Thursday, 25 November 2010

Lies, more lies and statistics

I have a growing irritation in this job. That irritation is statistics. Many of you reading this will think this is going to be about the great God ORCON (time targets that ambulance trusts get measured by) but it goes much deeper than that....

For those of you who are not aware, ambulance trusts in the UK are primarily measured by how quickly they get to jobs - ORCON targets. For urban areas this is 8 minutes from the time the 999 call is routed to our call centre for Cat A jobs (highest priority) and 19 minutes for Cat B jobs (not as life threatening as Cat A but still sometimes not well patients). Cat C (Low priority but also sometimes unwell) used to be 4 hours but now they have different measures. The category of the call is determined by AMPDS. I will not be discussing the "wonders" of this system here but feel free to look it up on Wikipedia or something. Or ask anyone in EMS about it. I'm sure they'll give you an idea about its "Brilliance".

So, these targets exist. Get there in that time and *woop woop* jobs a success. Outside, and it's a fail. Get to a sick patient in 7 minutes and give poor quality care and the patient dies, that's a success. Get to the same sick patient in 9 minutes and perform excellent, high quality care and save a life, well that's a fail. It is that black and white. Needless to say this bugs me quite a bit but I have got to a stage where I am more concerned with the care that I give than whether I got there quick enough. Don't get me wrong, I don't hang around - I get there as quick as I can - even if the details on the call lead me to believe that the Cat A job is actually a Cat C job just the person knows how to answer the questions so they get a quick response (not that any member of the public would do this!). I am paid to get there quickly, so I will get there as quickly AS IS SAFE TO DO SO.

"As is safe to do so". This is the important bit. Now I am currently doing a stint on an RRU / FRU (Rapid / Fast Response Unit). These are cars that are designed to get to the sickest patients (Cat A) very quickly to initiate life saving treatment (the cynical amongst us may well say that they are there just to meet these Cat A targets). So currently my job is mostly about getting there quickly. And I do. Very quickly. BUT I will only go as quick as is safe. Rule No. 1 - If you don't get there because you crash, you are no help to anyone. I refuse to drive any quicker than I do because a) I am not going to be responsible for an accident that may kill / injure other people b) I don't like pain c) I like my driving licence. I am responsible for the vehicle and it's actions. EMS people are NOT exempt from dangerous driving.

So - in my mind, I get to jobs as quickly as is possible. There may be some that can get there slightly quicker, but I'd say I do a fairly good job of using as much diesel as I can. However, my "Statistics" don't show this. The target for Ambulance Trusts to meet is 75% of all Cat A's in less than 8 minutes. I am above this target but not by much. My trust expects cars to be 80-85%. I am not in this bracket. I am in the middle of all the car people in my area, with some lower and some higher. Some are in this 80-85% bracket. And so to management, 80-85% is achievable so why am I not doing this well??

My biggest problem with all this is the way these statistics are calculated. All they do is pull from the computer systems the number of times I got there WITHIN 8 MINUTES OF THE CALL STARTING and the number of times I don't. There is NO consideration given to any delays I book - for instance, delays because of traffic (you try moving anywhere in a built up area during a) school leaving time b) rush hours), delays for distance (I know I am quick but I don't not have warp engines) or my favourite, delays due to activation (If I don't get given a job until 6 minutes into the call this does not leave me with a great amount of time to get anywhere!). These statistics are raw data. We are judged by these statistics yet management can't be bothered to get them right.

Just to rub salt on the wound, when this is pointed out to management types their response is "Well everyone else has the same problems so it should average out over time with everyone getting the same number of delays etc so if one person can get 80-85% then everyone should be able to". Eh? Hello! Do you understand statistics and probability? Now I am no statistician however I do understand a few basic principles. I believe (and if anyone out there does know statistics better than me please correct me) that there is as much chance of one person getting all "impossible" jobs, that is jobs that no matter what speed you were doing you'd never make the target, and another getting all "possible" jobs, as there is of getting an even mix. In the same way that each time you flip a coin you have an equal chance of getting a heads and a tails. It has no bearing on your previous flip.

In my mind, my personal performance targets are 97%+. That is, all jobs that I have not booked a delay for distance / activation / traffic - i.e. all jobs I deem it possible to get there quickly, I have made it 97% of the time. There will always be some exceptions but I still believe that I get to (virtually) every job in the fastest time I can THAT IS SAFE. Any faster would be unsafe and thus unacceptable. If I am sent a job with 2 minutes to spare and is 5 miles away, it's rush hour and the main roads are blocked, well that is not a PERSONAL failure if I do not make it. A service failure perhaps for not having enough vehicles in the right areas or not giving me the job quick enough, but not a personal one. To be honest, if I were to make that job in time I'd be asking questions about how the bloody hell I did this without driving dangerously! Just because there are not enough vehicles in the right areas, just because the jobs don't get sent to us quickly enough, or a patient changes their story 5 minutes into a call changing it from a green to a red, none of this should be held against the individual in the car.

However it is. It is on my head. Now, my main concern is with patient care. I will get to a patient as quickly as I can and give them the best care I can give. That is my target. However I am judged by these other, inaccurate targets. I have pressure put on me to "do better". Thankfully I'm old enough and cynical enough to smile and nod and keep doing what I'm doing. However younger people who I see going on the car, those with less driving experience, less life experience, and more fear of management, I see them pushing them selves to drive faster. And I am worried that one day I'll be sent to an FRU with a dead colleague in it because they had recently been told off for not getting to calls quick enough and were pushing it too hard.

Clearly this is just one set of statistics. There are many more: Mobilisation times, Compliance on filling in PRF's, Patients taken to appropriate facilities rather than nearest A+E, all sorts. But it is these inaccurate times that get under my skin from time to time. Is it just me that feels this way? Am I the only one that believes that all these statistics detract from what we are there to do - provide good quality care?

1 comment:

  1. You are so so right. It's a never ending struggle. And a lot of the trouble is that a significant proportion of the people in management have NEVER been on the "front line" so to speak, so don't have any idea/understanding of the other pressures!
    It is an illogical system, but it's difficult to get these things changed.
    With AMPDS while it is far from perfect that is also very difficult to change, in a different way: if you change it to give call takers more responsibility in judging the calls and one makes a wrong call then everything is screwed. With AMPDS it would probably help if people didn't try to trick the system by saying they have chest pain to get an ambulance quicker!
    I wish the public had more respect.