Production Model Science & Theory Applied to a Service Industry Enables Balancing of Patient Care, Employee Wellbeing & Financial Stability in a Poor

High Performance EMS Concepts for Healthcare

Understanding High Performance EMS

Production Model Science & Theory Applied to a Service Industry

Enables Balancing of Patient Care, Employee Wellbeing & Financial Stability in a Poor Economic Environment

Production Model EMS Theory: Service Demands ARE Predictable

▪ Temporal (When is the Demand - Time of Day and Day of Week)

▪ Geospatial (Where is the Demand)


Our “Product / Widget” is a Unit Hour Ambulance Available for One Hour

▪ Medical Staff▪ Vehicles▪ Supplies / Hardware▪ Support Systems▪ Administration

Supply our Unit Hours Using Peak-Load Staffing to Meet Temporal Demand Curves Based on a Service Reliability Standard / Goal

Peak Load Staffing Model

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Saturday Staffing Vs. Demand

All Calls Staffing june 07 New Bid w/o downtime New Bid w downtime


Efficiency & Effectiveness Drives Throughput Driven by Task Time / Call Segment Timeliness

▪ Call Processing Times▪ Response Times▪ On Scene Times▪ Transport Times▪ At Destination Times

The Longer it Takes to Run an EMS Call The More Resources You Need to Meet a Service Reliability Standard

The Shorter it Takes to Run an EMS Call the Less Resources You Need to Meet a Service Reliability Standard


All Functions Performed Under a “Command & Control” Structure using “Push Engineering” vs “Pull Engineering” Controllers (Dispatchers) Make Key Process

Decisions Regarding Resource Allocation and Usage and Collect Key Data for Metrics and Benchmarking

Information Systems Used to Gauge Performance in Real Time

Clinicians Make All Clinical and Pathway Decisions Very Different then Fire or PD Model (Location of

Command & Control)


Data Collected is Used to Improve Efficiency and Effectiveness for ALL Processes and Sub-Processes in the System and is “Re-assessed” Every 6 Months in Order to Adapt to Changes in Demand or Improvements in Efficiency Supply Chain Adjustments

▪ Temporal▪ Geospatial

Adopting High Performance EMS Concepts in Healthcare

Strong Similarities in Most Key Areas Strong Evidence That ER Demand is Predictable and

Follows EMS Demand Curves Allows us to Hypothesize That Other Patient Service

Demands are Also Predictable Based on ER Demand Patterns and Admitted Patient Census : Lab X-Ray / CT Consulting Medical Groups Food Services Housekeeping

Substantial “Push” Based System Design Improvement Opportunities

No Command & Control / Processes Siloed


Patient Clinical Pathway Dictates Approach: ER Walk In/EMS Admission: Discharged from ED ER Walk In/EMS Admission: Admitted ED / Direct Patient Transfer: Admitted ED Patient Transfer: Discharged

Pathway Processes Before Admission (Registration / ER)

▪ Highly Contained & Limited Span of Control▪ Minimal Silo Effect

After Admission (Admissions / Floor / Unit)▪ Poorly Contained & Large Span of Control▪ Substantial Silo Effect


Before Admission Processes Triage Registration Waiting Queue Room Assignment Primary Assessment RN Primary Assessment MD / PA Testing Treatment Reassessment (More Treatment / Testing Possible) Disposition Decision (Discharge / Admit) Discharge Patient


After Admission Processes Room Status / Availability / Cleanliness RN Report ED to Floor Patient Transport RN Assessment MD Assessment Orders Testing Nutrition Other Ancillary Services (Medical & Customer Service) Reassessment (MD / RN) Disposition Decision (Stay, Transfer, Discharge) Discharge Patient


Adoptable Best Practices Setting Service Reliability Standards Temporal Demand Analysis Peak Load Staffing Centralized Command & Control Centralized Data Collection & Analysis Real-time System Reactivity Bi-annual Adjustments to Demand / Efficiency “Push Based” Systems Engineering of Practices Utilizing APL vs AVL Systems


Benefits Dramatically Improved Throughput Using

Same or Less Staffing Improved Customer Satisfaction Efficient and Effective Delivery of Care Improved Margins via Cost Reductions,

Capitalizing on Lost Opportunity Revenue & Revenue Improvement Through Increased Patient Volumes


Pitfalls Significant Change MD / RN Rejections of:

▪ Schedules▪ Command & Control▪ Perceived Loss of Control

Must be Combined With Clinical Standards That Balance Competing Interests

Capital Layouts▪ Software & Hardware Must Be Created / Modified /

Adapted▪ Physical Plant Changes / Updates May be Necessary

Documents

Production Model Science & Theory Applied to a Service Industry Enables Balancing of Patient Care, Employee Wellbeing & Financial Stability in a Poor