Tag Archives: Jack Stout

Is 'SSM' Still a 'Bad Idea'?

Ideas often take time to saturate a market. Even if the idea is generally recognized as a good one, complete with compelling evidence, change can still take time.  As a current example, how many agencies still have a protocol for complete spinal immobilization on a long spine board for “any fall” or “significant impact”?  On that very point, Dr. Ryan Jacobsen puts forth a lengthy argument in this recording of a  presentation at a NAEMSP conference.  The process of acceptance can be even worse yet if the idea has been controversial – as in the case of “System Status Management” introduced by Jack Stout in 1983. This distinction means it takes longer still in order for it to receive a “fair hearing” even if the evidence now shows a positive impact. In an ideal world, the best ideas would always be automatically and universally adopted, but that simply isn’t how the world works.  And for any professional industry it is a good thing that ideas are properly “vetted”over time to determine what is truly “best” before wholesale adoption or, in the case of “bad ideas”, that they are discarded only when a fair reading of the evidence discredits them.

CycleDynamicsGartner, Inc. of Stamford, Connecticut, has built both a reputation as an information technology research and advisory firm and a booming business of annually publishing their signature “hype cycle? graphs by industry segment.  For those unfamiliar with these charts, the basic structure starts with a technology trigger near the origin of time and is visibility followed by a quick rise to the “peak of inflated expectations” that is often driven by a combination of unrealistic claims by proponents and the hopes of users desperate to believe those claims.  The exaggerated peak of hype is inevitably followed by a crash of popularity into the so-called “trough of disillusionment.”  Many ideas just die here and drop off the curve, but for others, a more realistic set of expectations develop as ‘believers’ (the “early adopters” according to Everett Rogers’ “Diffusion of innovations”) begin to experience measurable benefits and serves to push the idea (sometimes with changes) up the “slope of enlightenment.” This gradual advance passes an important point of inflection on the performance “S” curve known as the “attitude confirmation” identified by Joon Shin.  The next landmark is crossing a social “chasm” identified by Geoffrey Moore at another critical inflection point called the “attitude plateau.”  Once an idea successfully crosses the chasm, it plateaus as a generally recognized productivity concept for that industry. Some ideas fly quickly along these curves passing other older ideas that seem to just plod along at a much slower pace.

So, is “SSM” still on the curve? And if so, where is it?  We must first realize that ideas evolve and sometimes morph into other names (just as “Emergency Medical Services” is known by some as “Mobile Integrated Healthcare” now.)  One apparent synonym for “SSM” is a broader idea of “dynamic deployment.”  If we look at the literature and practices of emergency ambulatory services, we find that the underlying concept is still quite popular despite attempts of detractors to further discredit or simply ignore it.  One such potentially damning article was written by Bryan Bledsoe back in 2003 after a crash of industry expectations for the idea.  This could easily be explained as the time that SSM passed its own pivot point where its value was questioned in the trough of disillusionment. (Some may also claim that hypothermia treatments for cardiac patients was also recently in this trough.)

Computing performance has increased dramatically since the 1980’s (or even the early 2000’s) and algorithms are discovering patterns in many human activities.  Demographic data show socioeconomic clustering that leads to similar health issues and traffic patterns with road designs that see more accidents than they should. These patterns are proving to be key in forecasting demand for EMS services. Automated Vehicle Location systems allow far better tracking than ever before and traffic patterns are being used to calculate more realistic routes. These are some of the advances that help explain the numerous agencies that are significantly improving response performance and making use of resources. Where field providers take an active part is developing strategies, there are also reductions in post moves, unloaded miles driven, and better disbursement of work loads.  The efficiency gained by its use in mainstream agencies beyond the initial public utility model organizations seem to vindicate Stout’s early vision and research as the concept moves up the slope of enlightenment toward the plateau of general acceptance.

Ideas are not static entities, so our understanding must continue to evolve and incorporate new thoughts.  As the iconic American social commentator, Will Rogers once said, “even if you’re on the right track, you’ll get run over if you just sit there.”  So, to honestly argue an idea, proponents of either side must continue to evolve their understanding and witness the current thought and evidence of an idea.  There is little point in continuing to attack past grievances which have been addressed while ignoring the mounting evidence out of sheer disbelief.  If “SSM” is not a “good idea’ yet, it is certainly moving in that direction all the while being shaped by those who are concerned over the future of EMS (or MIH.)

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Dynamic System Status Management

System Status Management (SSM) is the fluid deployment of ambulances based on the hour-of-the-day and day-of-the-week in order to match supply, defined as Unit Hours of Utilization (UHU), with expected demand, expressed as calls for service, in the attempt to provide faster response by locating ambulances at “posts” nearer their next calls.  While the practice is still not unanimously embraced by all services, it has a sound foundation both in the research literature dating back to the 1980’s as well as in practice today.  Experience has shown that ambulance response times can be dramatically decreased using this type of dynamic deployment, but it is also recognized that it is possible to reduce performance when these techniques are not applied properly.  The direction of the results of a system implementation are typically influenced by the system design, competence of the managers creating the plan, and commitment of the workforce in implementing it.  Therefore the best practice is a simple and straightforward implementation that will show positive results quickly.  This methodology ensures a positive return on investment along with garnering the necessary buy-in from staff to make the project a success.

In his article, “System Status Management – The Fact is, It’s Everywhere“,  published in the Journal of EMS (JEMS) magazine back in 1989, Jack Stout explained the concept of SSM and tried to dispel certain myths.  Based on foreseen Geographic Information System (GIS) technology and even general computing capabilities of that time, it was quite logical to assume in his Myth #2 that “no matter how thoroughly the response zone concept is fine-tuned in practice, it cannot be made to cope effectively with the dynamic realties of the EMS environment.”  But systems implemented today around the US are capable of calculating dynamic response zones in a small fraction of a second while even being based on time-aware historic driving patterns making a truly dynamic system status management process a reality.  A practical and proven example of a dynamically functioning system status management application is the Mobile Area Vehicle Routing and Location Information System, or simply MARVLIS.

The following Slideshare presentation does an excellent job of telling the story of why and how the system works:

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