Competitive Advantage

“Strategy is about making choices, trade-offs; it’s about deliberately choosing to be different.” – Michael Porter

During business school, the professors often discussed the successful companies and organizations in terms of “competitive advantage” – the attributes that allow an organization to outperform its competitors – usually in terms of cost advantage or differentiation. For Amazon, it’s the online retailers ability to inventory, warehouse and ship goods quickly and efficiently anywhere in the world. For Apple, it’s the technology company’s ability to design and build easy to use products that function within its entire ecosystem of stores, apps and devices. When it comes to the debate over pre-hospital care and the role of community paramedics, its increasingly becoming necessary to consider our own competitive advantage and advocate EMS’s value proposition – the attributes that differentiate the delivery of care by EMS providers from other healthcare providers. However, outside of EMS’s historical role of “you call, we haul,” it is difficult to clearly articulate what distinguishes paramedics and EMTs from visiting nurses, social workers, care coordinators and community volunteers. As a thought experiment, I’ve found myself wondering if paramedics and EMTs desiring to fill the community paramedic role should just get their RN and save themselves the hassle of petitioning to change reimbursement policies and state licensing regimes…

One of the difficulties in defining our competitive advantage stems from the varied forms that EMS can take, from non-profits to for-profits, from fire-based services to hospital-based services, operating in super rural geographies to dense urban cities. These differences seem to overwhelm the ability to find commonality. Fortunately, Dr. Gregg Margolis, Director of the Division of Health Systems and Health Policy at the Department of Health and Human Services, has found a way to cut through the differences and describe the core attributes that define EMS’s competitive advantage. Paraphrasing, they are the following:

  1. Mobile – Able to go to where the patient is
  2. Available 24/7 – When the care is needed
  3. Integrated into the Community – Cognizant of differences in culture, access to care and needs
  4. Structured – Able to function using guidelines while still employing critical decision-making
  5. Autonomous – Capable of delivering care in austere environments with limited resources

The transformation of healthcare is already seeing providers expanding beyond their traditional roles.  Scopes of practice are increasingly porous and skills are more distributed. Paramedics and EMTs definitely have a role in performing scheduled, in-the-home, non-emergent care. Yet, in searching to evolve EMS, we shouldn’t just look to see what gaps paramedics and EMTs can fill, but also consider where these providers can be most effective and successful given their competitive advantage or we risk the ire of other vested healthcare interests and the risk of setback from unconvinced payors.

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