Not too long ago I was reading an article in Entrepreneur Magazine when I came across an article speaking on negotiating tactics. I wish I could find it, but unfortunately it was long enough ago that Iíve disposed of the printed issue (I subscribe) and cannot find it on the web. It was a good article and it taught me some words that Iíve since used quite a bit in my own life:
ďIs that the best you can do?Ē
From the time our parentís first put us out there in the world most of us have probably been told to ďDo our BestĒ when we try to do something. No matter if we win or lose, weíve been told that itís ok as long as we ďdo the best we canĒ while trying. We seem to feel better at the outcome of almost anything if we feel that weíve ďGiven our best shotĒ when we try to accomplish what weíve set out to do. We all like to do our ďbestĒ and we hope that our ďbestĒ will be good enough.
This begs the questionÖ is what youíre doing today in EMS ďthe best you can do?Ē Career wise, operationally, with your serviceís treatments, with your own personal training and education, and with your own attitudeÖ is this really ďthe best you can do?Ē
I would like to think that I ďtry my bestĒ in my own EMS career and paramedic practice. I would also like to think that I work for an EMS organization that is trying to do the best it can for its people and its collective patients. However, there are quite a few situations where I have felt that I have not done or have been prevented from doing my best for a number of reasons. Some are reasonable and others are not. Iíd think that all of us would give the answer that we always want to provide every patient with our ďbestĒ possible care. However, Iíd also guess that everyone reading this can think back to any number of situations where they feel that they didnít give it. Sometimes this reason comes down to the skill set of the individual provider. This could be a situation where the provider didnít have the best possible information or knowledge available to them. They may have provided an ineffective or even harmful treatment modality or might have failed to act upon a missed assessment finding, such as by giving a medication for which a patient has a documented allergy because the provider didnít know or simply forgot that the patient had the allergy. Sometimes the actions of others in the organization can prevent a provider from rendering the best possible care. This could be by failing to check, clean, or restock a needed piece of equipment or by providing inadequate care prior to a provider assuming patient care such as in the case of a first-responder crew failing to place a patient in full c-spine precautions when indicated prior to moving a patient to the transporting ambulance and the transporting EMT not having enough manpower to safely immobilize the patient. Sometimes the organization can hinder an EMS provider from doing his or her best by doing things such as providing inadequate equipment or medical protocols, or by mandating that a provider regularly work past exhaustion-level hours.
People inherently want to do well at whatever they choose to do for their careers as well as at other tasks where they feel strongly†about the outcome. I may have accepted that Iíll never be as good of a basketball player as Michael Jordan, nor the same-level of cartoonist as Scott Adams, nor the best noodler in the worldÖ but Iím certainly going to try to be the best paramedic I can be.
Sometimes our own personal biases prevent us from doing the best we can do and for this Iím not talking about bias regarding any protected classes or topic, rather Iím talking about our own version of the status quo. A personal example of this would be my ALS Quick Response Vehicle at work. We went a solid week without having the proper forms available for the daily equipment checks and I didnít have the computer access to print more off. During that week, I got in the habit of not using the forms and simply checked the truck based upon my knowledge of what was supposed to be in there and what was supposed to be checked. The way it played out, I ended up continuing to not use the check sheets when checking the vehicle, even though the forms had been replenished. A few weeks later, someone found that there was equipment missing in the vehicle that had gone unnoticed for some time. At that point, I realized that I had developed my own bias against using the forms for a reason that is even unbeknownst to me. I had gotten in the rhythm of not using the forms, and that caused me to miss that the infrequently-used piece of equipment was missing. I had developed a personal mental bias that prevented me from ďdoing my bestĒ and thoroughly checking the truck.
Another preventer of best practices can be organizational politics, both internal and external. As a paramedic who regularly responds to other ambulance services to provide ďALS InterceptsĒ, I have observed that the politics between the services we work with can affect patient care for both the negative and the positive. While I am not saying that any of these arrangements result in inadequate patient care, I can say that the services with whom I interface most frequently and most pleasantly get a better provider out of me than do the services with whom my relations are less frequent or are strained due to political turmoil. When I respond to a request for an ALS intercept, I am being called to the ďhouseĒ of another group of providers. While I am the highest level of care on the scene, Iím also a guest in their house. They have their own internal biases and I have mine. Sometimes the synergy in our working relationship can be strained, which results in a palpable difference in the flow of the scene and the teamwork exhibited at it. While I will ensure that I ďdo my bestĒ, itís easier to do it when I work well with the team Iím working with.
So how do we change things? Weíre all human and we all have things that prevent our ďbest shotĒ from being the only thing that we ďgive itĒ in our EMS careers. This may be consciously, as in the case of internal politics; Subconsciously, as in the case of my not using the check sheet; or Involuntary, as in our service not providing us with needed equipment or our coworkers failing to replace an item in the ambulance that we did not have an opportunity to check. As in most things, the easiest thing for us to change is ourselves. Changing ourselves is a great place to start and will make serving as an example to others your main tool to use to try and get the best out of them.
Most situations can be made better and almost all of us can try harder. The secret is to attempt to do our ďbestĒ at all times and to try and ingrain our own best practices into our daily routines. This can be as simple as always trying to check the truck in the most thorough way possible or by making sure that you always check and recheck things to ensure that theyíre done right. It helps to continuously seek out and recognize oneís own personal biases, (remember my check sheet?) to make sure that our own preferences and routines arenít leading to suboptimal performance. Consistently ask yourself if what youíre doing is the ďbest you can doĒ and then ask yourself what you can do to make it your best. Mentally prepare yourself for your shifts with adequate rest when possible, manage your stress level so you can keep your thoughts focused on your care, and train hard. Ingrain your best efforts into the systematic way you do things and make your best way your normal way of doing things. We canít change everyone around us in an instant, but our quiet positive efforts can pay large dividends in how people around us think, feel, and act. Our best may in turn get the best out of our partner, which may in turn get the best out of the next crew, and so forth. Soon enoughÖ deciding to give our best may change your organization, our industry, or our profession.
And I assure you, doing your best will indeed make the difference in someoneís life. Itís just what we do, Folks.
ďIs that the best you can do??
For more on doing your best in EMS and in getting the best out of your EMS people read:† “The Shine Factor”