Paramedics have always been a little different than other healthcare professions. Existing at the junction between healthcare and public safety, paramedicine has evolved from funeral home and fire department-based transport only services to a distinct profession that provides high quality out-of-hospital care. These changes have occurred quickly, in response to gaps and opportunities in the healthcare system (1). The rapid evolution and success of modern paramedicine represents a disruptive innovation in the healthcare industry. To progress and grow as a profession, paramedics must continue to identify and champion disruptive innovation. Successful disruptive innovation requires inclusion and support of a diverse workforce.
What is disruptive innovation?
Disruptive innovation is a business theory that emerged in the mid-90s from a Harvard professor. A product or company is deemed a ‘disruptive innovator’ when their product or services targets an underserved or overlooked market. Successful disrupters use the foothold they gain in the underserved market to improve the quality or performance of their product or services, resulting in rapid gains in the market and challenging more established products and services (2). For example, Netflix is a disruptive innovator. What started as a by-mail movie rental company quickly evolved into the largest streaming video subscription service. Within 13 years it had managed to put Blockbuster, the company that previously dominated the market, out of business (3).
Disruptive innovation in Paramedicine
The theory of disruptive innovation was created to describe a new type of business innovation. There are, however, examples of disruptive innovators in many other industries including healthcare. The modern practice of paramedicine and out of hospital care can be seen as a disruptive innovation in healthcare. Modern paramedicine started through serving a population that the rest of healthcare could not reach: those who are in need of urgent or emergency care, and are unable to get themselves to a hospital. As the role of paramedic gained traction in the healthcare landscape, it has evolved in scope and type of care provision. The emergence of programs and initiatives like community paramedicine serve as the next logical evolution in the continued disruptive innovation of the paramedic profession.
For a disruptive innovator to be successful, it requires enabling technology, an innovative business model and a coherent value network (2). These features are all present in paramedicine and have all led to the growth of paramedicine from a transport service into knowledgeable clinicians delivering out-of-hospital care.
While paramedics may not consider their services to have ideal technology, the reality is that modern paramedicine would be impossible without advances in radio and wireless technology. Most paramedic services use medical and diagnostic devices like cardiac monitors that sync with electronic medical records and allow for wireless sharing of patient information with other healthcare providers and facilities. These technologies have allowed greater interaction between paramedic crews and hospital staff while paramedics are on scene. This creates more definitive care that is delivered earlier, while also helping to further the paramedic scope of practice. A range of other technologies continue to evolve and support the work and expanding scope of paramedics.
Innovative business model
Traditionally in business, disruptive innovations target non-consumers or low profit consumers. In the model of paramedics as disruptive innovators for healthcare, out of hospital care targets urgent and emergent conditions, low intervention patients, and those with mobility or accessibility challenges. These patient populations face accessibility, time, or other barriers that make it more challenging to directly access traditional hospitals or clinics. Paramedics have the ability to reach remote and rural areas and bring care to the patient rather than requiring a patient come to a facility. These differences separate paramedic services from other healthcare providers, meeting a unique need for patients.
Coherent value network
“Coherent value network” is business-speak for a network in which all groups benefit from a product or service. In paramedicine, a coherent value network is created when patients have care brought directly to them, while hospitals avoid unnecessary transports and paramedics can function within their full scope of practice. Every time a paramedic crew consults with an on-call physician, treats a patient in their home, and avoids an unnecessary trip to a hospital, all parties are benefiting from out of hospital care. Palliative care programs are another example of a coherent value network: patients remain at home, hospital volumes are reduced, and paramedics can exercise their care skills.
Supporting innovators: Gender & diversity in disruptive innovation
Disruptive innovation is a process, not a single service or product (2). Paramedicine, still a relatively young profession in the context of healthcare, has been refining its services over decades to ensure they are continually meeting the needs of the population and delivering high quality care. Many of us have witnessed this shift happen: a profession once focused solely on bringing people to the hospital is now working on how to deliver care in communities. However, just because a disruptive innovator is evolving does not mean it will be successful (2). For paramedicine to realize its full potential, services provided must continue to meet the demands of an underserved market and maintain quality levels.
The types of care paramedicine has evolved to provide in the last five to ten years has come from feedback of paramedics about what is happening in populations, and what services communities really need (4). Paramedicine saw a gap and took action to fill it. To continue to successfully innovate and meet population needs, paramedics must embrace and support a diverse workforce that matches the relative demographics of the population being served. Greater perspectives allow for greater innovations (5). A healthcare workforce with gender, age, and racial diversity increases an organization’s ability to innovate (6). When paramedics of different genders, ethnicities, and backgrounds are brought together, a wider variety of skill sets, experiences, and values are represented. By building and supporting a diverse paramedic workforce, frontline clinicians will have a wider lens through which service gaps and areas of need can be identified.
While paramedicine has started to establish itself as a disruptive innovator in healthcare, there is still plenty of work to be done. Historically, paramedicine is reactive in nature: paramedics respond after an incident occurs, after a chronic condition has progressed to an urgent situation, after a diagnosis is reached. As new programs and care paths are built for paramedics, we can start to be more pro-active as a profession: administration of vaccines, frailty assessments prior to serious incidents, preventative illness testing, etc. These programs require clinicians that recognize and understand the issues and challenges in the communities they work in and the populations they are serving. This insight requires not just a diverse workforce but a culture that values diverse voices and perspectives. In the innovation process, diverse perspectives allow for more creative solutions. Paramedicine needs to embrace and support all voices to help build innovative solutions and programming.
Paramedics are the disruptive innovators in the healthcare world. Despite the healthcare industry’s resistance to change or adaptation, the evolution of the paramedic profession demonstrates that new innovations for delivering patient care are feasible. Paramedicine has solidified itself as an integral part of the Canadian Healthcare system through meeting needs that traditional healthcare organizations are unable to address. To continue to succeed as disruptive innovators, paramedics must support a diverse workforce and cultivate a culture that values new voices and perspectives. It is only through embracing diversity that paramedic innovation will continue to develop inventive ways to address patient needs and provide essential care.
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