How are we going to save EMS?

Systemic Organizational Improvement

 for

Volunteer and Combination Rescue Squads

and other EMS organizations.

OR

How are we going to save EMS?

By Alan Perry

AAS, BS, NREMT-P
5/8/2013

Introduction

The world economy has changed dramatically over the last decade. There is increasing demand for more businesslike performance from government and public safety organizations. With this comes increasing competition for human and monetary resources. The challenges facing Emergency Medical Services (EMS) systems where identified by the National Highway Traffic Safety Administration (NHTSA) 16 years ago and have not been acted on by most organizations since then. The combination of these factors now threatens the existence of volunteer organizations that are unwilling or unable to adapt.

As an industry, the provision of EMS has become very competitive. Volunteer and publicly operated EMS agencies must prove their ability to provide the best care possible for the lowest cost to the taxpayers, and insurers, if they are to survive. This paper explores many common business practices, and recommendations of the EMS agenda for the future, which provide a starting point for organization self-evaluation and action. The goal is to inform, educate, and guide management in the process of identifying opportunities, and taking both general and specific action that will improve the efficiency and effectiveness of their organization. Achieving this goal will give the organization the tools to facilitate not just survival, but some measurable success.

This will not be a rehash of business school or a review of the EMS agenda for the future. Readers are encouraged to understand both of these for their own benefit. This is down and dirty problem solving, and fixing that which is broken.

Getting in the right frame of mind

Be honest.

This is a critical “must have”, if you and your staff cannot be honest about the organization and the environment it operates in, you will miss key opportunities and blind the organization as it heads along a perilous route.

Be objective.

Base your assertions and actions on fact; emotion has no place in effective decision making. Tradition also has little value in this arena, and is often used as justification for neglecting leadership.

Who is your customer?

I would argue that your customers fall into several categories; the general public, your workforce, other agencies and facilities you work with and state/local government. Your best chance at success is making them all happy with your service. Not an easy task.

What does the customer need?

Careful here, what they need may not be what you currently provide. Here again you must include all of your customers, internal and external. This is a good place to be innovative.

What does the customer expect every day and during emergencies?

Think of the full range of possibilities here, from public education programs, bread & butter calls, major disasters including extended events, and the Saturday afternoon cookouts. The organization should be more than just a service provider; it should be a center of community activity.

Define the mission of the organization.

Analyze the mission statement. Does your mission statement truly reflect the goals of the organization and the needs of your customers? This basic statement defines the attitude and relationship of the organization to the public it serves. Keep it simple.

Define the mission of public service in general.

Think generally of the tenants of public service, not the stereotype, more like Moses, Jesus or the Buddha. This is for your own personal reflection and to center your thought process on what is not only right, but also righteous.

Where to start?

The opportunities you know (or think you know).

These are the opportunities you and your staff are already aware of. These need to be examined objectively to determine if they are what they seem to be. Be careful to identify the cause, not the symptom.

The opportunities you know, but won’t repeat.

The suspicions and inconvenient truths present in every organization. Failure to recognize and address these will poison any effort at overall improvement. There can be no “sacred cows” in an honest evaluation.

The opportunities others see.

The view from outside is frequently more telling than from within. The organization should seek objective feedback from customers, workers, affiliate and competitive public safety organizations, and local government to produce a comprehensive source of improvement possibilities. You cannot adequately effect change without a comprehensive view of the circumstances and public image.

Collect the data

When an opportunity is identified look for data to support and quantify it. This is critically important, without quantified data no measurement can be made and no benchmark can be established. All data is good since it enables management to determine what works and what does not.

Where to look

Areas for organizational improvement (not exclusive)

Human Resources

o   Recruitment- Are your recruitment methods producing adequate numbers of qualified and motivated candidates? Are you attracting the right people?

o   Training- Does your training program meet the needs of the provider and the state? Does it support advancement and transition to higher levels of EMS care and/or organization management?

o   Advancement- Are their sufficient opportunities for members to advance or take on additional responsibilities if they desire to do so?

o   Retention- Are new members mentored and retained by the organization? Are exit surveys conducted?

o   Incentives- Are any incentives offered to offset the expenses and time involved with volunteer service?

Physical resources

o   Physical plant- Is your building adequate for your equipment, well maintained and comfortable for your crews? Is the physical appearance good?

o   Rolling stock- Are your vehicles appropriate and well maintained? Are they reliable, clean and comfortable for your crews and clients?  Do you have reserves?

o   Durable equipment- Does your equipment meet current standards of care? Is it in good condition and reliable? Do you have back-ups?

o   Soft goods inventory- Does your inventory meet current standards of care? Are items ordered and stocked in sufficient quantity to obtain meaningful discounts and prevent depletion?

Finances

o   Fund raising- Are there a variety of fund raising options for members and the general public? Are donations/proceeds adequate to support operations?

o   Revenue recovery- what percentage of calls produce revenue? Are all billing options pursued? Does the public understand why it is needed?

o   Fixed costs- How do these cost compare to industry averages? Any room for improvement? Any potential changes +/-?

o   Operating costs- Are maintenance and other costs in line with industry averages? Are vehicle maintenance costs excessive?

o   Investments- Are surplus funds adequately invested? Are investment vehicles appropriate?

Community relations

o   Citizen advisory panel- Is there an advisory panel? Is it a cross-section of the community? What are their concerns and recommendations?

o   Public education- Is there an EMS public education program? Community first aid or CPR? Regular community events, health & wellness fairs?

o   Emergency preparedness- Does the organization participate in community preparedness? Does the organization have a plan for extended emergencies & disasters? Are multi-agency drills conducted?

o   Public perception of the organization, if cultivated, will drive your recruiting efforts, fundraising, and create broad political support.

Government, Allied health organizations

o   Fire services- what is the relationship with the city and county fire service? Is a representative from these organizations involved with the advisory board? What are there stated positions and goals in the provision of EMS? Do fire and EMS agencies train together or participate in joint social events? Are conflicting goals challenged?

o   Emergency management- What involvement does the organization have with the county emergency management office? Is it directly involved in planning?

o   Other EMS services- What relationship exists with other EMS agencies locally? Is there any collaboration in purchasing, planning or training? Are any viewed as competitors? Are they united in the political arena?

o   County/State stakeholders- Are there concerns with the county or state agencies? Do either have any input in the decision and planning process?

o   Referring facilities- Is there a liaison officer to monitor and guide relations with referring healthcare facilities? Are there any recurring issues or opportunities for improvement of relations?

o   Hospitals- Is there a liaison officer to monitor and address concerns from receiving facilities? Is the OMD involved? Are there any recurring issues or opportunities for improved relations?

o   Public health- Does public health take an active role in Prehospital events? Is there a desire to see more integration between EMS and public health activities? Is there any interest in a community paramedicine program?

o   Social services/mental health- Is there a referral process in place for citizens requiring social services and/or mental health services? Is there an interest in cultivating this alliance?

Make your list

Be inclusive.

List all opportunities without prejudice. Determine which present the greatest threat or benefit to the organization. Be careful not to be biased in the process, it may be helpful to have an objective third party organization help in this process.

Priorities

Setting priorities requires some thought based on the severity of the problem, available resources, and political challenges. Usually you will want to deal with the most severe or easiest to complete ones first.

Resources

In the current economic climate your only resources may be those you already possess. Do not be afraid to redistribute assets to achieve a goal. Do not be afraid to ask for additional resources if you have the data and a plan to support it. Your resources include people, money, equipment, facilities, political capital and the community.

Politics

In this business some politicking is required. Internal politics, fire/ems politics, county politics and state politics can affect the ability of the organization to improve its performance. It’s not always a bad thing, but usually is. Politicians of all stripes respond well to facts, with facts they will have an easier time promoting a good decision to their constituency.

Can everybody win?

There does not have to be a loser, everybody can win if careful, responsible and unbiased decisions are made for the benefit of the public. Avoid being the aggressor if conflict arises, facts and a cool head will prevail.

Set goals that are measurable and obtainable.

Realistic goals are important, most people like being able to see progress being made, and in doing so become further encouraged and inspired.

Communicate

Publish goals, timelines and results. Keeping everyone informed and involved will keep your team and the community together in the process. Remember that in the absence of facts, rumors will abound.

Conclusion

Many opportunities exist for system and agency improvement by just asking a few questions, first of one’s self, and then of the organization and the environment it operates in. I encourage you to dedicate the time for yourself and your organization to explore these issues and solidify your position within the community you serve.

Volunteer EMS is a valuable resource in every community they serve. It has come under fire from for-profit EMS agencies, and the fire service more frequently in the current economic climate for purely economic reasons. These entities will take advantage of weakness in the volunteer system to secure more paid positions and private transports, in the process stripping the volunteer organizations of the resources they need to survive.

Our best defense in these circumstances is a good offense. We must educate the public and administrators about our value to the community, and daily impress them with our performance and dedication to the community and our citizens.