January 21, 2014

Problem-Solution

There was a note in my most recent annual review that made me proud: “Never brings a problem to a supervisor without a specific solution.”

Its funny – it is unintentional on my part, at least when I am dealing with supervisors.  I suppose what they mean is that I call them and say something like, “I’m out of narcotics, so I need more.  If you’re nearby I can meet up with you, but otherwise I will need to go back to the garage.”  Problem, solution.  I don’t just call and tell them I am out of narcotics.  When I was a supervisor, it was certainly my preference because I didn’t have to absorb the information, decide on what the real problem was, prioritize the problem among my other issues, and work out an appropriate solution.

I see this as being similar to my expectations when I am on a call.  When I ask for additional units, for example, I have a specific job for them and specific instructions as to what I want them to do.  I would never call dispatch and say, “There are four patients here.”  I would ask for what I need: “I need another nonemergency ambulance.  Have them access from the north and park behind my bus.”  I guess that habit kind of carries over.

I also follow this pattern when making base contact to consult with a physician.  It would be especially unusual for me to say, “I have a patient with Symptom X. What should I do?”  My normal pattern is to explain the issue and then explain my plan.  I end it with something like “How does that sound?” or “Do you have any other ideas that I am missing?” (I'm trying to stop, but sometimes I just pause when I am done talking.  If they don't speak up, I take that as their approval of my plan.)

It should be noted that I am open-minded.  Another plan can certainly replace mine.  This is true when I’m letting a supervisor know about an issue I’m having, as well as on a scene or on a phone call with a base physician.  If someone else has a better plan or more information that I don’t have, let me know; we’ll work it out.

I began to watch how often other providers act like this.  The results are mixed.  When they personally need something, medics will ask for it specifically – like with schedule changes, for example.  If a medic needs a day off, they will tell the supervisor about the wedding they need to attend and ask to be removed from the schedule on that day.  This doesn’t hold as true for other systemic issues, equipment issues, and the like.  Some will explain both the problem and solution and others will just explain the problem. 

I have heard way too many examples when it doesn’t happen in exchanges with dispatch, which is one of my pet peeves.  If you’re the provider on scene, tell dispatch exactly what you need.  Don’t tell them your problem, tell them your needs.  I am not talking about “I need you to get a phonebook, call every Jones in there, and ask if they own a red car.”   I’m talking about normal, everyday issues.

How often have you heard, “Nobody is making themselves known”?  Okay.  And?  Do you want dispatch to confirm the address?  Call the reporting party back?  Are you going in service?  What do you need?  Tell dispatch what you need to accomplish your assigned duties.

Dispatch doesn’t need updates.  They don’t need to hear, “We have a child care issue.  There are a lot of children on scene.”  A better way to word that request is to actually make it a specific request: “I need either an EMS supervisor or police officer, whichever is faster, to respond emergency to this scene.  The patient needs to be an emergency transport, and there are five children on scene who will need some supervision until the patient’s sister gets here.”  There are some days when I may not even explain why, but that is probably less optimal than having dispatch understand the issue that they are being enlisted to help me solve.

When you explain the problem only, you put the solution in someone else’s hands.  In that case, you are hoping that the solution they come up with is in your (and your patient’s) best interest.  I’d always rather have the solution come from me.


Check yourself over the next few shifts and see if you are giving general updates or specific requests.  Are you explaining both the problem and solution, or just the problem?  Try to increase your specific request rate.  

No comments: