I have often heard comparisons on the automation of System Status Management to the 2002 Spielberg movie starring Tom Cruise called “Minority Report” loosely based on the 1956 short story by Philip K. Dick. This science fiction action thriller is set in the year 2054 when police utilize a psychic technology to arrest and convict murderers before they commit their crime. The obvious comparison there is to the forecast of future call demand and the eerie accuracy of the reports that allow the right resources to get there in time to make a difference in the outcome. Sometimes in the movie, as in real life, there is a considerable cost to achieve that goal as well. It is easy to get wrapped up in the technology, particularly the virtual reality user interface that Detective Anderton (Cruise) uses to make sense of the premonitions and quickly locate the scene. I like to end the analogy there before we learn the darker side of the way the technology works and can even be manipulated to put a stop to the whole project. Perhaps some EMS providers think they see a similar inherent darkness and hope for an eventual collapse of the whole dynamic deployment paradigm as well. This may be where the art of a story and our reality diverge, especially considering the current economic dynamics even given the admittedly sporadic successes. This may also be why we need a different analogy.
Last night, I watched the 2011 movie entitled “Moneyball” starring Brad Pitt. This lengthy sports drama is an account of the Oakland Athletics baseball team’s spectacular 2002 season which included a record-breaking winning streak of 20 consecutive games. The film focuses on general manager Billy Beane’s (Pitt’s) attempts to assemble a competitive team with a severely limited budget by primarily using a sophisticated sabermetric approach that identifies undervalued talent. The film is criticized by some baseball fanatics for over-emphasizing the role of the theory developed by Bill James to collect and summarize relevant data by reviewing game performance. The reality is that at least some of the key players on that dramatic roster were discovered with traditional scouting methods, but it is still a cautionary tale understood by any manager who has attempted fundamental change. The portrayal of the conflict of instituting philosophical change within a traditional organization is compelling and instantly recognizable for those who have been through it.
Not to give any details of the factual-based story away, I see many parallels between the implementation of sabermetrics in baseball and system status management in EMS. The core idea of both concepts is a recognition that human activity is not purely random, and that behavior can be summarized, or even quantified, to facilitate decision-making activity. Forecasting the future does not demand the premonitions of “precogs,” but only the acceptance of the fact that humans are creatures of habit and maintain relationships with those who have similarities to each other. Any professionals who are entrenched in the history of a process see a long train of anecdotes called experience as the only valuable guide for decisions. But these admittedly “gut-feelings” can often be misleading and waste significant resources while failing to meet target objectives. That is not to say that experience lacks value, but if the conventional process remains mysterious, the failures are acceptable variations. However, once the issues can be measured and replicated within models, often initiated by outside thinking, we have no excuse not to incorporate that wisdom. The catalyst that has changed baseball recruitment forever was an economist interested in sports and a manager seeking new solutions.
That is not to say that experience lacks value, but if the conventional process remains mysterious, the failures are acceptable variations
It is not easy to accomplish this type of fundamental change and it can be sabotaged by well-meaning attempts to modify the recommendations with traditional thought. There must be buy-in, or at the very least a willing curious acceptance, throughout the organization before significant change can be successful. The misalignment between the Athletics general manager, who strategically built the team roster, and the head coach, who determined the tactical positioning of those teammates, nearly ended the experiment shortly after the new season began. Significant structural change requires time and a dedication on the part of every component of the team to see it through. Once success is recognized, it will become easier, but there can be real pain and sacrifice in the birthing process of any new idea. On the twenty-fifth anniversary of Polish freedom in 2014, President Barack Obama said, “there is no change without risk, and no progress without sacrifice, and no freedom without solidarity.”
Emergency Medical Services are facing momentous challenges at the moment as a result of strategies that have remained unchanged since long before the current epidemic. A new script was developed back in the 1980’s by an economist with an interest in emergency services named Jack Stout. That story was transformed into a practical application known as MARVLIS by BCS. The solution, although innovative, is not enough on its own. To be successful, the technology needs a champion willing to see it through to the end. Having good data doesn’t eliminate tough choices, and it doesn’t make low staffing issues go away. It does, however, make it possible to overcome some of the challenges you face to provide the very best service possible within whatever your limitations.
Here is to a happy ending for your own story.
High Performance EMS 