with the definition of the standard of care that is to be provided. What is the level of service that you want to provide to the community and to those internal customers who rely on your services? These standards may include how customers are to be treated when they call in. How quickly will their call be processed and dispatched? Should they expect a timely and accurate response? Will they be provided services, such as EMD, consistently by a trained and knowledgeable call handler?
Once these standards are defined they will need to be documented in writing and communicated to your staff. Before call handlers can be held accountable for their performance they must first understand what the expected standard of care is and how they are expected to meet those standards. Each standard will need to be written into a policy so that the intent of what service is to be provided is clearly defined. Written procedures will provide the steps for how the service is to be delivered.
This is a good time to ensure that the practices you are putting in place are in line with industry best practices. Best practices are defined as the most efficient and effective method of accomplishing a task, based on consistent procedures that have proven themselves over time. There is no need to reinvent the wheel. A best practice already exists for any task that you want to put in place. There are many public safety professional organizations that can be used as a resource to identify best practices.
Those agencies that already have policy and procedures in place, specific to the call handling function, should review them for accuracy. Policy and procedures will need to be written where existing documentation does not address recommended practices. The policy and procedures will then need to be compared to operational practices to be sure they mirror each other.
The next step is to create an improvement plan that will identify a strategy for meeting the defined standard of care. QA will provide a method of measurement to identify whether or not you are meeting the standard.
You will notice that a recurring theme in QA is consistency. As Deming stated, the key to a Quality Assurance plan is constantly striving to reduce variation. One of the most effective ways to reduce variation and increase consistency is to incorporate a nationally-recognized call handling protocol system. The industry standard and the protocols most people are familiar with for EMS calls is Emergency Medical Dispatch or EMD. There are also Fire Service and Law Enforcement protocol systems available. By adopting a recognized protocol system you are introducing a system built on consistency of standards into your organization. The use of the protocols alone will improve performance in your agency.
The QA process should include a random review of calls to identify call handling strengths and weaknesses. The goal of QA is consistency in meeting the standard of care. Therefore, it is as important to review routine calls as it is to review major incidents. Your staff should be providing a consistently high level of service regardless of the type or severity of the call.
The review and feedback portion of the QA process is critical to achieving performance improvement. The reviewer will evaluate how the call handler performed in accordance with the standard of care. A review form will have to be developed, which assists in evaluating whether or not the call handler met specific performance criteria, and assigns a numeric score to measure the results. QA is not black and white; sometimes judgment calls will have to be made. The reviewer will have to provide specific details as to what the call handler did right and what was done wrong. Focusing on specific behavior will allow the good performer to understand what actions they did well and should repeat in the future. Conversely, providing specific behavior will make it clear to the poor performer which actions were not in line with established protocols and procedures. The reviewer must provide suggestions for improvement and set measurable goals for performance development. In most instances, the reviewer will find both good and bad behaviors that will need to be identified and addressed.
Feedback needs to be provided in a face-to-face meeting. This is a great opportunity to praise and acknowledge good performance, which will encourage, promote and develop similar performance in the future. Recognition of employees shows them that their contributions are valued. In terms of job satisfaction, many studies show that this is more meaningful than pay and other forms of compensation. To facilitate a learning and improvement environment, the feedback needs to take the form of training and a discussion rather than a lecture. Lectures should be reserved for repetitive bad behavior where no improvement is being made or where there exists willful disregard for established procedures. Do not simply hand a review form to the call handler and expect them to draw their own conclusions. This will not lead to improved performance and may lead to a loss of credibility in the QA process in the eyes of the call handlers. To have the greatest impact, the review needs to occur as close to the call as possible.
The last portion of the QA process is the analysis and evaluation of the data produced. The QA program is meaningless without incorporating this last step. This data will indicate the level of compliance in meeting the standard of care. It can also provide valuable insight to institute change and guide improvements in the following areas:
- Personnel (praise, recognize, reward, develop, correct, change).
- Individual and staff training needs.
- Procedural changes.
- Budget justifications.
In order to know what data to collect, simply refer back to the original goals of the QA program:
- Ensure compliance with the defined standard of care.
- Standardize the quality of care.
- Ensure scene safety.
- Reduce litigation risk.
- Promote continuous improvement.
…chart a course for every endeavor that we take the people’s money for, see how well we are progressing, tell the public how we are doing, stop the things that don’t work, and never stop improving the things that we think are worth investing in.
-President William J. Clinton, on signing the Government Performance and Results Act of 1993
In 1993, President Bill Clinton signed the Government Performance and Results Act. The findings of the study completed in 1997 noted that “performance measures should be limited to those that relate to strategic organizational goals and objectives, and that provide timely, relevant and concise information for use by decision makers at all levels to assess progress toward achieving predetermined goals.” The report also cautioned against “collecting data simply because the data were available to be collected, or because having large amounts of data ‘looked good.’ Instead, organizations should choose performance measures that can help describe organizational performance, direction, and accomplishments; and then aggressively use these to improve products and services for customers and stakeholders.”
The reports that are created through the QA process can be a valuable marketing tool for your center. Once you have the process established and you are receiving consistent results, be sure to share this information with the stakeholders in your agency. Your fire chiefs, sheriff, police chief, city council members, county commissions, city manager and other leaders will appreciate receiving positive information that they can share with the community. Be creative and consider using Facebook or Twitter to announce your accomplishments.
The Need for QI: One Example
On one occasion, my center had a man call 9-1-1 to report a medical emergency. The dispatcher assumed it was a 9-1-1 misroute because the man lived in a neighboring county. The dispatcher filled out an ANI/ALI correction form and forwarded it to the Master Street Address Guide (MSAG) Coordinator. After doing some research and speaking to the man, it turns out that he had worked for the phone company, and before he retired, he manipulated the MSAG so that 9-1-1 calls from his residence would route to our dispatch center. He told us that he did not trust the dispatchers in his county. The MSAG was corrected, and the man’s 9-1-1 calls were routed to the correct dispatch center. Three months later, the commissioners from that county contacted me and said their citizens had lost confidence in their dispatch center and asked that our county provide those services for them.
It is imperative that managers keep their centers competitive by instituting best practices, having a quality improvement plan in place and holding their call handlers accountable for delivering high-quality service. Just as in the private sector, our jobs and services can be outsourced.