Self-regulation and medical direction

Abstract

Purpose The purpose of this paper is to describe and analyse two approaches to paramedic service clinical governance and quality management from the perspective of two groups of paramedics and paramedic managers working in North America. Design/methodology/approach A case study approach was utilised to describe and analyse paramedic service medical direction in North America and contrast this with the professional self-governance and clinical governance systems operating in other high-income countries. Researchers interviewed participants at two remote North American sites, then completed transcription and thematic analysis. Findings Participants identified three themes: first, resourcing, regulatory frameworks and fragmentation; second, independent practice facilitators and barriers; and third, paramedic roles and professionalisation. Those trained outside North America tended to identify self-regulation and clinical governance as the preferred approach to quality management. Few participants had considered paramedicine becoming a self-regulating health profession. Originality/value In North America, the “medical direction” model is the dominant approach employed to ensure optimal patient outcomes in paramedic service delivery. In contrast, other comparable countries employ paramedic self-regulatory systems combined with clinical governance to achieve the same ends. This is one of two studies to examine medical direction from the perspective of paramedics and paramedic managers.

Exploring the structure and characteristics of the Anglo-American paramedic system in developed countries: a scoping review

“…(2018b), with paramedics notably interested in moving away from the status quo to a system that embraces new roles, such as community paramedicine, and support for self-regulation and higher education. However, many paramedic participants feared that paramedicine lacked the maturity to take this step towards autonomous practice, and some were critical of existing professional associations that lack the will to change the status quo (O'Meara et al. , 2018a).…”

“…Medical direction has a strong hold over paramedicine in North America, where paramedics and paramedic leaders have limited power or agency to change a system that is embedded in the legal structures and accreditation requirements of state legislatures (Wankhade and Mackway-Jones, 2015). This contrasts with the situation in other high-income countries operating within the Anglo-American paramedic system, where professional self-regulatory boards and clinical governance systems support the growth of an independent paramedicine profession with its own unique body of knowledge (Wankhade and Mackway-Jones, 2015;O'Meara et al, 2018a).…”

“…This scoping review is built on the work of (O'Meara et al. , 2017, 2018) to identify and build on the existing narrative related to the different systems of paramedicine found within the Anglo-American paramedic system. The research question was developed to include a wider scope than previously researched and includes the work of health-based academics and paramedics.…”

“…Paramedics' attitudes towards the directive model were studied by O'Meara et al (2018b), with paramedics notably interested in moving away from the status quo to a system that embraces new roles, such as community paramedicine, and support for self-regulation and higher education. However, many paramedic participants feared that paramedicine lacked the maturity to take this step towards autonomous practice, and some were critical of existing professional associations that lack the will to change the status quo (O'Meara et al, 2018a). Other participants saw little need to or prospect of changing from medical direction, even when they were criticising this model for being ineffective and sometimes punitive (O'Meara et al, 2018b).…”

The Structure and Characteristics of Anglo-American Paramedic Systems in Developed Countries: A Scoping Review Protocol

“…This review is built on the work of O'Meara et al (3,8) in identifying and building on the narrative related to the different models of clinical leadership found within varying models of paramedic systems around the world. With the addition of a wider scope of review, the research question was developed by a multidisciplinary team of researchers including health-based academics and practising paramedics.…”