Home Emergency Medical Services Moving from a QA to QI Program Helps EMS Managers Focus on Improvement, Not Blame

Moving from a QA to QI Program Helps EMS Managers Focus on Improvement, Not Blame


By Dr. Shana Nicholson and Joseph Heaton

As emergency medical services (EMS) managers, quality assurance (QA) can be a struggle when it comes to guiding our staff. It is imperative that we ensure staff is not only treating patients appropriately, but that we document this care within the appropriate guidelines and medical protocols. However, as we know, this effort can be a struggle.

Many times when we discuss the QA process of medical care review with emergency medical providers, the initial response is to become defensive or aggravated. Historically, the QA system has been used as a weapon in a sort of blame game for problems with a call. EMS providers have been judged by peers and medical directors as lacking in professionalism, skills, and providing bad patient care on an opinion-based system. However, there has been a shift in federal patient care guidelines toward the Quality Improvement (QI) method of review.

Medical professionals are transitioning to a QI for peer review of patient care records. The QI process of chart review looks for performance deficits over multiple care scenarios. The QI process sees a standardized level of care and utilizes a fair approach to evaluating the needs of the agency’s emergency providers. The QI process allows for self-reporting and sampling of run sheets. Data capture focuses on multiple areas of the run report for sampling as well. As the patient care sheets are evaluated, learning opportunities for the providers are identified as areas of improvement.

What Does the QI Process Focus On?
Good patient care can be established and maintained through an understanding of evidence-based practice, regulatory guidelines, and a standard of practice that must be followed. In order to ensure that each of these standards are met, we must self-assess our skills and the skills of the agency. We must assess the evidence-based practice and identify the risks in our practice. There should be an ongoing assessment of current practices within our field personnel to identify gaps in communication, knowledge, skills, and workflow. These gaps must be identified and improved upon.

The ultimate goal of any QI program is to improve patient care. Therefore, we can utilize a QI program to improve skills and mentor EMS personnel with potential weaknesses. For organizations that support quality assurance programs, there is a decrease in cost resulting from improved efficiency as well.

The QI approach encourages EMS providers to do the right skills well. QI programs may improve provider morale as a result of participation in the move toward excellence, and pride in workmanship. One survey found an improved sense of teamwork after initiating these programs. Patients must receive quality emergency medical care from the moment they enter the health care system.

Leadership by the medical community is crucial if this goal is to be realized. It is important to focus on improving skills and mentorship of EMS personnel. As a QI program improves provider results, management can further support their staff by sharing these improvements and achievements in staff meetings, with awards, and even with simple acknowledgments.

EMS as a profession does not embrace change well, especially in comparison to other medical fields, but through the QI approach, we as EMS managers can encourage EMS providers to do the right things and do them well.

Shana Nicholson headshot_v2About the Authors: Dr. Shana Nicholson has more than 20 years of emergency medical and fire science service experience. Her professional background also includes government, social services, and nonprofit administration. She is currently a faculty member in emergency and disaster management at American Military University. She received a bachelor’s in criminal justice from Fairmont State University, a master’s of science in Human Services with a specialization in criminal justice from Capella University and a PhD in human services with a counseling specialization also from Capella University.

Joe HeatonJoseph Heaton has more than five years of service as a volunteer EMT and firefighter. Currently, Mr. Heaton serves as a line officer for Farmingdale Fire Department in Farmingdale, NJ. He received a bachelor’s degree in public health and a master’s degree in biomedical science from Rutgers. He is currently pursuing admission to medical school.



  1. As a QA manager in the EMS setting I find this article to be right in terms of what the true objective and culture of QI should look like. Great article!

    1. Hi James,
      Thank you for your response! I know a lot of EMS professionals are resistant to critique and improvement but it is necessary to ensure not only good patient care but effective communication.

  2. As a QA manager in the EMS setting I find this article to be right on in terms of what the true objective and culture of QI should look like. Great article!

  3. Good article. Do you feel that by moving from QA to QI a Just Culture can be established easier? While I understand what each is designed to do, it looks to me to be a perfect fit.


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