How to Ratchet Up
(and Squeeze Out Those Final Percentage Points of
Performance)
Jonathan D. Washko, BS-EMSA
Director of Deployment – REMSA
President – Washko & Associates, LLC
Partner – Stout Solutions & FirstWatch
The journey of tightening up
response time performance can be
daunting. Learn the tips, tricks,
traps and mental models that
allow your team to break the final
barrier
An EMS Fact…
Understand that all the training,
equipment, personnel, supplies, drugs,
protocols, hardware, vehicles,
technology, maintenance, QI systems
etc, etc, etc don’t mean a thing if…
An EMS Fact…
Understand that all the training,
equipment, personnel, supplies, drugs,
protocols, hardware, vehicles,
technology, maintenance, QI systems
etc, etc, etc don’t mean a thing if…
We Can’t get to the Patient in/on Time
Session Overview:
 Homeostasis & The EMS Success Triad
 Production Model EMS Theory & The Quality





Unit Hour Concept
Understanding The Theoretical Performance
Model
The Variables of Performance Improvement
Strategies / Best Practices for Performance
Improvement
Performance Improvement Pitfalls & Tips
Summary / Review / Questions
Homeostasis & The EMS Success Triad
 The Constant Balancing of 3 Key Elements



Patient Care
Employee Well-Being
Financial Success (however you define it)
Success
Triad
Employee Wellbeing
Homeostasis & The EMS Success Triad
 Patient Care

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
Response Times
Clinical Performance
Customer Service
Success
Triad
Homeostasis & The EMS Success Triad
 Employee Well-Being
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Retention
Health / Safety / Welfare
Satisfaction
Schedules
Work Environments
Compensation
Recruitment
Family
Success
Triad
Employee Wellbeing
Homeostasis & The EMS Success Triad
 Financial Success

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A/R Billing Practices
EMS Delivery Model & System Design
Operational Efficiency & Effectiveness
Employee Compensation
Safety & Risk Management
Systems Engineering
Profitability
Subsidy Needs
Success
Triad
Employee Wellbeing
Production Model EMS Theory
QUESTION:
Is EMS a Service Industry or Production
Industry?
Production Model EMS Theory
High Performance EMS Systems Believe…
That EMS is a Production Industry that
provides its customers with a level of Quality
Service as an end result of a Quality Product
Production Model EMS Theory
Quality Services from Quality Products
 Examples:
 Radio
/ Boom Box. The quality of the sound,
reception, etc. (Service) is based on the quality of
the Radio (Product)
 Televisions. The quality of the picture provided
(Service) is based on the quality of the TV
(Product)
 Etc, etc, etc
Production Model EMS Theory
Quality Services from Quality Products
So what Widgets (or products)
do HPEMS Systems Produce?
A Quality Unit Hour
A “Quality Unit Hour” is an ambulance that
is available to the EMS System for one hour
that responds to properly triaged calls for
service, is produced within a CQI
environment that uses modern technology to
collect and assess accurate data, is fully
staffed, fully trained, fully maintained, fully
stocked, properly placed in location and
time, properly funded and safely operates
within an educated population
The Quality Unit Hour Concept
PR/Marketing
The
Quality
Unit Hour
Production Model EMS Theory
The Quality Unit Hour
Manufacturing / Production Cycle
Based on Supply & Demand
Ratcheting Up Performance
 Assumes you understand the EMS
Success Triad
 Assumes you understand and/or operate
under the Production Model EMS
Premise
 Assumes you understand the Quality
Unit Hour Concept
It’s never safe to assume so any
questions before we move on?
The HPEMS Theoretical Performance Model
Employee Well-being / Satisfaction
HPEMS / SSM
Productivity / Unit Hour Utilization / Profitability
Station Based EMS
Union Formation Zone
Performance
Improvement
Zone
Performance Comfort Theshold
CONTRACTUAL DANGER ZONE
Response Time Goal
UHU Syndrome
Triad Homeostasis
Response Time Reliability / Performance
Unit Hour Reduction Zone
Geospatial / Unit Hour Deployment
Plan
Least Aggressive
The Triad Tradeoff
Most Aggressive
Best Care
Best Profit
HPEMS System Operational Maturity
Young
Middle Aged
Patient Care
Mature
Copyright 2006 by Washko & Associates, LLC - All Rights Reserved
The HPEMS Theoretical Performance Model
It’s actually a graphic representation of my last trip with my wife, twin two year old
boys and my 5 year old little girl
The HPEMS Theoretical Performance Model
Employee Well-being / Satisfaction
HPEMS / SSM
Productivity / Unit Hour Utilization / Profitability
Station Based EMS
Union Formation Zone
Performance
Improvement
Zone
Performance Comfort Theshold
CONTRACTUAL DANGER ZONE
Response Time Goal
UHU Syndrome
Triad Homeostasis
Response Time Reliability / Performance
Unit Hour Reduction Zone
Geospatial / Unit Hour Deployment
Plan
Least Aggressive
The Triad Tradeoff
Most Aggressive
Best Care
Best Profit
HPEMS System Operational Maturity
Young
Middle Aged
Patient Care
Mature
Copyright 2006 by Washko & Associates, LLC - All Rights Reserved
Understanding The HPEMS
Theoretical Performance Model
The HPEMS-TPM is a graphical representation of how
HPEMS systems can progress over time in relation to the
EMS Success Triad based on changing key deployment
and performance variables. This enables visualization of
great and not so great performance and the positive and
negative tradeoffs associated with changing these
performance variables.
It also allows for a visual representation of HPEMS
“Homeostasis” which is an achievable but difficult band in
the TPM to reach and then maintain
Understanding The HPEMS
Theoretical Performance Model
 Empirically Driven “Common Denominator” Model
Based on Years of HPEMS Exposure and Experiences
 Variables (Color Coded)

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Response Time Reliability / Performance
Patient Care
Productivity / Unit Hour Utilization / Profitability
Employee Well-being
 Zones
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



Union Formation Zone
Contractual Danger Zone
Performance Comfort Threshold
Performance Improvement Zone
Triad Homeostasis
Unit Hour Reduction Zone / The Triad Tradeoff
HPEMS / SSM
Station Based EMS
Response Time Reliability / Performance
Understanding The HPEMS Theoretical
Performance Model - Variables
Response Time Goal
UHU Syndrome
Response Time Reliability / Performance
HPEMS System Operational Maturity
Young
Middle Aged
Mature
Copyright 2006 by Washko & Associates, LLC - All Rights Reserved
Understanding The HPEMS Theoretical
Performance Model - Variables
 Response Time Reliability / Performance


Depicts response time reliability based on fractile
measurement
The further up the matrix the higher the performance,
the lower on the matrix, the lower the performance
 Response Time Goal depicts contractual or self
imposed response time reliability standard
 UHU Syndrome represents what can happen to
many HPEMS systems when productivity drops too
low
HPEMS / SSM
Station Based EMS
Response Time Reliability / Performance
Understanding The HPEMS Theoretical
Performance Model - Variables
Response Time Goal
UHU Syndrome
Patient Care
HPEMS System Operational Maturity
Young
Middle Aged
Patient Care
Mature
Copyright 2006 by Washko & Associates, LLC - All Rights Reserved
Understanding The HPEMS Theoretical
Performance Model - Variables
 Patient Care

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

Can represent many different aspects of patient care
 Survival rates / outcomes
 Customer Service Satisfaction
Assumes patient care is proportional to response
times and employee well-being
The further up the matrix the better the patient
outcome, the lower on the matrix, the lower the
patient outcome
Notice that Patient Care degridation crosses over
Response Time Performance – Why?
HPEMS / SSM
Station Based EMS
Productivity / Unit Hour Utilization / Profitability
Response Time Reliability / Performance
Understanding The HPEMS Theoretical
Performance Model - Variables
Response Time Goal
UHU Syndrome
Productivity / UHU / Profitability
HPEMS System Operational Maturity
Young
Middle Aged
Patient Care
Mature
Copyright 2006 by Washko & Associates, LLC - All Rights Reserved
Understanding The HPEMS Theoretical
Performance Model - Variables
 Productivity / UHU / Profitability



Represents the typical productivity curves seen as
HPEMS systems mature
Assumes profitability improves as performance and
productivity increases
The further up the matrix the higher the performance,
the lower on the matrix, the lower the performance
 Profit Departure

When productivity hits a level of diminishing returns
based on poor performance outcomes
Understanding The HPEMS Theoretical
Performance Model - Variables
HPEMS / SSM
Station Based EMS
Productivity / Unit Hour Utilization / Profitability
Response Time Reliability / Performance
Employee Well-being / Satisfaction
Response Time Goal
UHU Syndrome
Employee Well-being
HPEMS System Operational Maturity
Young
Middle Aged
Patient Care
Mature
Copyright 2006 by Washko & Associates, LLC - All Rights Reserved
Understanding The HPEMS Theoretical
Performance Model - Variables
 Employee Well-being
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Represents employee satisfaction:
 Turnover rates
 Health / safety / welfare
 Employee happiness
 Good employee satisfaction survey scores
The further up the matrix the higher the satisfaction /
less turnover, the lower on the matrix, the lower the
satisfaction / higher turnover rates
Note that employee satisfaction is the first to go as
systems attain higher performance….why?
These Elements Should Look Familiar
 The Homeostatic Balancing of 3 Key Elements



Patient Care
Employee Well-Being
Financial Success (however you define it - Productivity)
Success
Triad
Employee Wellbeing
Understanding The HPEMS Theoretical
Performance Model - Zones
Employee Well-being / Satisfaction
HPEMS / SSM
Productivity / Unit Hour Utilization / Profitability
Station Based EMS
Union Formation Zone
Performance
Improvement
Zone
Performance Comfort Theshold
CONTRACTUAL DANGER ZONE
Response Time Goal
UHU Syndrome
Triad Homeostasis
Response Time Reliability / Performance
Unit Hour Reduction Zone
Geospatial / Unit Hour Deployment
Plan
Least Aggressive
The Triad Tradeoff
Most Aggressive
Best Care
Best Profit
HPEMS System Operational Maturity
Young
Middle Aged
Patient Care
Mature
Copyright 2006 by Washko & Associates, LLC - All Rights Reserved
Understanding The HPEMS Theoretical
Performance Model - Zones
HPEMS / SSM
Station Based EMS
Union Formation Zone
Productivity / Unit Hour Utilization / Profitability
Response Time Reliability / Performance
Employee Well-being / Satisfaction
Response Time Goal
UHU Syndrome
Union Formation Zone
HPEMS System Operational Maturity
Young
Middle Aged
Patient Care
Mature
Copyright 2006 by Washko & Associates, LLC - All Rights Reserved
Understanding The HPEMS Theoretical
Performance Model - Zones
 Union Formation Zone

Represents areas where HPEMS systems have
typically unionized, mostly due to poor
management communication / employee education
or area specific cultural issues
 Key Union Formation Areas

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
Beginning of a HPEMS System (largest change)
When attempting to improve performance by holding
employees accountable for avoidable mistakes without
balancing employee needs / understanding
Dramatic increase in productivity (employee workload)
after performance improvement steps taken
When Job security is threatened (real or assumed)
Understanding The HPEMS Theoretical
Performance Model - Zones
HPEMS / SSM
Station Based EMS
Union Formation Zone
Productivity / Unit Hour Utilization / Profitability
Response Time Reliability / Performance
Employee Well-being / Satisfaction
CONTRACTUAL DANGER ZONE
Response Time Goal
UHU Syndrome
Contractual Danger Zone
HPEMS System Operational Maturity
Young
Middle Aged
Patient Care
Mature
Copyright 2006 by Washko & Associates, LLC - All Rights Reserved
Understanding The HPEMS Theoretical
Performance Model - Zones
 Contractual Danger Zone
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Represents an area where experienced operators shy
away from when managing response time performance
Typically ½ to 1 percentage point above the minimal
contractual requirement
Less experienced operators will sometimes try to manage
their response times within this region, however they
typically burn out their management teams and/or
problems will begin to arise in operator trustworthiness /
integrity
Primary reason an operator manages in this zone is due
to poor financial performance (for a variety of reasons)
Understanding The HPEMS Theoretical
Performance Model - Zones
HPEMS / SSM
Station Based EMS
Union Formation Zone
Productivity / Unit Hour Utilization / Profitability
Response Time Reliability / Performance
Employee Well-being / Satisfaction
Performance Comfort Theshold
CONTRACTUAL DANGER ZONE
Response Time Goal
UHU Syndrome
Performance Comfort Threshold
HPEMS System Operational Maturity
Young
Middle Aged
Patient Care
Mature
Copyright 2006 by Washko & Associates, LLC - All Rights Reserved
Understanding The HPEMS Theoretical
Performance Model - Zones
 Performance Comfort Threshold

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
Represents an area where most experienced operators
manage response time performance to
Typically 1 to 2 percentage point above the minimal
contractual requirement
Less experienced operators may get frozen in the left side of
this zone not understanding that performance can be
improved (What we will be discussing today)
Some performance based contract systems force their
operators to live either on the left or right in this zone and
are sometimes have disincentives to operate in the middle
(at Triad Homeostasis), however some do receive
performance bonuses for operating in the middle (through
performance penalty forgiveness)
Understanding The HPEMS Theoretical
Performance Model - Zones
HPEMS / SSM
Station Based EMS
Union Formation Zone
Productivity / Unit Hour Utilization / Profitability
Response Time Reliability / Performance
Employee Well-being / Satisfaction
Performance
Improvement
Zone
Performance Comfort Theshold
CONTRACTUAL DANGER ZONE
Response Time Goal
UHU Syndrome
Performance Improvement Zone
HPEMS System Operational Maturity
Young
Middle Aged
Patient Care
Mature
Copyright 2006 by Washko & Associates, LLC - All Rights Reserved
Understanding The HPEMS Theoretical
Performance Model - Zones
 Performance Improvement Zone
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
Represents an area where experienced operators improve
systemic system performance
Can increase performance upwards of 3 or 4 percent based
on approach that works for their particular system and / or
contractual need without the need for additional unit hours
Takes time and patience to achieve and most successful
systems wait to reap the financial rewards of this zone until
the systems needed to manage improvement are in place,
tested and are habitual
I believe the dollar pay-off for this is not as great as the
patient care and employee well-being payoff (contrary to
what many may believe), however there are financial
rewards if taken advantage of
Understanding The HPEMS Theoretical
Performance Model - Zones
HPEMS / SSM
Productivity / Unit Hour Utilization / Profitability
Station Based EMS
Union Formation Zone
Performance
Improvement
Zone
Performance Comfort Theshold
CONTRACTUAL DANGER ZONE
Response Time Goal
UHU Syndrome
Triad Homeostasis
Triad Homeostasis
Response Time Reliability / Performance
Employee Well-being / Satisfaction
HPEMS System Operational Maturity
Young
Middle Aged
Patient Care
Mature
Copyright 2006 by Washko & Associates, LLC - All Rights Reserved
Understanding The HPEMS Theoretical
Performance Model - Zones
 Triad Homeostasis
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The HPEMS Sweet Spot!
Where maximum response time reliability, best patient care
outcomes and almost best employee-wellbeing collide
 Purely due to the aggressive geospatial deployment
methodologies needed to achieve this level of performance,
employee well-being begins to wane
Notice that maximal financial performance is not yet
achieved in this zone as they are typically competing (based
on contractual requirements) although financial performance
can come quicker if an agency chooses to do so
May bring into question the need for first-responder services
for certain geographic areas within a service area as
typically Ambulances will beat First Responder Services on
scene (upwards of 60% to 70% of the time and sometimes
higher)
Understanding The HPEMS Theoretical
Performance Model - Zones
Employee Well-being / Satisfaction
HPEMS / SSM
Productivity / Unit Hour Utilization / Profitability
Station Based EMS
Union Formation Zone
Performance
Improvement
Zone
Performance Comfort Theshold
CONTRACTUAL DANGER ZONE
Response Time Goal
UHU Syndrome
UH Reduction Zone / Triad Tradeoff
Triad Homeostasis
Response Time Reliability / Performance
Unit Hour Reduction Zone
The Triad Tradeoff
Best Care
Best Profit
HPEMS System Operational Maturity
Young
Middle Aged
Patient Care
Mature
Copyright 2006 by Washko & Associates, LLC - All Rights Reserved
Understanding The HPEMS Theoretical
Performance Model - Zones
 Unit Hour Reduction Zone / The Triad Tradeoff


Where profitability or availability of system funds will
increase due to the lowering of unit hours
 Lower Unit Hours come from an increase in production /
UHU
 Increased production / UHU comes from lowering response
time reliability back into the Performance Comfort Threshold
region
The Tradeoff
 Patient care begins to drop from slower response times
 Employee well-being will drop from increased workload
demands
 Other problems may arise if Performance Improvement
Systems fail or apathy invades an operation
Understanding The HPEMS Theoretical
Performance Model - Zones
 Unit Hour Reduction Zone / The Triad
Tradeoff

Additional Facts
 Based on the make / model of your HPEMS
system, the dollars and/or unit hours may be used
for other things…

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Acceptance of increasing call volume on a marginal cost
basis
Better servicing of outlying (rural) service areas
Increasing contiguous service area size on a marginal
cost basis
Attempting to shore up employee well-being though
increased compensation, benefits, appreciation
programs, etc.
Understanding The HPEMS Theoretical
Performance Model - Zones
Employee Well-being / Satisfaction
HPEMS / SSM
Productivity / Unit Hour Utilization / Profitability
Station Based EMS
Union Formation Zone
Performance
Improvement
Zone
Performance Comfort Theshold
CONTRACTUAL DANGER ZONE
Response Time Goal
UHU Syndrome
Deployment Aggression Zone
Geospatial / Unit Hour Deployment
Plan
Least Aggressive
Triad Homeostasis
Response Time Reliability / Performance
Unit Hour Reduction Zone
The Triad Tradeoff
Most Aggressive
Best Care
Best Profit
HPEMS System Operational Maturity
Young
Middle Aged
Patient Care
Mature
Copyright 2006 by Washko & Associates, LLC - All Rights Reserved
Understanding The HPEMS Theoretical
Performance Model - Zones
 Deployment Aggression Zone
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Defines (on a sliding scale) the impact of deployment tactics
based on aggressiveness and approach.
A key and necessary element in Performance Improvement
Your success to performance improvement is directly
correlated to how you do your deployment model
Least aggressive static models are on the far left side of the
scale
Most aggressive dynamic pure SSM models are on the far
right side of the scale
Everything in between is some form or mix of these two
extremes
Understanding The HPEMS Theoretical
Performance Model - Discussion
Employee Well-being / Satisfaction
HPEMS / SSM
Productivity / Unit Hour Utilization / Profitability
Station Based EMS
Union Formation Zone
Performance
Improvement
Zone
Performance Comfort Theshold
CONTRACTUAL DANGER ZONE
Response Time Goal
UHU Syndrome
Triad Homeostasis
Response Time Reliability / Performance
Unit Hour Reduction Zone
Geospatial / Unit Hour Deployment
Plan
Least Aggressive
The Triad Tradeoff
Most Aggressive
Best Care
Best Profit
HPEMS System Operational Maturity
Young
Middle Aged
Patient Care
Mature
Copyright 2006 by Washko & Associates, LLC - All Rights Reserved
The Performance Improvement Zone
 The Performance Improvement Variables…

Simple Stuff (low hanging fruit – can do tomorrow)

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
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Intermediate Stuff (takes more time but can happen quick)




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Data Integrity & Accuracy (is it)
Measurement / Reporting Systems (are they accurate)
Underlying Technology Systems (causing problems with data)
Chute Times (dispatch & unit) Clock Start to Physically En Route
Open Minded Management Team Capable of Change!
Educate entire team on HPEMS & SSM (VERY important!!!)
Temporal Supply & Demand Matching (do they?)
Deployment Plan Aggressiveness & Approach (simple or complex)
Open Minded Management Team Capable of Change!
Advanced Stuff (takes lots of time, patience & consistency)





Fix controllable response errors
Implement & USE Granular Accountability & Reliability Tracking
Systems, find the problem areas and fix them
Implement & USE Real-time Situational Awareness Systems (based
on data driven and human driven intelligence) to adjust as needed
Implement & USE Bleeding Edge Technology (don’t $kimp)
Open Minded Management Team Capable of Change!
The Performance Improvement Zone
 Strategies for Performance Improvement…

Simple Stuff (low hanging fruit – can do tomorrow)
 Data



Integrity & Accuracy
Check data and dispatch practices / procedures to ensure
accuracy…analysis is only as good as the data it is
performed on
Reconcile missing data points (especially Call Lat / Long)
Perform internal audits of every late call to ensure they
are in fact late (audit clock start and stop times)
 Measurement

/ Reporting Systems
Make sure your data reporting systems used to measure
response time performance are accurate and meet
contractual obligations or internal standards
The Performance Improvement Zone
 Strategies for Performance Improvement…

Simple Stuff (low hanging fruit – can do tomorrow)
 Underlying


Check CAD to CAD interfaces, Atomic Clock
Synchronizations and CAD system itself to ensure proper
data collection accuracy & call processing efficiency
GIS systems are an integral part of today’s response
systems. Ensure an up to date geo-database and
attempt to achieve 100% accurate geo-validation of
addresses (also check response zones)
 Chute


Technology Systems
Times (dispatch & unit)
Measure, monitor & report on chute time performance at
the granular (employee) level
Work to mitigate & remediate problems
 Open
Minded Management Team Capable of
Change!
The Performance Improvement Zone
 Strategies for Performance Improvement

Intermediate Stuff (takes more time but can happen
quick)
 Educate entire team on HPEMS & SSM (VERY important!!!)




A common denominator of ALL successful HPEMS operators
Provide advanced courses for management and supervisors
Provide basic courses for the rest of the crowd (including field)
Temporal Supply & Demand Matching (do they?)



Plot your Unit Hour supply against your Demand. Do they
match? If not, adjust schedules and unit hour supply
accordingly…yes it may be time for a shift bid
Be sure to incorporate call task time into the model as longer
call task times require more resources (most demand models
assume 1 call takes 1 hour)
 Investigate why task times are long and mitigate if possible
Measure & Control Lost Unit Hours. Non-productive unit hours
are commonly at the root of many performance problems
The Performance Improvement Zone
 Strategies for Performance Improvement

Intermediate Stuff (takes more time but can happen
quick)
 Deployment Plan Aggressiveness & Approach


Aggressive Deployment Models
 Hourly demand focused posting plans
 Strategic & prioritized redeployment of resources after
each call is assigned to a unit
 Short post roaming distances, post to post moves, chute
time tolerances
 Typically use street corner posts only (quicker chute times)
Less Aggressive Deployment Models
 Hour grouping of demand based plans
 Strategic & prioritized redeployment of resources after
each call is assigned to a unit
 Longer post roaming distances, post to post moves, chute
time tolerances
 Typically use some stations intermixed with street corner
posts
The Performance Improvement Zone
 Strategies for Performance Improvement

Intermediate Stuff (takes more time but can happen
quick)
 Deployment Plan Aggressiveness & Approach


Least aggressive Deployment Plans
 Typically one plan for all hours / all days, may or may not
be demand based (typically geographically based)
 Strategic & prioritized redeployment of resources after
each call is assigned to a unit is less aggressive and
dominant
 Longer post roaming distances, post to post moves and
chute time tolerances usually apply
 Typically use more stations then street corner posts
Open Minded Management Team Capable of Change!
The Performance Improvement Zone
 Strategies for Improving Performance

Advanced Stuff (takes lots of time, patience &
consistency)
 Fix controllable response errors




ACCURATELY perform root cause analysis of all late calls
Categorize into controllable and non-controllable errors at the
granular (employee) level
Fix controllable errors as causes unveil themselves / patterns
arise (and they will!)
Implement & USE Granular Accountability & Reliability
Tracking Systems, find the problem areas and fix them



Measure and monitor KPI’s (key performance indicators)
Design reporting systems so that data can be drilled down into
so problem areas can be easily identified
Trend history and use this to help predict future events, then
act upon prediction models before problems arise (a novel
concept for many of us EMS folks ;-)
The Performance Improvement Zone
 Strategies for Improving Performance

Advanced Stuff (takes lots of time, patience &
consistency)
 Implement & USE Real-time Situational Awareness Systems
(based on data driven and human driven intelligence) to
adjust as needed




PULSE Process / After Action Reviews (see last day)
 Daily meeting of management key players
 Based on military After Action Review process
 Assess Late Calls, System Performance, Scheduling
Gain information about your system and act on it to improve
performance
Many “broken” systems and sub-systems will become evident
the more you look….you just have to look!
Manage headcount by anticipating losses, properly calculating
requirements and FTE weights and hiring ahead of the curve
The Performance Improvement Zone
 Strategies for Improving Performance

Advanced Stuff (takes lots of time, patience & consistency)

Implement & USE Bleeding Edge Technology







Don’t $kimp – go see the vendors outside!!!!!!
AVL/GIS/In Vehicle Mapping systems that work are worth their
weight in gold
Deployment tools like MARVLIS, SIREN, MUM (and others) are
taking the guess work out of deployment plans with scary, dead on
accuracy
Scheduling tools like Zoll’s Resource Planner & Crew Scheduler,
eCore’s NetScheduler Pro, ADP’s HR/Scheduling/Payroll suites and
others are taking supply chain management online and are making
it an easier and a much more efficient / accurate process
Electronic charting is opening up new horizons for billing DSO,
clinical research and call processing time minimization
Operational intelligence systems such as FirstWatch and Microsoft
Office Live provide easy, customizable and real-time data
dashboards used for benchmarking & process improvement
Open Minded Management Team Capable of Change!
Performance Improvement Pitfalls & Tips
 Closed minded management incapable of change

Without a good solid team you’re dead in the water. I
recommend not moving forward until you have one
 Assume Nothing & Question Everything

Even your most trusted team-mates should be questioning
their own “expertise” and always attempting to
improve…isn’t this how we grow and learn
 Hasty Greed Kills EMS Systems!

A balanced EMS Success Triad is just that – BALANCED.
Short term profiteering will lead to a long term death, let’s
take a lesson from the Japanese business approach
 Don’t $kimp on your employees or their families


Without them, you’re dead in the water
Spend the extra bucks to make their office more livable
especially in an aggressive deployment model system
Performance Improvement Pitfalls & Tips
 Find the mix of performance improvements that work
best for you…not all will and not all are necessary

Taking an EMS system to the profit / performance edge and
keeping it there will give you grey hair (it has me). Do
yourself, employees and patients a favor, only use what you
have to
 Many performance improvements are strongly based on
technology so hire only the best IT folks and pay them
as such

Often times EMS systems skimp in this area and end up
paying dearly for it in the end
 You must be consistent and unwavering in using newly
developed tools, systems & approaches for the long
haul

Many systems are able to obtain the holy grail (triad
homeostasis) but keeping it is the most difficult thing you
will ever do
Performance Improvement Pitfalls & Tips
 Use caution in the union formation zone

Unless you like unions, you need to listen to your
employees, compensate them appropriately, take care of
their families and most importantly do your best to educate
them on why you are doing what you are doing…and all
should turn out well
 During your performance improvement, stay in tune
with your employees and meet often with them

Really this should be done all the time but is really important
when trying to move mountains
 Increased productivity / UHU / profitability is possible
within the performance improvement zone if necessary
but use caution (it’s why it’s the same color)


Remember hasty Greed Kills EMS Systems
Slow and steady wins the race
Performance Improvement Pitfalls & Tips
 Avoid the Contractual Danger Zone like the plague

Living in this zone will burn you up, places patients,
employees and contracts in jeopardy and eventually may
lead you down a path you never want to be in (survival
mode)
 The Theoretical Performance Model is Cyclical


Unfortunately, many HPEMS systems are based on 5 to 7
year operational cycles and then go out to bid. A new
operations contractor will have to learn how to walk all over
again…and this can be painful…especially for the employees
and patients
Unfortunately, cycles also happen within bid periods within
the same operations contractor. This typically happens
when the present team “masters its domain” and the parent
company moves them to fix another system, leaving huge
experience holes which starts the cycle all over again
 THEREFORE - DO SUCCESSION PLANNING & TRAINING!
Summary / Review / Questions
Employee Well-being / Satisfaction
HPEMS / SSM
Productivity / Unit Hour Utilization / Profitability
Station Based EMS
Union Formation Zone
Performance
Improvement
Zone
Performance Comfort Theshold
CONTRACTUAL DANGER ZONE
Response Time Goal
UHU Syndrome
Triad Homeostasis
Response Time Reliability / Performance
Unit Hour Reduction Zone
Geospatial / Unit Hour Deployment
Plan
Least Aggressive
The Triad Tradeoff
Most Aggressive
Best Care
Best Profit
HPEMS System Operational Maturity
Young
Middle Aged
Patient Care
Mature
Copyright 2006 by Washko & Associates, LLC - All Rights Reserved
Jonathan D. Washko
 Contact Information


REMSA
 Phone: 775-858-5700 x140
 Email: jwashko@remsa-cf.com
 Website: www.remsa-cf.com
Washko & Associates, LLC.
 Phone: 804-347-3337 / 775-626-4459
 Email: jw@washkoassoc.com
 Website: www.washkoassoc.com