After many years of always carrying around some earmarked textbook and a file folder of articles, of squeezing in writing around family and typing away in hotel rooms on client trips, and of wondering when it will ever end, I finally finished the doctoral journey. The dissertation is finished and approved, the defense is complete, and the administrative checkboxes are filled in. My research will soon be published in the ProQuest UMI Dissertation database and add to the learning about patient-centric systems. In the meantime, here is the official abstract. Thank you to all who have supported and encouraged me over the years. I really appreciated it. –Dr. Dave.

Abstract

THE INDIVIDUAL, ORGANIZATIONAL, AND SYSTEM OBSTACLES TO PATIENT-CENTRIC EMERGENCY MEDICAL SERVICES SYSTEM DESIGN

David M. Williams

Saybrook University

Research regarding emergency medical services systems design is inadequate and is largely focused on individual components or patient conditions (e.g., cardiac arrest) rather than on an interconnected system designed to serve the patient. In addition, patient demand has expanded from life-threatening illness and injury to include general medicine, which current EMSSs are not designed to serve. The purpose of this research was to examine the individual, organizational, and system obstacles to developing a more patient-centric EMSS design.

Fifteen factors potentially associated with patient-centric EMSSs were identified from clinical and systems literature. Using a multi-case study, five United States EMSSs, representing five major design models (fire department, hospital, private organization, public/third-service department, and public utility model), were studied. Data collection included four sources of evidence: (a) data metrics, (b) document review, (c) interviews (n=11), and (d) archival records. Data analysis involved coding 582 independent obstacles into 38 distinct categories and using a Pareto distribution to identify the leading obstacles to each patient-centric feature. Fifty percent of interview transcripts were externally reviewed for reliability. Results were presented in written narrative and displayed in Pareto charts.

The top five categories, representing 33.5% of the total obstacles identified, were cost/funding, data measurement, process/outcome focus, systems view/design, and public information/education. Six recommendations resulted from the findings, including quantifying a reasonable cost, changing the funding model, developing an EMS research consortium, initiating data measurement to improve, integrating quality improvement as an operational strategy, and documenting and sharing learning on practices that work and do not work.

This inquiry provided new insight into the current state of EMSS design, how it aligns with patient-centric factors, and what obstacles exist for medical directors, operational leaders, and policy makers in positions to transform future EMSS design and operations. The obstacles identified provide information for additional EMSS research and the results will further the vision of creating a more patient-centric EMSS design that better serves patients through prevention, reduction of morbidity and mortality, and facilitating access to the most appropriate care.