Administration and Leadership, EMS Insider

Key Performance Indicators: A Mature Agency

This is the third and final article in a three-part series about performance measurement and improvement. Part 1, Key performance Indicators: What to Measure and Why is located here.  Part 2, Key Performance Indicators: Where do We Start? is located here.

This article reviews the practices of Medic, the Mecklenburg (N.C.) EMS agency. Medic operates the busiest 9-1-1 EMS agency in the state of North Carolina. Medic’s responsibilities span 544 square miles, including the rapidly expanding city of Charlotte, N.C.


With two professional sporting venues, multiple college campuses, two major lakes, a busy international airport, several major business centers, two nuclear power plants, and a population of more than 1,000,000 people, bustling Mecklenburg County certainly presents Medic with a diverse, exciting environment to service.

Documenting How your Organization Operates

The first step in managing operational performance with KPIs may seem obvious, but it’s important to understand how your organization operates. It seems simple, until you’re asked to document this information on paper in the form of an Operational View as a System (OVS).

What’s important in an OVS is defining the functions—not the people—and how they interact with the entire system. This is done so that when a new or improved process is contemplated, you can easily assess the impact it may have on the entire organization.

For example, your scheduling department wants to implement a new scheduling software. Before implementation, using the OVS, all stakeholders in the process are easily identified and brought into the proposed change at the beginning—so no surprises or communication breakdowns occur.

It may sound intuitive, however, many times the processes and sub-processes that require action within other areas are often overlooked in the focus of one department desiring to implement change for the right reasons.

This seems like an easy task, but it took Medic several months to have all the stakeholders identify the functions and processes and how they interact with each other.


The benefit of a detailed OVS is that anyone new to the organization will have a document showing how the distinct functions are interconnected.

A Culture of Analysis and Transparency

To manage with KPIs, implement and engage in a culture where data and analysis are appreciated—not feared. The following achievements lead to solid groundwork for creating a culture rich in analysis:

  • Be clear on what’s important at the institutional level;
  • Communicate how each individual affects the success or failure of the institution; and
  • Set goals and KPIs collaboratively with management, operations and field personnel.

The underlying theme of this work is to be transparent at all personnel levels. To practice transparency, it’s important to provide a safe environment for information sharing, contribution and engagement.

It’s important to start educate personnel at all levels about how and why it’s important to measure and track KPIs. Employees should be engaged in defining the KPIs to be measured, including a clear understanding of what will be measured, why it’s important and its importance to everyone’s success.

KPIs should also be used to reward personne and should include input from all affected personnel. Medic found that field personnel, operational supervisors and executive management all brought different but equally important perspectives about how KPIs should be assessed for reward. At Medic, others that were included in the process included the Agency oversight committee and the County.

KPIs and How They Have Increased Patient Survival

In the first article, we introduced the concept of separating KPIs into various categories: revenue, operations, patient outcomes and workforce. Over the years, Medic has strategically added KPIs to their system to identify areas that may need improvement. Today they track 17 KPIs and provide the data to employees and the public monthly.

The cardiac arrest survival rate has always been a critical measurement within the EMS community. In the mid-90’s, Medic began looking for process improvements to increase the cardiac arrest survival rates.

In this example, cardiac arrest survival is defined using the Utstein template. This data is for a two-year period between June 2015 and June 2017. In measuring and analyzing the KPI, Medic was able to assess the value of new processes/techniques. 

Once they started measuring and employing process changes such as choreographed CPR, compressions-first telephony CPR and other process improvement initiatives, Medic was able to increase cardiac arrest survival rates to the noted measure of 49%.

This chart is designed to monitor the processes and changes that were put in place to track the average time from 9-1-1 call to PCI. Using reports and charts like these, Medic is able to validate that their processes for improvement are still effective in meeting the demands of the public.


With over 500 employees, how can you get such great consistent results? As seen in the previous examples, these processes are stable, predictable, and have been for the two-year reporting period.

By creating well-identified and measurable KPIs, Medic is able to manage critical processes while they continue to value the people who make it all happen. 

By using KPI dashboards, directors, managers and supervisors can easily monitor critical processes and identify areas for improvement.

Training is a big key to success, but having a workforce that is informed, valued, and engaged is critical.

This is why Medic has taken it one step further and implemented a reward for performance system. As shown in the chart below, this system is based on seven critical KPIs that are agreed upon each year with collaboration from the workforce, agency oversight committees, and the county.

The performance pay tracking period shown above is representative of the period beginning on Nov. 1, 2016.

The first three criteria must be met for any payout and to trigger the remaining four measures to be included. These criteria are system-wide and all employees below a manager level are eligible.

The measures haven proven to be to be critical in operational and service delivery, thus leveraging a fully vested and engaged workforce to achieve agency goals.

By managing their system with well-defined and relevant KPIs, Medic has created a sustainable, high-performing agency that delivers excellent patient care, is fiscally responsible and is continually investing in the people responsible for carrying out the organization’s mission every day.

This concludes the series of articles on Key Performance Indicators (KPIs). In the first article, we looked at the definition of KPIs, challenges in EMS, and a suggested approach. The second article is a case study from a Fire/Rescue service and how they approached getting started. This final article concluded by showing how managing via KPIs has transformed Medic, Mecklenburg EMS Agency, into one of the highest performing EMS agencies in the United States.