The Norwegian Air Ambulance might have some good tips for the rest of us in the health game, or for business in general…
It’s minus eighteen degrees celsius, in one of the snowiest winters in Oslo in years, and I’ve just been asked how I feel about going out to stand by a windy rockface for an hour or two, whilst the Norsk Luftambulanse crew practise some helicopter cliff rescue techniques. “You might want to grab an extra jacket,” my host, Dr Christian Buskop smiles.
It’s always impressive watching well-drilled crews do their thing, particularly when that thing is heroically hanging out of helicopters and saving lives. But it wasn’t helicopter manoeuvres, ropes or extreme trauma management that I learnt most about out here in the Nordic ice. It’s the way this outfit runs, how they work together and with others, and how they constantly improve that gave me the most food for thought.
Once I had the feeling return to my face and fingers, I put down a few of the key features of their success that struck me:
Let experts be experts.
The Norsk Luftambulanse crews all have at least ten years in their respective disciplines: Anaesthetist, Paramedic and Pilot, before being eligible to be selected for the service. And they know how to use these experienced professionals. Rather than expecting them to merely conform to the established methods, the Norwegians value the experience and knowledge the experts bring to the team from their experience and knowledge gained throughout the world.
Across other prehospital and emergency systems around the world, the idea of constraining procedures down to a single, protocolised method gains plenty of popularity. Whether they improve outcomes might depend on what baseline outcomes they are tested against. It’s obviously an attractive prospect for managers and trainers to have only a single way to teach or ensure compliance to. And with a protocol, there’s that certain satisfaction that everyone (by default) is agreeing with your way of doing things. “Let’s work together as a team and do it my way!” But does a baseline protocol give the best outcome for an individual patient/client? Does your “standardised” way of working fit your own needs, give an “OK” outcome across the board, but let down the individual?
So what about protocols for prehospital anaesthesia , or other procedures in Norsk Luftambulanse? Dr Christian Buskop explains, “Why would you hire experts, and not have them deliver the best care for the individual in whatever setting? Protocols are great to ensure a safe baseline where the staff might have different levels of experience, or be in training, but they’re not always the best care for that individual patient.”
Another push, particularly in the prehospital arena, is to minimise cost, training and complexity by narrowing the drugs and equipment down to the “desert-island essentials.” (Ketamine and bougies for everyone?) As for the Norwegian options available, equipment and drug-wise, the rule seems to be “as simple as possible, but no simpler.” The crews carry a sensible range of drugs and equipment to allow tailoring to each patient context, but not enough to risk over-complication, confusion or waste.
Respect the team.
The Norsk Luftambulanse crew of three: Anaesthetist, Pilot and Paramedic, essentially undertake a 14-day shift on base together. It’s considered by the service that this continuous service (with enforced rest breaks, obviously) helps to establish closer communication and bonds within the teams, and thereby improve performance.
There’s something to be said for these blocks of consistency, I think. Certainly in terms of communication, repeated exposures to someone’s way of working certainly helps with verbal communication, but also to the non-verbal cues and pattern recognition we all know but most likely fail to recognise the significance of. Would blocks of time working with one crew before changing work better in your workplace?
Devote serious resources to training.
“When it comes to training, we are lucky enough to have no budget restrictions.” The Norsk Luftambulanse truly value and resource training, and they encourage the crews themselves to design the training schedule to suit both theirs and the service’s needs.
I was fortunate enough to see this policy in action, as the crew organised a cliff-rescue exercise, liaising with the mountain rescue service, and a local land-holder to practise placing mountain rescue teams onto the cliff along with the necessary attachments.
Essentially, if not on a mission, these crews are training for one, and recording their progress and continual improvement. It’s inspiring to see, and I wish our training-to-service provision ratio could be tweaked to be similar!
Play nicely with others.
When I commented that it was interesting to see such close work with the volunteer mountain rescue team, the reply was, “These guys are the experts at climbing and getting stuck climbers off mountains. With everything we need to train for, we could never reach their level of experience or expertise.”
Elsewhere, ‘elite’ teams will often work toward exclusion of others from their workflow, believing that working with others adds complexity, or that experts from another discipline could never match their own high standards. (*Narrows gaze at certain intensive care units, ambulance services and health administrations…) It was refreshing to see honest respect for the expertise and work of others in Norway. There are plenty of instances in our game where we confect barriers or demarcation to ensure we can work in the way we always have. But are we doing our patients a disservice by neglecting the expertise of others outside our bubble?