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Emergency medical services providers, like other health care workers, are dedicated to improving the lives of their patients. Unfortunately, even with the best of intentions, there are times where the care provided may be suboptimal. This may be the result of an error by an individual provider or a larger system issue. Providers and organizations should embrace quality improvement efforts as a means of reducing errors and improving clinical care to benefit the overall health of the patients they serve.


  • Describe the components of an EMS agency CQI program.

  • Describe the components of an EMS system CQI program (local, regional, state).

  • Discuss how the CQI process interfaces with protocol design (Chapter 5) and provider education (Chapter 7).

  • Discuss surveillance of high-risk call types and procedures.

  • Define retrospective and prospective CQI, and give examples of their use.

  • Determine how patient care can be evaluated through analysis of tasks and outcomes.

  • Describe how the Plan-Do-Check-Act model can be used to evaluate system changes.

  • Understand the legal protections that may, or may not, be afforded to the CQI process.

  • Discuss what it means to develop a culture of quality and safety.

  • Discuss the importance of utilizing a Just Culture approach.

Oversight and active involvement in continuous quality improvement (CQI) is a key component of any medical director's duties to an EMS agency. CQI has been defined as a “structured organizational process for involving personnel in planning and executing a continuous flow of improvements to provide quality health care that meets or exceeds expectations.”1 When considering CQI in the EMS system it is logical to consider the components of a quality improvement program (Box 6-1).1 In examining a provider, agency, or system, quality measures (now better known as performance indicators [PI]) must be examined and applied to programs and initiative designed to improve quality and patient safety.

Box 6-1 Components of a CQI Program

  1. A link to key elements of the organization's strategic plan

  2. A quality committee made up of representative leadership

  3. Training programs for personnel

  4. Mechanisms for selecting improvement opportunities

  5. Formation of process improvement teams/initiatives

  6. Staff support for process analysis and redesign

  7. Policies that motivate and support participation in process improvement

  8. Application of the scientific method and statistical process control

Modified for EMS agencies from Sollecito, WA, Johnson, JK. The global evolution of continuous quality improvement: from Japanese Manufacturing to Global Health Services. McLaughlin and Kaluzny's Continuous Quality Improvement in Health Care. 4th ed. Burlington, MA: Jones & Bartlett Learning; 2011. Reprinted with permission.


The basics of modern day quality improvement can be traced back to manufacturing principles from the Industrial Age. As mass production spread, it was necessary to ensure products looked similar, worked the same, and had minimal flaws or defects. Initially, these principles ...

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