This power point presentation first developed in 2008 reviews Understanding and Adopting High Performance EMS Concepts in Healthcare.

2.  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)

3.  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

4. Saturday Staffing Vs. Demand
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All Calls Staffing june 07 New Bid w/o downtime New Bid w downtime

5.  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

6.  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)

7.  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

8.  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

9.  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

10.  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

11.  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

12.  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

13.  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

14.  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