Measuring

1
Measuring Improving Rural EMS Performance

• Mic Gunderson
• President, HealthAnalytics
• Co-Executive Director, National EMS Management
  Association
• Editor, EMS Management Journal

2
Everything that can be counted does not
necessarily count Everything that counts cannot
necessarily be counted.

• - Einstein

3
Measure what matters

• - Gunderson

4
Other Measurement Maxims

• What gets measured gets done.
• You cant effectively manage what dont measure.

5
Rural EMS Differences

• Urban EMS tools and techniques not always
  appropriate for rural EMS
• Rural performance measures should reflect rural
  process differences

6
Some Rural Differences

• Starting and stopping the clock
• w/ multiple call outs
• multiple squads
• Chute times
• Responding from home
• Unit hour costs
• w/ volunteer hours
• Employee satisfaction and retention
• w/ volunteers

• Scene times and appropriate timing of when to
  begin transport
• When 30 minutes is too long to wait to start
  treatment
• Driving performance
• Rural roads and distances
• Fleet performance
• Rural roads and distances
• Cardiac arrest survival rates
• Extended response intervals

7
Approach to Performance Improvement

• Include the entire organization and all of its
  processes
• Not just the clinical processes

8
If you cant describe what you are doing as a
process, you dont really know what you are
doing. - W. Edwards Deming
9
Overall EMS Organization System Assessment

• Early Phases
• CAAS Criteria
• Intermediate Phases
• EMS Agenda for the Future
• Rural EMS Agenda for the Future(in development)
• Ongoing
• Baldrige Criteria for Healthcare Excellence

10
Assessment of Specific EMS Processes

• Use Process Performance Indicators
• Resources for ideas and industry standard
  indicators
• National EMS Performance Indicators Project
• Open Source EMS Initiative Performance
  Indicators Group
• North Central EMS Institute Performance Measures
  Project
• California EMS Authority Performance Measures
  Project
• IAFF / IAFC EMS Performance Measures Project

11
Building Performance Indicators

• Who is the process customer?
• What do they need or expect?
• How can meeting that need be measured?
• What data elements are needed?
• Where can that data be obtained?

12
Building a Performance Indicator

• What process can be used to get that data?
• How can that data be validated?
• How should the measure be calculated?
• How should the results be disseminated and acted
  upon?

13
Indicator Example

• Process
• Fleet
• Process Customer
• Crew
• What do they need or expect?
• Reliability

14
Indicator Example

• How can it be measured?
• Vehicle breakdowns per 100,000 miles
• What data elements are needed?
• Dates for each breakdown
• Fleet mileage for time frame

15
Indicator Example

• Where can that data be obtained?
• Log of vehicle breakdowns
• CAD
• Fleet Office
• What process can be used to get that data?
• Ask manager to email it
• LAN or intranet access
• Sneakernet

16
Indicator Example

• How can that data be validated?
• Compare fleet and CAD logs
• How should the measure be calculated?
• Excel formula
• How should the results be disseminated and acted
  upon?
• Dashboard system
• Fleet stewardship team charters team as needed

17
Process Performance Indexes

• Combine multiple indicators into one index
• Can be weighted by importance

18
Cardiac ProcessPerformance Index
19
Putting it All Together

• Six Sigmatools and techniques

20
Getting Help

• Look to resources in your community
• Colleges
• Business, engineering
• Businesses
• Books
• Web searches
• National EMS Management Association

21
Summary

• Measure what matters
• Rural performance measures should reflect rural
  process differences
• Involve the entire organization / system
• Overall EMS Agenda and Baldrige
• Process Performance Indicators and Indexes
• Six Sigma tools techniques
• Get support from community resources

22
Web Links and Copy of Presentation

• http//www.healthanalytics.net/ems/presentations/
  flex2004.htm
• mic.gunderson_at_healthanalytics.net
• 978-223-1443 x 210