Brian Dale, Associate Director, Medical Control and Quality Processes, IAED
Quality improvement is the heart and soul of effective emergency dispatching. Case review, feedback, system analysis, and continuous improvement define the high-performing center and provide the structure and support to develop high-performing emergency medical, fire, and police dispatchers. The foundations of this system of continuous improvement are the International Academies of Emergency Dispatch (IAED) ED-Q Performance Standards. Developed by a volunteer Council of quality improvement and emergency dispatch experts, the Performance Standards literally define what high-quality, high-effectiveness emergency dispatching and customer service look like.
As part of its own mission toward continuous improvement, the IAED, through the ED-Q Council of Standards, is always revising, expanding, and improving upon the existing standards—pushing ourselves and all of our member agencies to the highest possible measures of quality and performance.
ED-Q Performance Standards version 10.0, released in 2018, marks a significant expansion of the scope of the standards—and also provides unprecedented levels of support and clarity for the ED-Q, the emergency dispatcher, and the agency. The simultaneous release of AQUA version 7.0 also provides a new level of connection between the standards and the software designed to assist the ED-Q in applying them.
Ten features of this double release stand out in particular, demonstrating the innovative new approach ED-Q version 10.0 and AQUA version 7.0 bring to the practice of emergency dispatch quality assurance and quality improvement.
1—Made for Each Other
The new ED-Q Performance Standards are made for use with ProQA. For the first time, the Performance Standards include specific standards for all the workflows and elements of the ProQA software. In particular, the Universal Standards include new clarifications regarding how to handle Operant (or “blue for you”) Questions, ProQA Fast Track features, subquestions, Primary Discipline Selection, and more.
2—One Standard to Q Them All
Version 10.0 presents a single, unified set of standards for emergency dispatching in all three disciplines. Emergency dispatchers are professionals, and like any professionals, they aspire to meet a high and consistent standard of practice. The new combined standard reflects this—and offers ED-Qs the ability to apply that standard consistently and fairly across all emergency dispatchers, even in multi-discipline or consolidated agencies.
3—In This Together
Gone are the days when ED-Qs had to open ProQA on a separate screen, or hold a QA Guide in one hand, while reviewing a call. In AQUA version 7.0, when ProQA incidents are exported to AQUA, all the elements of ProQA that are needed to review the case are actually visible right there, accessible from the AQUA interface, where and when ED-Qs need them.
4—It’s Not Insignificant
The INSIGNIFICANT error type is a thing of the past. Instead of attempting to decide whether a very minor alteration in word choice is INSIGNIFICANT or not, ED-Qs can now mark questions “Not As Scripted” (NAS) when the verbiage used does not change the meaning, intent, or objective of the question. The change allows ED-Qs to give dispatchers the benefit of the doubt while still tracking trends in NAS question-asking over time.
5—The Performance is the Thing
The purpose of case review isn’t to trap, punish, or “ding” emergency dispatchers; the purpose is to improve outcomes for callers by ensuring appropriate, high-quality dispatcher behaviors. The new ED-Q standards make the distinction even clearer, focusing on providing feedback on performance rather than lists of deviations. Using AQUA version 7.0, ED-Qs can more easily get insights into specific behaviors—such as not asking questions as scripted, difficulties selecting the most appropriate Chief Complaint, or failure to provide PAIs when needed—that can actually be improved. Everybody wins with this approach: emergency dispatchers receive focused, effective feedback on behaviors they can address, and ED-Qs become partners in improvement rather than just “graders.”
6—Defining the Wiggle
No matter how much a person wants to achieve perfect performance, some amount of variation is inevitable, especially given the complex and time-pressured nature of emergency dispatching. The question is, how far can a behavior deviate from the expected standard before becoming a problem? At what point does a misspoken word become noncompliance? Where is the line between acceptable clarification and freelancing? The new Performance Standards much more clearly define both the expected behaviors for emergency dispatchers and the allowances, or “tolerances,” for deviation from those behaviors. For example, EPD-Qs will notice increased clarity around requirements for collecting Description Essentials information during Cold Call incidents.
AQUA version 7.0 includes a large number of user interface upgrades, making the system easier and more intuitive to work with. New menus and menu locations, buttons to access ProQA features and elements during case review, updated report-generating features, and many other improvements make this the best and most user-friendly AQUA version to date.
8—Now You See It
In addition to ProQA elements, the new AQUA interface also offer ED-Qs the ability to put aside the printed Performance Standards manual while working. All Performance Standards can now be accessed from AQUA, during case review, as needed. No more rummaging through the manual to find the relevant standard; now, ED-Qs can pull up the information they need on the fly.
9—AIs, Diags, and DEs
In addition to the elements of the ProQA call being reviewed, AQUA now also provides ED-Qs the ability to pull up Additional Information, Diagnostic and Instruction Tools, and Description Essentials within the AQUA interface. No need to run test cases just to see whether the emergency dispatcher properly used the Stroke Diagnostic Tool or the Persons Description entry panel. A click of the button pulls up any of these, from any discipline, at any time.
10—Reporting for the Rest of Us
Finally, no Quality Assurance or Quality Improvement initiative could be complete without feedback—including both the feedback ED-Qs provide to emergency dispatchers and the feedback that provides insight into overall system functioning. That’s where reports come in; they offer visual insight into problem areas, trends, and improvements across time, individuals, and shifts. An entirely new report structure in AQUA version 7.0 reflects the new Performance Standards and provides new ways to gain insight into your personnel and system. Moreover, the new software also offers User Defined reports, giving ED-Qs and agency management the ability to mine their own data for increased insight.
Thanks to the incredible time and effort volunteered to the IAED by the members of the ED-Q Standards Council and the ED-Q Curriculum Board, as well as the tireless work by the software developers who worked on AQUA version 7.0, these new Performance Standards and user interfaces are better than ever. They represent a major step forward in the drive to build and maintain high-quality, highly-effective emergency dispatching systems and to support, train, and inform the professionals who do this critical work.