I have spent the overwhelming majority of my career working in the private, for-profit sector of healthcare. I got my feet wet working at a radiology clinic while I went to EMT school at night. I worked there for about 2 years before I finally landed my first EMS job at a very small “mom-and-pop” ambulance service about an hour north of town. I worked there part-time and stayed full-time at the radiology-clinic for about 2 years before landing a full-time job at the large metropolitan ambulance service. Nearly 7 years later I parted ways with that job and am now working at a non-profit children’s hospital and a small, rural, non-profit ambulance service.

Many things have changed throughout my journey. My work setting has changed dramatically several times, but what has remained consistent is me. Sure, I have certainly grown and matured throughout my career, but my work ethic, professionalism and level of care has pretty much stayed the same.

In every setting I have seen exceptional care-givers and I have seen exceptionally bad care-givers. Every place I worked at had their strengths and weaknesses. Sometimes I agreed with their practices, and other times I didn’t. Over the years I have developed an opinion on what I feel is the “best” way to run an EMS system, and I know that there are plenty of people out there that disagree and most likely have equal – if not better – ideas than I do. I know that I’m never going to be 100% right, and neither will anyone else. What remains the same, is that we both care enough about the profession to share ideas and try to improve the industry.

One thing that has really stuck with me, was something my boss said to me before leaving my job at the metropolitan ambulance service: “No matter where you end up, don’t ever lower your standards”. I didn’t fully grasp what he was saying until I started both of my new jobs recently. During classroom orientation at the hospital, I quickly learned that the management practices are much different than what I’m used to. Not in a good or bad way, just different. Once I got onto the floor and started training, the human factor set in. Both places offer plenty of training resources, good protocols, and top-of-the-line equipment. And just like both places, there are those who choose to take advantage of it, and those that don’t. Most people care about the quality of care that they provide, but unfortunately, some people just do enough to stay out of trouble and bring home a check.

Now let’s look at the other side of the coin. The small, rural ambulance service I work for reminds me a lot of my first EMS job. Both companies don’t have the resources of the large hospitals or the metropolitan EMS systems. They may not have bleeding-edge technology, but their equipment is good, functions well and serves it’s purpose when caring for patients. Most of the EMT’s and Paramedics working on the trucks (a new term I picked up working out here in Texas) use the long transport times and limited resources as an opportunity to improve their skills and actually do some real hands-on patient care. And of course, there are the few that choose to use the setting as an excuse for “not being able to do their job”. Once again, completely different settings, essentially the same people working.

I guess where I’m going with this, is that it doesn’t matter what setting you work in. Whether it be fire-based, private-based, non-profit, 3rd-service, or volunteer, the decision to provide quality patient care is up to you.

Good patient care isn’t measured by your protocols or resources. It’s measured by compassion, competence, and the willingness to do what’s right for the patient. It doesn’t matter if you show up in a brand-new ambulance with all the latest equipment and aggressive protocols, or if your on the side of the road in your private vehicle with nothing but a first-aid kit. You can still provide quality care to the best of your abilities.

So, back to the previous statement about “not lowering your standards”. It doesn’t matter what system you work in, the decision to provide quality care is yours. Just because a service doesn’t require you to attend airway training doesn’t mean you shouldn’t practice on a dummy frequently. Your service might be very conservative on the amount of medications and procedures that are allowed in your protocols, but that doesn’t mean you can’t do a thorough assessment and treat your patients to the best of your ability. The same goes for appearance. You should always present yourself in a professional manner, regardless of the mandatory dress code or lack thereof. You may be able to get away with wearing a worn-out, faded uniform – hell, it may be all that’s available to you – but that shouldn’t stop you from ironing it every day and at least looking like you give a damn about your job.

If there is one thing that I have learned throughout my years in healthcare, it’s that management simply cannot force good or bad patient care. They can certainly influence it one way or the other, but the final decision rests with the provider on the ground.