High Performance EMS Concepts for Healthcare – 2008.ppt

Report
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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)
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Our “Product / Widget” is a Unit Hour
 Ambulance Available for One Hour
▪ Medical Staff
▪ Vehicles
▪ Supplies / Hardware
▪ Support Systems
▪ Administration
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Supply our Unit Hours Using Peak-Load
Staffing to Meet Temporal Demand Curves
Based on a Service Reliability Standard / Goal
Saturday Staffing Vs. Demand
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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
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Efficiency & Effectiveness Drives Throughput
 Driven by Task Time / Call Segment Timeliness
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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
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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)
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Data Collected is Used to Improve Efficiency
and Effectiveness for ALL Processes and SubProcesses 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 :
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Lab
X-Ray / CT
Consulting Medical Groups
Food Services
Housekeeping
Substantial “Push” Based System Design Improvement
Opportunities
 No Command & Control / Processes Siloed
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Patient Clinical Pathway Dictates Approach:
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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
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Before Admission Processes
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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
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After Admission Processes
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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
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Adoptable Best Practices
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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
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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
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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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