By James Thalman
GREELEY, Colo.—Just before 5 p.m. on a warm day this past March, one of the nine veteran Weld County dispatchers attending Brian Dale’s Emergency Dispatch Quality Assurance (ED-Q) course pushed back from the table and asked no one in particular: “Who talked me into this?”
The group had just finished a somewhat spikey discussion about case review feedback and a short debate of what “obvious” really means. It capped an intense two days spent going deep into quality improvement, discussing what ED-Q even means in the communications center, how whatever that is is maintained, and who in the heck would want to take on asking the toughest questions inside a center: Why wasn’t this incident handled according to protocol?
Dale, who is the National Academies of Emergency Dispatch (NAED) Accreditation Board chairman, let dispatcher Melody Paxton’s question hang as if it were to be the last official word of the class. He kept his right elbow on the lectern and his chin seated in the palm of his hand. He raised his eyebrows, briefly surveyed the group, and then said: “There’s only one person who can answer that one, and it’s not me.”
Case reviewing is certainly not for everybody, Dale had said repeatedly during the previous two days. But having people who are willing to do it is a must, “and it must be done with fairness, attention, and near-infallibility if a center is to maintain the quality of calltaking and processing the public deserves.”
ED-Qs have to be über-dispatchers in a way. Not only do they have to be an individual of exemplary interpersonal and organizational skills, but having traits listed in the Boys Scout’s Law—trustworthy, loyal, helpful, friendly, courteous, kind, obedient, cheerful, thrifty, brave, clean, and reverent—doesn’t hurt.
In addition, ED-Qs, according to the ED-Q Course Manual, “. . .will need to be patient, tactful, empathetic, compassionate, and organized. You need to be able to express your thoughts and feelings in a way that shows your concern for the quality of care received by your agency’s customers, as well as your concern for the well-being and advancement of those taking and processing the calls.”
It goes without saying that ED-Qs must know and show extensive working knowledge of the NAED protocols—the standard of care as well as the gold standard for professional emergency dispatchers. Minimum Q requirements vary slightly. EMD-Qs, for example, must have Advanced Life Support level medical skills and knowledge. EFD-Qs and EPD-Qs must have corresponding levels of skill and knowledge in their disciplines. A three-year commitment to be a Q is also expected.
Each center can take its own unique approach to quality assurance. The peer-to-peer review is how they do it in Greeley. Veteran dispatchers can take on ED-Q duty for three years or longer and rotate back to the console. Calltaking and processing can be done during the ED-Q commitment, but case review is the primary function. Getting more Q in case review was the goal of dispatchers who attended Dale’s class.
Peer-to-peer is the healthiest approach, as long as case reviewers stay professional and don’t get personal, Dale said. A person sitting next to you one day and then in judgment the following day can create a “Who do you think you are?” attitude that must be openly addressed from the beginning, he said.
Staying in the game
The player-coach approach can be much more effective in raising a call center’s quality level and consistency because of the inherent all-for-one, one-for-all ethic, Dale said. It’s a matter of recognizing strengths as well as weaknesses, a big part of which is to be as detail-oriented in the praise as the evaluators tend to be in pointing out deficits, he advised.
“If the objectives are clearly stated and consistently and openly followed in improving performance, the ‘Who do you think you are?’ aspect naturally fades away,” he said.
Just like a calltaker should be personable but not personal, case evaluations should be the same way.
“Everyone worthy of the job should be open to improving their handling of every call,” Dale said. “Good enough to get by is neither good enough nor getting by. If the standard is set, and everybody knows exactly what is expected, and that is maintained as a group, individuals can’t help but improve.”
“That, of course, is the ultimate example of ‘easier said than done,’” said Heidi Gillespie, an ED-Q with the Weld County Law Enforcement Center, at the Q course. “When you take work as personally and as seriously as dispatchers tend to take their profession, reviewing it becomes pretty personal, too. It’s pretty tricky.”
It doesn’t have to be if everyone knows and tries to show that case evaluations are about reviewing the incident, not about criticizing the individual, Dale emphasized at least a dozen times during the course. “People aren’t robots, and every incident has some obvious elements that are black and white and some are just a lot of gray. And sometimes what seems obvious to one might not be to another, and sometimes even obvious isn’t obvious. But, again, case evaluation isn’t about you.”
Those in attendance worked to understand the concept.
“But it is about you in a way,” Paxton, as well as others, said not trying to argue but to understand. “You’re looking for ways the dispatcher screwed up. At least that’s what a lot of people think; I know that’s how it feels to me sometimes, even though I try not to take anything personally.”
The subjective objective
Maintaining quality in the communications center can be a combination of herding cats and hypnotizing chickens—both difficult tasks, yet easier than you think.
Dale, deputy chief, Administrative Services, with the Salt Lake City Fire Department, took ED-Q down to its essence by showing prompts for quality assurance and public safety every driver knows—speed limit signs.
Showing a slide of the ubiquitous black and white “55” sign, Dale said most drivers regard the limit as a “55-ish” suggestion, although they know a highway patrol officer could technically pull them over and give them a ticket for driving 56 mph.
“Most officers won’t stop a driver for going 56; would they be more likely to stop them at 65? Probably, and drivers know it. There’s a tolerance built into the limit, everybody knows it, and traffic seems to keep going smoothly.”
Dale showed his next slide, a speed limit sign with the word “School” above “Speed Limit 20,” and then asked, “Does that mean 20-ish? Would a police officer be likely to notice a driver going 25 mph? Would he or she be ticketed? Probably, and both the driver and the officer would know it was deserved.
“Why?” Dale continued. “Because it’s a shared communal, cultural, and public safety attitude that it is dangerous for kids to be in the close proximity of cars traveling faster than 20. Certain situations have looser conditions and tolerances; in others, the tolerances are very narrow and everybody knows it.”
Times used to be such that the tolerance in dispatching was the expectation to say 10-4 at the appropriate time, Dale said. “Then they started expecting dispatchers would get help to show up,” he said. “Now they expect us—and they won’t tolerate less than—to tell people what to do until help shows up.”
That makes dispatching more difficult by a factor of 12, and the job of keeping the best possible performance and sticking to the protocols roughly twice that, Dale said.
Dale stressed that being a Q is not a matter of knowing the protocols inside and out, nor is it figuring out how to get the best review. “It makes quality an obvious and abiding goal of the PSAP and defining what quality is at the individual center, keeping track of it, and constantly trying to do better,” he said.
Check the local library, or, if your kind of quality includes instant access to infinite bits of information on a subject, Google the word. It’s the most popular word in advertising next to the slogan “New and improved.” The pursuit of quality has been both a great motivator for achievement and the dragon doggedly chased but never captured.
Dale believes quality is something to pursue, sought seriously but never quite achieved—not completely. The only definition that works is what a center decides means quality for its region. It must be stated clearly, precisely, and often if people are really going to make any measureable difference in their response time or whatever goal they choose.
It’s not like case review and improving the quality of call intake and processing is some kind of dispatching higher consciousness, but yet it kind of is, Dale said. “Just the effort of pursuing is a unifying act,” he said. “It’s what a center does when deciding to have trained and certified dispatchers and structured calltaking.”
A customer is dependent on the dispatcher to provide the quickest help in the most appropriate way for his or her particular set of circumstances. The person calling 9-1-1, unlike customers at a department store, for example, won’t know exactly what she wants, and will be less than able to obtain her own emergency services without a dispatcher’s help. There really is nowhere else to take her business.
The same goes for the Q, said Dale, who believes that “the dynamic of quality improvement is the singular important issue facing communications centers going forward.”
With that in mind, he offers a list—by no means complete—of guides for quality improvement within individual centers:
• The emergency rule applies to the calltaker as well as to the caller: A person in crisis is not held to the same standard as the person not in crisis.
• The calltaker has to do the call right the first time. Case reviewers do too. Qs should therefore mark their responses the first time through a call. They can listen to the recording multiple times, but be honest enough in the review to note any mistakes the calltaker missed, the first time through the call. Remember, hindsight is 20-20.
• If you’re telling someone he or she did well on a call, don’t say “nice job.” Explain exactly what you liked. “Don’t put a smiley face on the report; what are we in kindergarten?” Dale asked. Don’t wait for a formal review if you hear about someone who did excellent work. Make a point of saying so immediately.
• The defining attitude is: People who understand the protocols will do their best to follow them; reinforce strengths.
• Avoid freelancing at all levels. If dispatchers are allowed to do too many things differently because it “just felt like the right thing to do at the time,” a center can’t be sure it is upholding the standards and practices.
• Profanity is Plaintiff’s exhibit “A.”
• You are reviewing human beings helping other human beings in crisis. The situation is fraught with slip-ups and errors. Correct them and commit together to doing better next time.
• Qs shouldn’t go around the call center trying to create “mini-me’s.”
• It’s not about you. It’s not about you. It’s not about you.
• Take cases and the work seriously, but not yourself. Don’t create people who hate what they do.
• Dispatchers are willing to have their job performance scrutinized constantly and at random. It’s not a thing to trifle with.