Ottawa Paramedic Implements Service Quality Model

Jennifer Bionda

In 2003, the Ottawa Paramedic Service (then known as Ottawa EMS) developed a quality improvement model, which was subsequently published in Canadian Emergency News as a two part series in the Oct./Nov. 2003 and Dec. 2003/Jan. 2004 issues. The purpose for developing and communicating the model was to:

1. Educate our staff and other stakeholders about the key components of a performance-based EMS system.
2. Explain the relatively new (to us) concepts of quality assurance and continuous quality improvement.
3. Discuss the relevance of the model's components and how they were integrated.
4. Put into context the various initiatives and projects implemented by the Ottawa Paramedic Service (OPS).
5. Identify opportunities for all OPS employees to contribute to our overall service goals.

Fast forward seven years to 2010, when the senior management team of the OPS took the opportunity to reflect on the ongoing relevancy of the model within the current context and evolution of our service, and whether or not our original goals and objectives were achieved.

As far as the first two goals, we were relatively successful in raising awareness within the broader management team (inclusive of commanders and superintendents) of the key elements of our performance based system (i.e. the five pillars – Performance Accountability, Response Time Reliability, Economic Efficiency, Clinical Excellence and Customer Satisfaction). In fact, most superintendents and aspiring superintendents/commanders could quite readily recite the five pillars (and were often asked to do so in an interview situation), and demonstrate how their position within the organization contributed to the achievement of these service goals. Most, I believe, had a general understanding and appreciation of the quality assurance and quality improvement initiatives within the service.

Unfortunately, we had difficulty truly integrating the model into our day-to-day business and engaging our front-line staff in the model. As can so often be the fate of these somewhat academic exercises, the quality improvement model began to collect dust.

Re-build it, communicate it, live it

So in 2010, the senior management team engaged in a facilitated dialogue about the future of the quality improvement model – was it still relevant as we moved into our second decade as an organization? How could and should it support decision-making within the service? How could and should it guide strategic planning? How could we successfully integrate the model into the organizational culture of the OPS?

At the outset, the senior management team agreed unanimously in the value of the model to represent and communicate our organization’s commitment to excellence to our employees, to our corporate partners (City of Ottawa senior bureaucrats and politicians), to our external stakeholders – especially to the public we serve. However, revisions were needed. There was unanimous agreement that for the model to have maximum value, we needed a comprehensive communication strategy to “tell everybody about it,” and most importantly, for the model to have credibility, we needed to “walk the talk” to ensure it truly becomes imbedded in the psyche of our organization; incorporated into the culture of our organization; and that it remains visible and relevant.

The ‘New and Improved’ Service Quality Model

In the original model, performance accountability held centre stage. This was reflective of where we were in terms of moving from a “level of effort” service to one that is committed to developing, reporting and most importantly, being accountable to key performance metrics. A few years later, customer service took centre stage, as we began to work with our front-line staff on customer relations and service excellence. Now we recognize it is the simultaneous achievement of all the pillars – Patient and Community Satisfaction, Public Safety, Public Accountability, Service Reliability, and Excellence in Care, which is both our ongoing challenge and measure of success.

The five original pillars remain intact, albeit two were amalgamated into one. The new pillar is Public Safety, reflective of our increasingly active and significant role in emergency planning at a municipal and provincial level, and our commitment to ensuring high standards for our equipment, vehicles and staff training.

Most of the drivers within the model were retained, with two new drivers emerging – research and innovation, and partnerships. As with many paramedic services across the province and country, the Ottawa Paramedic Service is an active participant in numerous research studies, and is committed to evidence-supported practice. We work collaboratively with many other organizations to ensure high standards in patient care and seamless service delivery.

Through partnerships we gain access to knowledge, skills and resources that we lack, and through partnerships we have the opportunity to share with others our unique expertise and resources. More than ever, we seek innovative solutions to the challenges we face, and partnerships are an essential means of discovering innovative solutions and potential new funding streams.

The framework of the model was originally comprised of communication and Mission, Vision and Values.In our working sessions, this outer ring became known as the “gravitational field” because we recognized it holds the model together. Ironically, we didn’t actually have a Mission, Vision or Values statement until 2010, although we recognized its importance to the model back in 2003. I think this was rather symbolic of our maturation and cohesiveness as a senior management team.

To these elements, we now add leadership and organizational culture. Leadership is inclusive of leadership instilled through rank, and also through trust and respect. Leadership demonstrated through collaboration and cooperation throughout our organization, and with external partners. Leadership vis-à-vis our collective knowledge and experience, to remain progressive, innovative, effective and reliable in delivering a quality paramedic service to our community, and leadership through active participation in local, Canadian, North American, and International paramedic associations.

We’ve come a long way in 10 years, and the change in our organizational culture towards professionalism, commitment, pride, career, service excellence and patient-focus is a barometer of how far we have come.

Our organizational culture has influenced the revisions to our new Quality Service Model, and conversely as we move forward to the next 10 years, our culture will be positively influenced by our new Quality Service Model.

Through the professionalism and dedication of technicians, communication officers, paramedics, administrative and support staff, we have fostered a dynamic organizational culture of service excellence.

The Quality Service Model serves to focus our collective efforts toward simultaneously achieving success in key priority areas. To achieve success, we depend upon each and every one of our employees to be aware of, understand, believe in and contribute to our commitment to quality service.

Talk, then walk

We’ve re-built and re-committed ourselves to our Quality Service Model, and we’re executing our communication strategy internally and externally. The model has a new professional design, and an interactive website (ottawaparamedicservicemodel.ca). We’ve engaged our superintendents through a series of interactive town-hall style meetings; recognizing the importance of their buy-in and ability to influence the uptake by our front-line staff. We’re developing a picture poster series to hang on the walls of our headquarters, communication centre, and stations that will illustrate how all our employees bring the model to life every day.We’re including a dialogue around the model in our Fall Professional Development Program (staff training) for all front-line staff. We recently celebrated of our employees and our 10-year anniversary where we officially launched our Mission, Vision and Values. And as previously done, we will continue to incorporate an introduction to the model in our new hire orientation and with our local college paramedic program curriculums.

Living it remains the biggest challenge and one we are committed to make happen. Purposefully, we have redesigned various working templates (e.g. annual operational work plans, project charters and key performance indicators) to incorporate strategic links to the model components. If it doesn’t fit the model, why are we doing it? The Quality Model is increasingly being used as a grounding principle in other internal planning exercises. But there is still a long way to go before the model moves from being a continuously conscious effort to being second-nature, so to speak. That is when we will know that we are truly living it.