Quality Assurance In EMS

Not everything that counts can be measured. Not everything the can be measured counts.

                                                         – Albert Einstein

Merriam Webster defines quality assurance as a planned and systematic production processes that provide confidence in a product’s suitability for its intended purpose. And with that definition, and the best of intentions, our quality assurance teams march forward to confirm that our care has “got air”.

Don’t misunderstand me here. This isn’t going to be about beating up on the QA folks. I know that QA programs get a bad rap. In general we tend to both fear and loathe them. We do this for two reasons.

  • They’re overseeing us. We really don’t like people looking over our shoulders do we? Especially people who are waiting for us to do something wrong. And for all the talk about recognizing the folks who are consistently getting it right, QA evaluators are looking to see if we’re doing anything wrong. You just can’t pick up one side of that stick without picking up the other.
  • We’re afraid of them because they amplify our own insecurity about or care. We fear that we may not be up to the task in our knowledge or skills and QA reviewers are monitoring our work with the same concern. They amplify our own fears.

The point I’d like to make is this. In EMS, quality is a complex animal. To begin with, were not exactly sure what our intended purpose is. We get away with not knowing because the public is even less sure about what we’re supposed to be doing.

Second, and even more troubling, is the idea of product suitability. In essence, we are the product. When people call for help the expect our knowledge, our training and our experience to show up with us. They need us to bring our resources to bear on the problem at hand. How do we measure human suitability? It’s a lot harder than checking for air in the tires. That’s what Einstein was talking about.

There are two types of quality.

The first sort of quality is about meeting specifications. Are all of our certifications up to date? Have we attended the correct amount of continuing education? Are we recognizing the right signs and symptoms? Doing the proper evaluations? Utilizing the correct equipment? Successfully completing the needed skills? Documenting the whole shebang with detail and gusto? The first sort of quality is neat and orderly. On a spreadsheet it looks phenomenal.

The second sort of quality is about our suitability to care for others. It’s about the less tangible elements of service. Did we recognize the value inherent to the human lives we serve? Did we stand ready to serve? Were we compassionate? Were we patient? Were we kind? Did we listen? Did we meet the challenge of care with just enough effort to get by, or were we remarkable? This sort of quality is difficult to measure. It many cases, it’s impossible to measure.

This leaves the quality assurance folks with a bit of a dilemma. They have to figure out what matters. They have to figure out if they can measure it, monitor it and act upon it. Then, when they are all done, they have to recognize that their evaluation is forever incomplete. Parts of the equation will always remain invisible. Much like taking care of patients.

Just as in patient care, the quality assurance gurus will need to make decisions knowing that some essential elements will need to remain unseen. But it pays to keep in mind that the equation before us is not whole.

Not everything that counts can be measured. Not everything that can be measured counts.


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  1. Love your piece here. Right on. I’d be interested in your take on a similar themed piece I did. http://leadrant.wordpress.com. Best Regards,


  1. […] can also create problems if your quality assurance manager has an idea that everyone should adhere to the protocols as if they were an advanced beginner. If […]