USING QUALITY ASSURANCE AS A TRANSITION TOOL
BY BARBARA J. MURPHY, RN, MN, EMT-A
Change is sometimes hard to take, even if it hits you between the eyes. The Ashburn (VA) Volunteer Fire and Rescue Department has been in existence for 52 years. For many years, it was the center of the Ashburn community. We were the small band of good guys born from the ashes of a disastrous house fire that took the lives of three small children. The event devastated and mobilized the farming community of 800. The fire department continued on, with little need to change, as a small but significant mainstay of the community in much the same way for many years. But much has changed since those early days: technology; training; and, most of all, the community we serve.
The dairy farms and pastures became a developer`s dream. Now, we are a rapidly growing suburban “bedroom” community for the Washington, D.C. area and business communities adjacent to “the Beltway,” with all the excitement and aggravation that can bring to an all-volunteer force.
Our demographic size is literally exploding (18,000 and growing rapidly). We find we now have members of the community who are often unaware of our department. Many do not understand the function or dynamics of an all-volunteer service. The newcomers tend to come from areas of the country where emergency services are incorporated into the tax structure and are an assumed “right” delivered by paid strangers, requiring no personal involvement or obligation. Like all volunteer groups, our organization is founded on the “neighbors helping neighbors” philosophy and citizenry involvement. These concepts are often foreign to our new citizens and the majority of our residents. However, the department had not been particularly worried. After all, we had functioned for years with no need to change.
OUR THINKING BEGAN TO CHANGE
So, what happened? The influx of a more consumer-aware “customer” and volunteer members slowly began to affect our thinking. The rapid community growth and the equipment needed to service that growth required an adjusted approach. The number of fire and rescue calls increased dramatically. We needed and acquired more equipment. Our service needs now called for more than fire support. Besides adding additional apparatus, we began to provide EMS transport: BLS (basic life support), ALS (advanced life support), and heavy tactical rescue. As the quantity and complexity of equipment grew, so did the need for trained volunteers.
Recruitment was one of the areas that had to be changed. We were confronted with the distinct challenge of promoting the appeal of a volunteer service to a new breed of residents. We could no longer count on the sons of current members to staff all the apparatus. We also needed to revise our fund-raising efforts, always a concern for any department. We needed to tap into a way to educate the members of our community as to who we were, what we did, and why. A semiannual newsletter began that process.1 The newsletter provides bits of historical information, safety tips, a list of upcoming events, introductions of department members, and “want ads” that recruit for vacant volunteer positions.
The newsletter, while an effective communication technique, only provides a one-way flow of information. We needed feedback from our community members to better learn their perceptions and expectations of our services. The level of understanding and perceptions of our “newly acquired” customers were great unknowns. How could we gain their support and acceptance and thus their involvement? We raised these and many other questions: How do you define the quality of what we do? By what criteria should quality be measured–especially in a community that does not know all that we do or how well we should do it?
THE ADVENT OF A SURVEY
We began by looking at methods that had been tried by others. We undertook a literature search and found references citing a variety of survey methods ranging from telephone solicitation to written surveys.2 Some approaches were random; others were more systematic. Mailings worked for some, and others provided some type of survey form while on the emergency scene. In addition to the survey technique, consideration had to be given to the type of information we wanted. What are the important concerns of our customers? What questions did we want answered?
Because we wanted to focus on the quality of the service provided, the logical approach seemed to be to ask those we had touched. We decided to ask those who had called for fire or rescue services to give us feedback. We started with a cover letter to explain our survey and designed the questionnaire with other objectives in mind. The letter was developed as both a marketing and recruitment tool (see page 16). It educated our consumer and emphasized points we wanted to make clear: our all-volunteer status, our commitment to provide a valued community service, and our ever-growing need to recruit more members. Our questionnaire (see page 21) again emphasized that “We are always here for you!” and listed 10 questions focusing on courtesy, credibility, and the caliber of the emergency service provided. Respondents were asked to grade our service using a scale ranging from 1 (poor) to 10 (best). Space was provided for comments (and we get plenty!) and an additional solicitation for membership.
OPERATIONAL “BUY IN”
After the design phase, we set out to gain administrative as well as operational “buy in” for the project. Although the financial outlay was expected to be minimal, there was the larger issue of support for the proj-ect and the concept that triggered it. An effort was made to engage in “informal” discussion with many of the board members, many of whom have been with the department since the early years, before the actual presentation. After all, nobody likes surprises! A draft of the letter and a sample questionnaire were presented to the chief, the president of the company, and the board of directors for review and funding. Some requests for fine-tuning were made, but there was a clear message to go ahead.
The first letters/questionnaires went out in September 1994. Initially, I reviewed the call sheets for the previous month to evaluate the nature of the calls. Calls were screened to reflect responses within our first-due vs. mutual-aid area. Our ever-increasing volume of calls requires that calls now be reviewed weekly. Each letter is accompanied by a self-addressed, stamped envelope, a mechanism we believe has helped to keep our return rate averaging between 40 and 50 percent (20 percent is considered the norm). We find that we get a higher response rate from rescue calls, since many fire calls are mutual aid or responses to the frequent calls generated by multiple construction sites.
We currently average more than 2,500 calls per year. To date, the surveys have provided valuable information. Our customers are learning one by one who we are and a little about how the department functions. Overall, it is nice to see that most appreciate the job we do. A serendipitous bonus is the donation that occasionally accompanies the returned questionnaire. To date, we have received more than $6,000 in “unsolicited” funds. We really don`t know the full impact of this campaign and how much increased community awareness it has generated. We do see, however, that our community events are better attended.
Our membership has also gained insight from the project. All returned questionnaires are posted on a designated bulletin board, which is read regularly. Many a training session has resulted from a simple statement written by one of our customers. We learned our customers constitute a varied and discerning group; they appreciate the service provided but expect it to be done with professional expertise. More importantly, our members are more aware of the impact made by our invasion onto the property and into the homes of our customers. It is a great reinforcement to hear “You did a great job” and “Thanks for doing what you do and for keeping our carpets clean while you were busy putting out the fire.”
Change always calls for adjustment in attitude and behavior. Measuring quality assurance has helped. Our community`s understanding and expectations have been enhanced, and our company`s ability to better meet our neighbors` needs has grown, too.
BARBARA J. MURPHY, RN, MN, EMT-A, is a state-certified firefighter III, instructor, and emergency medical technician with the Ashburn (VA) Volunteer Fire and Rescue Department. She is the coordinator for quality assurance for her company, co-chair of the Community Outreach Committee, and a member of the Loudoun County Recruitment and Retention Committee. She has a master`s degree in nursing.