11 of the Top 10 Tips for High Performing EMS

Rob Lawrence, the Chief Operating Officer of Richmond Ambulance Authority, offered these tips as an article for publication in this blog, but we decided they would make good initial discussion points in an ongoing dialog with our readers and contributors. Consequently, each of these points is made as a separate page under the EMS Deployment Community of Practice link. For ease in reading the entire list, we have presented the original article here. I do ask, however, that any discussion of the specific points not be made in this general comment section, but directed to the comments of the appropriate section within the Community of Practice. Each heading is linked to take you straight there.

11 of the Top 10 Tips for High Performing EMS

1. Economic Efficiency
From an economic sense, the mission of EMS, or any other healthcare organization for that matter, is to “convert the amount of available budget money into high quality healthcare in order to produce excellent clinical outcomes.” Money is too tight to mention right now and the days of well-padded budgets are a thing of the past. Municipal coffers are shrinking for the public sector, collection rates and reimbursements are down for private EMS, and charitable giving and the donation of free time is fast disappearing in the volunteer sector. In other words, no matter the type or style of your organization, it must be run as a business, with an eye on the bottom line and a realization that EVERYTHING costs something.

2. Data is our Favorite Four Letter Word
In this day and age it’s difficult to believe that some EMS organizations think they have little or no management information. The actual situation is quite the contrary and individual data mines are bottomless. Information is freely available from call volume to patient condition to mean times between failures of vehicle components. When collected, collated and analyzed this information becomes a valuable intelligence product that can be acted upon to improve the next cycle of response, care and administration.

3. System Status Management (SSM)
System Status Management (SSM) is the science of being in the right place with the right resource at the right time to meet the patient’s need. Some say it is the practice of placing ambulances on street corners, but the crucial thing we must remember is that the patient is the one having the emergency so we must be poised to respond with minimal delay and maximum impact. SSM takes the intelligence products of demand analysis for both time and space and matches manpower and availability to deploy a responder as close to the patient as possible. This achieves a minimal response time for the patient and reduces time spent running under emergency conditions for the crew (and distracted pedestrians!).

4. Clinical Excellence
So far all the planning and data crunching has been devoted to the first 10 minutes or approximately 1/6th of the patient response episode. It is ironic that some organizations set their store in, and are judged on, their response times alone. It’s not “high performing” if you are good at racing to the scene only to be incapable of delivering the clinical goods on arrival. A well-trained workforce that has sufficient preception, mentoring and training, and is clinically current is an absolute requisite for success. To achieve this, the involvement and active engagement of the Operational Medical Director (OMD) must occur (often).

5. Lean Systems
EMS is not only response, treatment and transport – the back office and support functions are the “power behind the punch” of service delivery. The creation of lean, efficient and measurable systems is the key to success. An example of this is a high functioning fleet service. If your vehicles fail on the way to calls, then so does the mission. Keeping your organization well serviced and maintained is an arterial function and performance could hemorrhage if you can’t get to where you need to go. The swift conversion of treatment – to bill – to income is also an essential function. Remembering the economic requirement that we turn the amount of available funds into quality healthcare requires the generation of said funds to keep the EMS circle of life turning. While those in support functions are not delivering lifesaving and patient care, they keep the organization alive and healthy.

6. Culture of Safety
The Culture of Safety is perhaps surprisingly a new concept to some quarters of U.S. EMS. This is nationally apparent by a stream of Line of Duty Deaths (LODD) and devastating vehicle accidents that result in well publicized photos of ambulances splayed like bananas after impacts with both moving and static objects. An environment of cultured safety seeks to establish the root cause of these issues then put techniques, practices, procedures and philosophy in place to create a safe environment for all.

7. We Are Public Health As Well
When I go out and speak, I often ask the audience if they know who their Public Health Director is. Many do not, which is shameful. EMS enjoys its role in public safety and recognizes its place in the house of medicine, but fails to realize it is an essential member of the public health camp. Prevention is better than cure every time so understanding the aims and objectives of the public health system is essential. The current Ebola crisis has reinforced the point that we are joined solidly to public health and we must interact often and well.

8. Innovation and Research
To continue to push the boundaries of the EMS world, we require evidence-based practice, outcomes and data to trump industry anecdote and tradition. To progress, we can’t simply hide behind the mantra that “We have always done it that way.” Organizations should consider researching, collaborating, capturing and presenting studies and good practices. It doesn’t have to be major projects or massive patient studies, but perhaps a series of “small cycle testing” that relies on a “Plan, Do, Study, Act” (PDSA) cycle. Large change can occur from small tests. Writing these up, complete with supporting evidence, can effect change not only in the researchers’ organizations, but in the wider industry.

9. Community-Based Programs
The evolution of community-based programs here is almost anthropological in nature. Community paramedicine, or mobile integrated healthcare, is evolving and forming according to local environmental and political conditions. No two programs are the same, which is technically good, as they are shaped to meet the needs of the population for which they are intended to serve. The bottom line for many of these programs to be successful and attain longevity is to be actuarially sound and generate income to be self sustaining.

Sadly many programs to date have operated on a loss leading footing and, unless sustainable income is forthcoming via legislative changes, some could fade as quickly as they initially shone. That said, some community-based activity is already part of normal daily EMS practice and could rightly be classed as “paramedic in the community” activity.

Understanding who your “frequent service users” are and managing their whole system use and creating case conferences is a great community activity. Fostering relationships with other local care organizations such as behavioral health, social services, faith-based groups and both the primary and secondary care sectors may lead to the creation of cost-effective and sustainable programs. This level of liaison also assists in the breaking of barriers and removal of care silos.

10. Communicate, Communicate, Communicate
Internally, “If no one is following, then you are not leading.” Externally, if you don’t broadcast your message, then no one will hear it! A key communication strategy should be a major corporate activity. Some say that it takes 10 good news stories to trump the one bad one. Having an active communication plan that involves providing your local media with positive stories (to get your 10 good ones in the bank) is a good investment in time. Good news stories inform the public as to the quality of your agency and instills a sense of pride within the service. In the social media age, it is now relatively easy to place news. A photograph and a descriptive paragraph can quickly be crafted and posted on your organization’s social media sites or sent to the editor of a national trade magazine for both national and international coverage.

11. A Bonus 11th Point: The Four Words That Count Most
EMS organizations are usually only separated by a single degree from the world of politics. Public sector organizations are governed by Councils or Boards of Supervisors, private sector companies have shareholders and executive boards. If those who lead our EMS organizations are not politically aware and astute at navigating the rocky waters of achievement and funding then no matter how good or efficient an organization, they can be overturned by four political words: “All Those In Favor.” If you have an inability to influence those who govern, then be prepared to be out-voted or worse, voted off the island.


Filed under Administration & Leadership, EMS Topics, News, Opinion, Training & Development, Vehicle Operation & Ambulances

6 responses to “11 of the Top 10 Tips for High Performing EMS

  1. Tom Scott

    This system seens to disregard care of the employees. None of these priorities will be acheived without a workforce that looks forward to coming to work every day.

  2. James Hawkins

    real waste of time reading. How can you expet economic efficientcy AND talk about communitymedicine like it’s a real working thing???
    The only thing “lean” in our system is our budgets. No budgets=no safety equipment.

    • Jon Kavanagh

      Economic efficiency comes from using personnel appropriately. Is it more cost effective to have an ambulance running to pick up Mrs. Smith four times a week because she keeps falling, or is it better to solve the problem which causes Mrs. Smith to fall, which reduces the runload on the crew, reducing wear on the vehicle, reduces cost to the healthcare system, etc.?

      It costs the same whether the crew is active or sitting playing video games–isn’t it better to have the crew doing something productive since you’re paying for them?

      Finding funding other than taxes and transport reimbursements is important–partner with a hospital and get a cut of their improved finances (due to improved reimbursements due to decreased readmissions, etc.)

  3. MIke Cole

    Excellent article. EMS will be as good as the workforce that deliveries services. A suggestion for the first point would be human capital development to support the workforce. High performance begins with the properly supported, developed, and credentialed workforce.

  4. Garry

    As already mentioned if you see your employees as drones than the success is a moot point. I agree with all of the factors ,but add number 12 hire good fit effective staff . Thinking proactive and enrich them with your goals and expectations and treat them well,don’t be good to them to there face and send them down the river asap when issues arise. It’s a good article ,but addresses only one dimension of a truly great EMS system

  5. Jim Burns

    Truth be told, there is nothing as valuable as a competent, trustworthy workforce. I agree with several of the comments made regarding not appreciating your staff. They carry all the weight anyway. Management loses their skills and then they lose touch altogether. Plain to see

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