Guideline 1-800-66 - Quality Improvement: Employee Remediation

CMH EMS & MIH Protocols

Scope:

Guideline:

Emergency medical staff shall maintain high levels of competence and when those levels drop below acceptable standards, procedures must be followed to identify causes, improve staff competence, and reduce future occurances.

Purpose:

The purpose of this guideline is to establish procedures to identify causes of low clinical performance and suggest methods of improving performance.

Procedure:

Triggers for this guideline to be used include but not limited to:

• A "poor" rating is given during a clinical chart review (see Guideline 1-800-33 - Clinical Reviewer Reference Sheet).
• Recommendation by Manager or Chief.

Step 1: Identify the cause.

• Utilize Just Culture Investigation Form to determine cause.

Step 2: Improve staff competence.

• "Support employee in decision" or "Investigate system cause" recommended from Just Culture Investigation:
1. Develop a plan for follow-up and deadlines.
2. Consider discussion with the Medical Director.
3. Consider an agenda item in the next Manager Meeting.
4. Consider an agenda item in the next Equipment Committee Meeting.
5. Consider an agenda item in the next Protocol Committee Meeting.
• "Consider punitive action" or "Consider reassignment or termination" recommended from Just Culture Investigation:
1. Consider progressive discipline to include coaching, DESK, written warning, or other actions with Human Resources Department.
2. Consider assigning self-educational task such as research and recommendations for protocol or staff education. Establish a deadline for completion.
3. Consider assigning a repeat of initial education (i.e. full 16-hour ACLS class). Establish a deadline for completion.
4. Consider remediation shifts with FTOs, Crew Leaders, and/or Managers. Remediation shifts could be on the ambulance, in the ER, or other locations. Establish a deadline for completion.
5. Consider scheduling one or more high-fidelity simulation labs to improve critical thinking and/or skills.
6. Consider scheduling a review meeting with the Medical Director.
7. Consider other items not included on this list.

Step 3: Reduce future occurances.

• Consider adding additional surveillance or clinical review rules to monitor future occurances.

CMH Pre-Hospital Services Mission: "Provide safe, exceptional, and compassionate care to our communities with an emphasis on highly trained and empowered staff."

CMH Mobile Integrated Healthcare Mission: "Provide exceptional, compassionate, and patient-centered care by a mobile collaborative team to improve patient experience, improve quality outcomes, and reduce healthcare costs."

Polk, Hickory, Cedar, & St Clair County EMS Protocols is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.