Todd Stout, founder and president of FirstWatch, has a rich history in public safety, having worked as an EMT, paramedic, flight medic, manager and executive. He also served as a consultant with his father, Jack Stout, a revered pioneer in EMS. He’s a frequent speaker at national conferences and is recognized as an authority on the use of data for improvement.
In July 1998, Todd left his job working for a CAD company (TriTech) to launch Stout Solutions, a one-man business in which he could be an educator and consultant around the topic he most loved—putting data to use for improvement. That company became FirstWatch, now celebrating its 20th anniversary, with 45 employees serving more than 400 communities in North America.
Early on, FirstWatch was known for improving situational awareness by spotting potential public health emergencies through real-time analysis of 9-1-1 and EMS patient report data. As customers’ needs changed, so did FirstWatch; now the company offers a variety of customer-specific solutions that allow organizations to use their data to monitor and improve performance in dispatch, operations, patient care and billing.
In this interview, Todd offers his insights on how the profession has evolved over the past decades and what we can expect in the future.
Q: What was the spark that inspired you to create FirstWatch?
The moment I started making customized reports for TriTech customers was when the idea that venturing out on my own became real. Working in technology taught me the complexities and challenges that come with software development, and I admired that it was every bit as interesting and complicated as EMS. That’s when I found a way to blend my two passions: data and helping people.
As my career progressed, I learned more about data and how to build reports for customers. At the time, computer-aided dispatch (CAD) systems and ProQA were the two data sources that people had, and electronic patient care record systems weren’t popular yet, so I aimed to do more with the data they had by providing answers to important questions that could help with quality improvement. Drilling down into specific metrics helped shed light for EMS professionals and provided insight into improving response times, ensuring call quality, and more.
Q: How did the idea for a biosurveillance tool come about?
I was working on reports for the Kansas City MAST system, a public utility model my Dad had set up, and they wanted to know if I could use their real-time CAD data to predict a public heath event, whether man-made or natural, such as an epidemic. This was in 1999, before the horrible events of 9/11, but their public health director, Dr. Archer, was ahead of the times in many ways.
So I wrote a “biosurveillance alert utility” in Microsoft Access watching for increases in certain types of complaints and it worked. Jerry Overton, who had once headed MAST, was then the executive director of the Richmond Ambulance Authority in Virginia and happened to be visiting when an alert happened. He immediately saw the potential and wanted it for his community, so the first official installation of what we called FirstWatch went live as a commercial product in Richmond in September of 2002.
Q: When many people hear the name Stout, they think of your dad, Jack. What is his legacy to the profession?
Of all the specific things my Dad is known for introducing into EMS, a common theme was about taking a “systems-based” approach, which encompassed the needs of our patients, our communities and our providers. Some of the things he is known for are fractile response times (rather than average), System Status Management (SSM), the Public Utility Model, performance and quality-based contracting and competition “for” serving a community, rather than call-by-call competition “within” a community, professionalizing EMS fleet maintenance practices, and popularizing ambulance membership programs. He credits the EMS leaders he worked with for many of those ideas and was definitely a best practice promoter.
The public utility model was a particularly important concept that he introduced to JEMS readers in 1980. At the time, my father was frustrated with a lack of federal resources and recognized a need for making better use of its limited wherewithal. Ambulance services were competing with each other, driving around across a wide area, with responders duplicating efforts. The public utility model was able to restructure the response process, changing the industry dramatically. The model built an infrastructure that organized where certain responders would cover. It sought efficiency and the model is still seen in how RFPs are released today, to create monopolies with carefully structured performance indicators to ensure a high level of effectiveness.
He was also an incredible communicator of ideas, both in writing and in speaking at conferences. His ability to articulate these ideas, in JEMS, at EMS Today and other venues, was a major reason he was able to create change on a national level.
Q: What makes FirstWatch different?
A crotchety old HR guy in one of my first EMS management jobs told me, “Your employees treat your customers the way you treat your employees,” and we live by that motto. We’ve developed an environment that instills respect for each other and fosters trust, and empowers our people to help our customers without a lot of bureaucracy.
Q: A couple of years ago, you asked Mike Taigman, a nationally recognized quality improvement expert, to join FirstWatch. What’s the connection between FirstWatch and quality improvement?
I think true quality improvement in public safety is about measuring and improving things that matter. I believe the vast majority of EMS professionals got into EMS to help people and do good work. If they can take better care of their patients and improve their performance with recommendations that make sense to them, then most will. With timely and actionable positive and constructive feedback, our customers have been able to dramatically improve both system and individual performance.
Q: True quality improvement has been a challenge for the EMS profession. Do you see a shift in attitude when it comes to how QI is implemented?
Managers are realizing that quality improvement isn’t just an expense—it actually makes things better and reduces cost, waste and frustration.
And there’s a move toward a newer, collaborative managerial style involving the entire team in the improvement efforts, instead of a top-down, “I’m the smart one, and I’m telling you lower people what to do” approach. I think things like provider wellness and fatigue monitoring, workload management, and post-traumatic stress have caused everybody to think about staff in a more human way, rather than the industrial-age idea that they are resources you use up and spit out.
Q: What are some of the interesting ways your customers are using data to make improvements?
For starters, our clients are using our analytics and processing power to do a lot of the hard but routine work, so that managers can focus on important tasks, like giving performance enhancing feedback to the staff. I’m a huge believer in having computers do all the repetitive and tedious tasks they can, to save humans for the work that humans do best. Things that require human perception, sense of the big picture, political and personal sensitivity, real listening, caring, and so on.
I think the work we’re doing in provider wellness for Allina Health EMS in Minnesota is one example of how our clients are using our products to make things better for their staff. Mike Taigman just worked on a survey with Chief Scott Dorsey in Snohomish County, Washington to identify the various types of stress-causing calls. This has helped managers realize “what stresses you may not stress me,” and is a big step in helping them in meeting their employees’ needs in a much more personalized way. Being more self-aware will help responders know what to look out for and understand their strengths.
Austin/Travis County EMS and other customers are using FirstWatch to help manage and balance staff workload and fatigue, which we believe will result in better patient care and staff retention, for example.
On a broader scale, we’re finding customers are tracking patient outcome data to build responder training programs, enhance patient assessment practices, and learn answers otherwise unknown.
Q: FirstWatch loaned out Mike Taigman to be the facilitator for the EMS Agenda 2050 project, scheduled for release in September. In your eyes, what does the agenda articulate for the future of EMS?
The driving theme in the Agenda is “people centered care,” which I think is genius in that it captures in a simple way our need to take care of our patients, our providers and our communities. And the only way to do that is to consider all of their needs and then adjust our systems around them. I am proud and excited to see that we are moving in that direction. I’ll be really interested to see how the profession integrates this into their plans for education, quality improvement and research, and expect we’ll be able to help.
Q: Are you feeling positive where things are headed? Would you recommend EMS as a career?
Absolutely. Taking care of people in need, whether in dispatch, the field, an ambulance or helicopter teaches you how to manage your own stress and fears. It teaches you how to work and communicate with others, and how to interact with patients and families. I think EMS is a great career for the long haul, but even for those who move on, you learn skills that are necessary for life, no matter the industry.