High Performance EMS Concepts for Healthcare 2008
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High Performance EMS Concepts for Healthcare 2008

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

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

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    High Performance EMS Concepts for Healthcare 2008 High Performance EMS Concepts for Healthcare 2008 Presentation Transcript

    •  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
    • Saturday Staffing Vs. Demand262422201816141210 8 6 4 2 0 0:00 1:00 2:00 3:00 4:00 5:00 6:00 7:00 8:00 9:00 10:0011:0012:0013:0014:0015:0016:0017:0018:0019:0020:0021:0022:0023:00 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
    •  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