Post Mortem or Lessons Learned

I was fortunate to be asked to work on a project several years ago that involved creating an in-house Critical Incident Stress team for an ambulance service (I was a full time employee at the time). A critical incident can be defined as, “an event which made you stop and think, or one that raised questions for you. It may have made you question an aspect of your beliefs, values, attitude or behaviour. It is an incident which in some way has had a significant impact on your personal and professional learning” (Language and Online Learning, 2011).

Paramedics work in stressful situations and sometimes see people at their worst or last moment in life. As a paramedic (back in the 80’s) we were always told to ‘deal with it’ as it was part of the job. Finding someone to speak about the incident was seen as cowardly and ‘weak’. Fortunately time and attitudes changed making it socially acceptable and mandatory (in some situations) to discuss certain incidents or calls. Creating an in-house team would allow easy access for paramedics and possibly reduce lost time from work due to critical incident stress. Other Emergency service agencies contracted outside organizations to perform critical debriefings or counselling, but we wanted to provide an alternative option to paramedics. Hopefully this would encourage more participation if it was easily accessible and less intimidating chatting with fellow colleagues.

Step 1 (An idea is born)
An incident occurred within the ambulance organization that resulted in one paramedic leaving due to critical incident stress. This was a wake up call for many of us given the paramedic is a seasoned soul who had worked for over twenty years. The concept for an in-house team was quickly conceived and presented to management for approval.

Step 2 (Organize team and begin work)
The team was selected and surprisingly enough there were more volunteers than we required so it was difficult, but necessary to keep the team small and focused. We participated in numerous brainstorming sessions and developed a confidential questionnaire for paramedics to complete regarding their knowledge on critical incident stress.

Step 3 (Looking forward)
Our final goal was to have our own team available for colleagues 24/7/365. We drafted our plan and discussed potential training needs for staff, interested in become team ‘counsellors’. We were fortunate to find enough qualified staff interested in becoming team members.

Step 4 (Identify tasks and phases)
Surveys were collected and the data collected showed that most medics did not understand what classified as a critical incident, therefore training sessions needed to be added to our task list.

Step 5 (Time and Effort)
Management was supportive of our project allowing us to meet during work time and also utilize existing office supplies for survey distribution. We had a specific timeline captured and our weekly meetings allowed us to remain on schedule.

Step 6 (Schedule)
Unfortunately we did not create an organized schedule, but rather went weekly to weekly based on discussions during those sessions.

Step 7 (Costs)
There was very little costs associated with the project except for the team’s time but it was decided early that we were volunteering our time to allow for costs to be allocated elsewhere if needed.

Step 8 (Project momentum)
Our enthusiasm and weekly meetings allowed us to keep the project moving despite a few obstacles along the way.

Step 9 (Scope creep)
We needed to modify the project slightly to incorporate some training for the paramedic staff based on survey results. This modification was agreed upon by all team members so there was no resistance felt.

Step 10 (Project complete)
The team was formalized and introduced to the paramedic staff on schedule and greeted with enthusiasm by management.

Mistakes Made

No formal project charter or statement of work was presented to the management team for approval. A proposal was designed and presented, but looking back it should have been more detailed and formalized (Greer, 2010)

The questionnaire received a poor response rate and I am not sure if it was due to being a paper version rather than electronic. I wonder if the response rate would have been higher using a tool such as survey monkey. http://www.surveymonkey.com/

A formalized schedule should have been created to assist with timelines for completion. Although the project was implemented by the proposed deadline it was not without frustration.
The team should have been compensated for their time as the weekly meetings and training session for the counsellors ate a lot more time than originally planned.

Small Success

When the request went out looking for volunteers already certified in critical incident stress management we discovered we had sufficient numbers so additional training was not required. This was a significant cost savings for us as we had not originally budgeted for staff training, but rather budgeted for the staff time during the counselling sessions

Lessons Learned

A formalized plan detailing every phase (conceive, define, start, perform, close) should have been documented and detailed allowing management and the team reference to refer when tasks became cloudy(Portny et al, 2008). One of the most frustrating parts of the project was dealing with some team members attitudes and beliefs on how the Critical team would function. Defining the roles and responsibilities of the critical incident stress team would have reduced some of the heated discussions that occurred during the performing phase of the project. Communication should have been more open among team members despite the culture surrounding the concept of the project. It is vital to “share the right messages with the right people in a timely manner” (Portny et al, 2008, p.357).

Post Mortem

Communication is such a key component to any project that when there was a break done in it, it not only frustrated all it made no sense. The entire team consisted of paramedics who are known to be effective communicators so wonder if an outside individual should have been placed on the team.
Overall, I am proud of what the team accomplished as the project is still operating today. It has gone through some slight variations and revisions but paramedics have found it to be user friendly. Management has provided some additional funding to compensate the in-house team if they are called out for extended duty. Critical incidents occur infrequently, but when it happens to you it is nice to know there is a shoulder to lean on to get you through the storm.

References

Greer, M. (2010). The project management minimalist: Just enough PM to rock your projects! (Laureate custom ed.). Baltimore: Laureate Education, Inc.

Language and Online Learning (2011). What is a ‘critical incident’? Retrieved July 7,  from: http://www.monash.edu.au/lls/llonline/writing/medicine/reflective/2.xml

Portny, S. E., Mantel, S. J., Meredith, J. R., Shafer, S. M., Sutton, M. M., & Kramer, B. E. (2008). Project management: Planning, scheduling, and controlling projects. Hoboken, NJ: John Wiley & Sons, Inc.