PowerPoint Presentation

Abuse or System Failure?

Start really listening to your patients. Nathan Stanaway, NR-P

INTRO

JOB EXPERIENCE

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Objectives Lets talk about:Where weve beenWhere were headedHow do we make the necessary changes to get there?Why is change SO hard?

Once, in the past, I worked in a very busy urban EMS system. I was well paid, the trucks ran well enough, and the heat and air conditioning worked most of the time. I had a great partner whom which I compare all my subsequent partners to. I was a young paramedic working on the mean streets of a big city. I was living the dream. What was not to love? After a while though, I began to feel bitter. I found myself constantly dispatched to calls that were a waste of time. Calls for sore throats and tooth aches that had been there for days or even weeks. I was becoming so angry! Why were so many people abusing the system? Didnt they know that EMS is for when youre dying? I was determined to change the way our customers used our services. I tried over and over again to educate the callers I felt didnt warrant an EMS response. I tried so hard to get them to change their ways, and my heart really was in the right place. Or so I thought.

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Traditional EMS

OldNew

This is of course not EMS. This is simply how EMS gets to the patient.

EMS started as a service provided by funeral homes. They got more money if the person died than if they survived to the hospital.

We have been a field that has rapidly evolved for many years.

Now EMS performs all sorts of unique roles for sick patients. Air Medical / Tactical Medical / Critical Care / Childrens / CDC contracts.

There is one more field that we have yet to really get into3

How do you see your organization?

OldNew

What does your organization specialize in?

What kinds of changes have you experienced or seen happen in the time you have been there?

As we go through these next few minutes I want you to think about how you and your organization fit into the healthcare field

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Why do we exist?

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Clinical Decision Cycle

Why do we exist???6

Business Decision Cycle

Why do we exist???7

After much philosophical EMS industry introspection.. Were a lot like a hamburger

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Have it your way. But dont get crazy

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We sell AMAZING hamburgers

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We DONT sell hot dogs, so stop asking!

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We LOVE our hamburgers. Why dont they?

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Are we ignoring the warning signs?

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Our patients CAN choose

One way or another, people choose the products and services they want.

Some people would say that our patients dont really have a choice.

Not true. They could:

Drive to the hospitalWork through the political system to have us removed and replacedCut funding

Why waste all the money we spent on getting people to use 911?Why not expand??

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Not many people wanted hamburgers

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System Failure

EMS is phased out or taken over. Wait, I thought we were talking about hamburgers.

We cannot expect that we can control what our customers (patients) want forever. At some point there will be a shift. Change is inevitable. To survive youve got to anticipate it and adapt.

III.Our patients are our customers

A.We need to meet their needs

B.If they didnt call, you and some of your friends would not have jobs1.We need to expand not contract

C.Private industry examples1.Starbucks (let your customers guide you, and you will be eternal)2.McDonalds (dont demand more money without supplying more value)3.

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Hot dog All they wanted was a hot dog

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What is our hot dog?Mobile integrated healthcare?Community paramedics?Concierge medicine?Educated providers??

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Abuse Is it really?Webster defines abuse as a corrupt practice or custom

The employees all start talking about how the customers are harassing them continually asking about hot dogs.

The reality is that we should be measuring what it actually is that our customers want.

What services or products do they feel like they need?

How can WE meet those needs?

This isnt about pacifying an needy population, this is about adapting to customer use trends. Its simply smart business practice.19

Change is Constant Inevitableif we rest on our achievements, if we resist the pace of progress. For time and the world do not stand still. Change is the law of life. And those who look only to the past or the present are certain to miss the future. (Kennedy, 1963)

But Goethe tells us in his greatest poem that Faust lost the liberty of his soul when he said to the passing moment: "Stay, thou art so fair." And our liberty, too, is endangered if we pause for the passing moment, if we rest on our achievements, if we resist the pace of progress. For time and the world do not stand still. Change is the law of life. And those who look only to the past or the present are certain to miss the future.20

If Youre not moving forward

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R&D Spending. In Billions

VW R&D spending in 2013: $13.5 billionAs a percentage of revenue: 5.2%

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R&D is Important to EVERYONE

R&D spending in 2013: $8.2 billionAs a percentage of revenue: 11.5%

R&D spending in 2013: $13.5 billionAs a percentage of revenue: 5.2%

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Change Is Hard Work. Painful Even

Point of Initial Awareness

Valley of Confusion --- What we thought we knew was WRONG

Peak of Elation ---- We want to tell EVERYONE about this cool new idea / treatment / tool.

Slope of understanding-- Understand the change and are more confident, think pragmatically, and your behavior is much more productive. Good thing.

Acceptance -- By this time, you have regained your ability and willingness to be flexible. You have insight into the ramifications, consequences and rewards of the change (past, present, and future.)24

25Complacency is EASY. You might be able to bypass ALL of this with complacency, but you are also likely to be marginalized and may end up out of. You WILL eventually become obsolete.

DENIAL-- Can be part of complacency, but its really willful ignorance. One knows there is change, but chooses to ignore it.

DISILLUSIONMENT-- Caused by education / training failure. Internal marketing failure. Change is too difficult. Im sure you can think of other causes.This is when one becomes frustrated because everything they knew about something is WRONG. Or most of what they knew Either way, too hard! Not worth it!

Hostility---The continued effort to validate social predictions that have already proved to be a failure.The problem here is that individual's continue to operate processes that have repeatedly failed to achieve a successful outcome and are no longer part of the new process or are surplus to the new way of working. The new processes are ignored at best and actively undermined at worst.

Denial

DENIAL-- Can be part of complacency, but its really willful ignorance. One knows there is a better way, but chooses to ignore it.

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Disillusionment

Im off === Turnover27

Hostility

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Successful Organization

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Stages of Change Stages of Grief

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How does one make change happen?

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If You Cant Support Change, think about this..

Even if you cant support change, know that if many people stopped using our services you or your friend would lose their job.

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A 2011 Deloitte Survey suggested that the public is becoming increasingly selective about its healthcare choices. (Cerrato, 2014)

Advances in medical technology and mobile health are enabling a growing number of consumers to take care of themselves. Employers are passing on more of the cost of medical care to the public in the form of high deductible insurance.The public is taking an interest in health as they never have before.Shopping for healthcare is going to increase. (Cerrato, 2014)

All patients have a choice.Patients are customers

Works CitedCerrato, P. (2014, January 17). Healthcare 2.0: Patients as consumers. Retrieved February 21, 2015, from Healthcare Finance: http://www.healthcarefinancenews.com/news/healthcare-20-patients-as-consumers

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Our patients Our customers

Customer/Consumer: A party that receives or consumes goods or services and has the ability to choose between different products and suppliers.

I enjoy this topic because:: I enjoy economics it kinda explains why people do what they do. I have to understand WHY.

Really high turnover. Lots of the people in my orientation class did not last very long

WHY?

False advertising! We expected blood guts and glory around every turn.

I expected something different. So did many other people.34

We need to listen to our customersWe cannot truly know what it is our callers want if we do not listen - if we do not measure.What are your callers asking for?If its an injury, manage their pain.If its psychological, put them in contact with resourcesIf its reassurance, hold their hand. Meet their ACTUAL need- not the need you think they should have.

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In Closing

Never forget where weve been We dont want to accidentally end up there again.Look ahead to where youre going!Dont forget to ASSESS your customers and decide what they are REALLY asking forDont fear change! Embrace it! Remember to HAVE fun on the roller coaster of change.

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We sell AMAZING hamburgers

CONCLUSION

Make sure you dont ONLY sell hamburgers Especially if your customers are asking for other things37

What is Abuse?

Once, in the past, I worked in a very busy urban EMS system. I was well paid, the trucks ran well enough, and the heat and air conditioning worked most of the time. I had a great partner whom which I compare all my subsequent partners to. I was a young paramedic working on the mean streets of a big city. I was living the dream. What was not to love? After a while though, I began to feel bitter. I found myself constantly dispatched to calls that were a waste of time. Calls for sore throats and tooth aches that had been there for days or even weeks. I was becoming so angry! Why were so many people abusing the system? Didnt they know that EMS is for when youre dying? I was determined to change the way our customers used our services. I tried over and over again to educate the callers I felt didnt warrant an EMS response. I tried so hard to get them to change their ways, and my heart really was in the right place. Or so I thought.

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