I thought doing quality assurance (QA) at my EMS agency was going to be a simple matter.
I was wrong.
A decade ago the QA person at my agency resigned. Because I was a willing, warm body I got the job. I didn’t get any training on how to do QA, but I also didn’t think I needed any – besides, it was just going to be a matter of reading reports and telling people when they screwed up.
Over the past decade, I have learned many lessons while doing QA; more than a few of them have been about me as a person than how to do quality assurance. Being blinded by ignorance (along with a side of arrogance) I was certain in my approach – treatments could be labeled right or wrong, protocols were followed or they weren’t and providers were either good or bad at their job. If you made a mistake the solution consisted of write-ups, remedial training, and discipline. I made complex flow charts to grade medical errors by the level of harm to the patient. The level of harm dictated the actions that followed. Level 2b yellow was bad but not as bad as a level C3 orange. God help you if you were found guilty of a level 4 red event.
The Dunning-Kruger effect was strong with me. There is nothing simple about doing quality assurance for EMS. From time to time I try to share what I have learned from doing this job. What follows is something that might have been better as two separate posts, or maybe you can view it as a two-for-one deal.
The Outcome Bias
Almost every decision you make is a gamble. Continue reading “The one about the outcome bias.”