The High-Performance Mantra

 

Those of you who know me often consider me a zealous individual when it comes to the teachings of Jack Stout and his philosophies of High Performance EMS (HPEMS) and system status management (SSM). Although some consider these concepts to he unfavorable or designed purely to maximize profitability, they’re based on sound operations management philosophies that have been embraced by our government, military and private industry since the early 1900s. These principles and concepts are also fundamental teachings in today’s modern business degree programs-like the MBA program in which I am currently enrolled at Hofstra University in New York.

 

Operations management is nothing more than the science, techniques and philosophies used to effectively match supply and demand of a service or product while simultaneously ensuring the utmost in quality, reliability, dependability, satisfaction (customer and employee) and efficient use of resources.

 

You embrace the results of these techniques every day whether you realize it or not. They are used to make sure your mail arrives on time and the dining experience at your favorite food chain remains affordable, consistent and desirable no matter where the restaurant is located. They helped to build the ambulances we drive, as well as the EKG machines we use and the stretchers on which we package our patients. Operations management is used in the manufacturing of the juice you drink at breakfast and the potatoes you eat at dinner.

 

Helathcare operations management

 

More recently, there’s a good chance that the healthcare experience one receives has been touched by some form or fashion of operations management principles or concepts.

 

Ever hear of “Deming’s Total Quality Management,” “Lean Manufacturing” or “Six Sigma”? These are all various forms and techniques used in operations management.

 

Another way to think about operations management and EMS is to consider the  plans, processes, approaches, procedures and techniques you use to deliver your EMS services on a daily basis.

 

Do you know why the schedule your EMTs and paramedics work was built the way it was? Do you know how the stations or street corners where you stage your EMS units were selected? Do you know why the communications process used to answer EMS calls and dispatch ambulances was developed? Do you know how the plan you use to re-optimize (or not) your resources after a call is dispatched came about? Did you know that the way you do all of these things will have a direct positive or negative impact on your agency’s response times, employee well-being and your financial viability?

 

Hopefully your answers to these questions are founded in solid data analysis, evidence-based practice, best practices and lean and efficient business workflows designed to optimize the patient experience given the finances and resources you have available (e.g., high-performance EMS, SSM or operations management).

 

Conversely, if your answers to these questions are “I don’t know,” “Because we have always done it this way,” “That’s what just felt right,” or “That was what  we could do with what we had at the time,” then I strongly encourage you to learn more about how operations management can not only benefit your organization, but more importantly, benefit your patients.

 

Reform makes it necessary

 

Necessity is the mother of invention and drives the acceptance of the previously unacceptable. If you have previously considered HPEMS or SSM (a.k.a. operations management) as an “unacceptable” mantra, then you have a very wealthy tax base, are a really good salesperson, are a provider-centric organization (vs. a patient-centric organization) that protects “tradition unencumbered by progress” or have been fortunate that the lack of intelligent system design hasn’t harmed a patient yet (or you did a really good job of keeping it buried if it did already happen).

 

The key here is that although your organization may have been able to stave off necessity, that seems to he harder and harder to do given the state of our economy and society today. Shrinking budgets in the face of increased service demands combined with expectations for high standards of accountability and quality scream for operations management-based solutions. To continuously deny this or cling to your old ways may place you, or your organization, on a collision with an unflattering fate.

 

Although I believe Stout’s philosophies and teachings were way ahead of their time in this industry, it is clear that healthcare has finally come to embrace the operations management and “high performance” mantra. Healthcare reform, with its mission to ferret out waste, ineffectiveness, inefficiency and the unsustainable practices of a fee-for-service-based system that rewards an uncoordinated care continuum, makes it a necessity.

 

Stout wrote the following excerpt as part of the American Ambulance Association’s EMS Structured for Quality program. It was one of the last documented pieces he published. A signed, original copy hangs in the halls at the Regional EMS Authority (REMSA), in Reno, Nev. I often re-read it to audiences when I lecture and like to occasionally reference it in my writings, because it keeps me focused, motivated and grounded on why I do what I do.

 

I also believe this wisdom from Stout to he profound enough that it applies to our current situation in healthcare (replace the words “EMS” with “healthcare” and you will see what I mean).

 

I hope the words of Jack L. Stout motivate you, as they do me, to do the right thing as a steward of your community’s resources, as that is part of your role and responsibility as a true leader in EMS.

 

“As EMS providers, we invite the public to literally trust as with their lives. We advise the public that, during a medical emergency, they should rely upon our  organization, and not any other. We even suggest that it is safer to count on us, than the resources of one’s own family and friends. We had better be right.

 

Regardless of actual performance, EMS organizations do not differ significantly in their claimed goals and values. Public and private, nearly all claim dedication to patient care. Efficient or not, most claim an intent to give the community its money’s worth. And whether the money comes from user fees or local tax sources , the claim is the same-the best patient care for the dollars available. It’s almost never true.

 

Our moral obligation to pursue clinical and response time improvement is widely accepted. But our related obligation to pursue economic efficiency is poorly understood. Many believe these are separate issues. They are not. Economic efficiency is nothing more than the ability to convert dollars into service. If we could do better with the dollars we have available, but we don’t, the responsibility must be ours. In EMS, that responsibility is enormous-it is impossible to waste dollars without also wasting lives.”

 

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