Improving Operational
Performance
The Theoretical Performance Model
Presented by
Jonathan D. Washko, BS-EMSA, NREMT-P
Director of Deployment – REMSA
President – Washko & Associates, LLC
EMS Performance Improvement Consulting
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
– Response Times
– Clinical Performance
– Customer Service
Success
Triad
Homeostasis & The EMS Success Triad
Employee Well-Being
–
–
–
–
–
–
–
–
Retention
Health / Safety / Welfare
Satisfaction
Schedules
Work Environments
Compensation
Recruitment
Family
Success
Triad
Employee Wellbeing
Homeostasis & The EMS Success Triad
Financial Success
–
–
–
–
–
–
–
–
A/R Billing Practices
EMS Delivery Model & System Design
Operational Efficiency & Effectiveness
Employee Compensation
Safety & Risk Management
Systems Engineering
Profitability
Success
Triad
Subsidy Needs
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
Improving 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
The Triad Tradeoff
Geospatial / Unit Hour Deployment
Plan
Least Aggressive
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)
–
–
–
–
Response Time Reliability / Performance
Patient Care
Productivity / Unit Hour Utilization / Profitability
Employee Well-being
Zones
– 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
– 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
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
– 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
– Employees are the foundation of your organization
– 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
The Triad Tradeoff
Geospatial / Unit Hour Deployment
Plan
Least Aggressive
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
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
Productivity / Unit Hour Utilization / Profitability
Response Time Reliability / Performance
Employee Well-being / Satisfaction
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
– 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
– 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
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
Productivity / Unit Hour Utilization / Profitability
Response Time Reliability / Performance
Employee Well-being / Satisfaction
Understanding The HPEMS Theoretical
Performance Model - Zones
Performance Comfort Threshold
– 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
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
Productivity / Unit Hour Utilization / Profitability
Response Time Reliability / Performance
Employee Well-being / Satisfaction
Understanding The HPEMS Theoretical
Performance Model - Zones
Performance Improvement Zone
– Represents an area where experienced operators improve systemic
system performance
– Can increase compliance upwards of 3 or 4 percentage points 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
– 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…
–
–
–
–
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
– 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
The Triad Tradeoff
Geospatial / Unit Hour Deployment
Plan
Least Aggressive
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)
•
•
•
•
•
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!
– Intermediate Stuff (takes more time but can happen quick)
•
•
•
•
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 Technology Systems
– 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 geovalidation of addresses (also check response zones)
• Chute 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
» 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
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