Quality Is the Problem

BY RICHARD MARINUCCI

How can quality be a problem? The pursuit of quality is not a problem. The problem today is that quality has taken a back seat to cost controls and the desire of many policy makers to save money at all costs. The economic woes of many communities have forced everyone to take a hard look at all expenses and reduce expenditures to balance the budget. There is value in fire departments, and departments are not all equal in the services that they provide. Further, while all fire departments offer some level of service, there are differences in the quality provided, which affects the outcomes of emergencies. The problem that many organizations are facing is the challenge to make sure that quality is considered when evaluating emergency services.

Many questions are being asked about the cost of fire departments and their value to the community. Fire departments must be ready to answer questions that arise in such a manner that those not in the fire service can easily understand the answer. This is not easy in that fire departments know how to speak to other fire service professionals but might not be able to communicate their message to those who do not know the intricacies of providing service during emergency situations. Those outside of the fire service have their own perspective on issues and have developed this from their experiences that have not included the challenges facing fire departments in today’s environment. They may have never had a need for emergency service so their frame of reference is very limited.

A short while ago, I was approached by a local politician who wanted some information on the fire service. (This was in the community where I live, not work.) He is a smart, successful businessman who I believe really wants to do a good job and make decisions in the best interest of the community. He was trying to learn about the fire service because he did not understand some basic concepts. One of his first questions was along this line: Since the number of fires was declining, why can’t we reduce the fire force? This was a reasonable question from his perspective. In his line of work, when production decreases, then staffing needs also are reduced. On the spot I was trying to think of a way to answer. I told him that regardless of the number of fires in a community, each individual fire required the right amount of resources, firefighters, and equipment, and they must arrive in time to make a difference. If you don’t have enough firefighters or equipment, the outcome will not be as good as it could be; hence, the quality of service would suffer.

Although I think I got him thinking, I wasn’t sure he was getting my message, so I tried another tactic. I asked him the last time he was in an automobile accident. He said it had been years. I then asked him if he had reduced his coverage on his automobile because he had not used the insurance that he had purchased for all these years. Of course, he said that he had not. I pressed further and asked if he had increased his deductible because he could get a cheaper policy if it was higher. Again, he said no. I went on to say that fire departments are similar in that they are somewhat of an insurance policy for the community and exist for the greater good, as this is the purpose of government. A reduction of staffing is similar to increasing deductibles. You are hoping that you will not have a problem. But, if you do need the service, there is a difference in the quality. I told him that as a policy maker he needed to evaluate the cost vs. the quality. I think the discussion at least got him thinking.

Sometimes even those in the fire service business do not consider quality. Consider this scenario. A fire department responds to a structure fire in an apartment building. All occupants are out, but the fire is doing significant damage. The fire eventually goes out. The report in the paper the next day states that 30 firefighters responded to the fire, they did an outstanding job, and no one got hurt. What it doesn’t say is that the first unit arrived in 10 minutes with two people, and the full complement of 30 did not arrive until 20 minutes into the fire. The public now believes it received outstanding service because of the number of firefighters on the scene, the fire went out, someone said that an outstanding job was done, and no one was injured.

I am not implying that everyone did not work hard and or that they didn’t do what they could with what they had, but where would this level of service fall on the quality scale? How would this compare to a community that spent more to get a shorter response time for the first unit and better staffing so that the needed number of firefighters arrived sooner, before the fire got too far out of control? Those who believe that there would be a significant difference must be able to explain this so that the public understands the difference in quality that can be achieved with more investment in the fire service.

The quality of service may be easier to explain for those organizations providing emergency medical service. There are various mandated licensure requirements and levels. Fire departments can choose to be medical first responders, basic life support or advanced life support. The different hours required to complete course work to test for licensure varies greatly, and those organizations providing paramedic-level service offer personnel with more hours of training who are authorized to provide more treatment procedures.

The concept that higher levels of training provide better quality of service is easy for people to understand. The only issue is that many people do not understand that there are differences. Basic EMTs respond, and the public sometimes thinks that they are paramedics because of their limited exposure to the service. Fire departments providing a higher level of medical care must actively promote this in their community so that those setting policy and those receiving the service know that there is a difference. They also need to know that this difference translates into better outcomes, specifically more of a chance to save a life, shorter hospital stays, shorter time in rehabilitation, and probably better pain management. If people have the information that distinguishes levels of service, they are better able to make choices as to which level they wish to fund.

Recently, I was conducting interviews for promotion in another department. One of the questions asked the candidates to identify the biggest challenge in their departments. One candidate said that staffing had become an issue because of the downturn in the economy. I thought this was a reasonable answer. Later during the interview, the candidate was asked to give an example of when he thought he had done a great job. The answer on its own was fine but got me thinking. He had used an example of when he was in charge of an incident in which only five firefighters and he had responded to a house fire. He described the incident and then said he couldn’t imagine how things could have gone any better.

I followed up by asking how this related to his answer regarding staffing in that he described a situation where the resources he had did the best possible job. If the job could not be improved, why should any more firefighters be hired? The challenge to organizations in this situation is to commend the firefighters for a job well done but also to state that there were limitations because adequate staffing was not available. If there would be no upgrade in the outcome, there is no need to add to the resources. I believe policy makers think along this line, which makes it much more difficult to increase resources.

Quality service is affected by the number of people available, their talents, their level of training, the apparatus and equipment available, and arrival at the scene of the emergency within a time frame that will make a difference. This is a simplification, but it makes logical sense. As such, fire departments faced with financial challenges and questions regarding expenses must be able to explain that an investment in the fire department will result in better quality. Organizations that cannot distinguish their service will be more susceptible to budget cuts and ongoing questions regarding funding. All departments are not created equal, and being able to explain this to those outside the fire service is extremely important to organizations that want quality considered as part of their value.

RICHARD MARINUCCI has been a fire chief for more than 27 years and has been chief in Northville Township, Michigan, since January 2009. Previously, he was chief in Farmington Hills (1984–2008), president of the International Association of Fire Chiefs, and chief operating officer of the U.S. Fire Administration. He is a speaker at FDIC, a columnist for Fire Engineering and Fire Apparatus & Emergency Equipment, and editor of the 7th edition of the Fire Chief’s Handbook. He is a faculty member at Eastern Michigan University and the Maryland Fire and Rescue Institute.

Richard Marinucci will present “Chief Problem Solver” on Monday, April 22, 2013, 1:30 pm-5:30 pm, at FDIC 2013 in Indianapolis.

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