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High Performance EMS Concepts for Healthcare – 2008.ppt

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					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)
Understanding High Performance
EMS
 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
                                                 Saturday Staffing Vs. Demand


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     0:00 1:00 2:00 3:00 4:00 5:00 6:00 7:00 8:00 9:00 10:0 11:0 12:0 13:0 14:0 15:0 16:0 17:0 18:0 19:0 20:0 21:0 22:0 23:0
                                                        0    0    0    0    0    0    0    0    0    0    0    0    0    0
                            All Calls     Staffing june 07   New Bid w/o downtime      New Bid w downtime
Understanding High Performance
EMS
 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
Understanding High Performance
EMS
 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)
Understanding High Performance
EMS
 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
Adopting High Performance EMS
Concepts in Healthcare
 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
Adopting High Performance EMS
Concepts in Healthcare
 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
Adopting High Performance EMS
Concepts in Healthcare
 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
Adopting High Performance EMS
Concepts in Healthcare
 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
Adopting High Performance EMS
Concepts in Healthcare
 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
Adopting High Performance EMS
Concepts in Healthcare
 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

				
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