BY JEFF SIMPSON
Many fire departments face the challenge of designing the most appropriate emergency medical services (EMS) delivery model for their jurisdiction. Little guidance exists for those confronted with initial startup, ongoing refinements, or expansion of an existing EMS program. This article outlines how one East Coast fire department strategically planned to meet the expanding EMS needs of its community.
THE GROUP’S EXERCISE
Over a two-year period, a local cross-functional group wrestled with the challenge of designing the best approach to providing a solution to meet its dominant request for service. Its growing combination department was facing increasing challenges to deliver EMS requests for intervention. The area’s growing population exceeded 100,000 residents, who lived across a geographical area of approximately 500 square miles. Other contributing factors to the group’s dilemma included annual increases in vehicle volume (340,000 cars daily average) on two major interstate highways, multiple requests for service support at festivals and sporting events, and growing seasonal attendance at a large-scale amusement park. As these and other external influences stressed the immediate system, similar occurrences in surrounding jurisdictions compounded the regional network of EMS delivery. Reactionary solutions were not going to provide a sustainable solution over the long term.
The cross-functional group set out with an initial goal of not only planning for today but also strategically designing a system that would function adequately five years from now. On any given day over the previous several years, 60 to 70 percent of the department’s call volume was EMS related, and that trend continues. Squeezing public sector planners is the relentless pursuit to achieve mandated service performance goals for providing definitive care within limited financial and resource constraints. Following are some of the key components of the cross-functional group’s arduous exercise that you may find of benefit.
1 Develop a readiness assessment. This fundamental approach is designed to establish a baseline foundation on which to build your operational structure. In strategic planning, this process follows the development of a SWOC analysis where strengths, weaknesses, opportunities, and challenges are identified. You review areas, assess them, and establish goals.
• Mission and Values. Successful organizations have a clear understanding of their mandates and establish and communicate an inspiring organizational mission or vision to their stakeholders. The stakeholders include citizens, employees, community leaders, cooperating departments, and agencies internal and external to the organization. Does your motto include a reference to your most visible service category?
• Budget, Human Resources, and Information Technology. Successful organizations achieve their mandates, fulfill their mission, and create public value by effectively managing their human and asset resources. Are you investing in your future?
• Communications. Successful organizations transmit clear messages, have well-developed communication networks, and have adequate forums to promote discussion and dialogue in appropriate ways. Messages are concise, targeted toward specific stakeholders, and designed to produce specific responses. Do you have silos or pockets of communication gaps that are hampering your capability and efficiency?
• Leadership, Management, Structure, Processes, and Culture. Successful organizations enjoy effective leadership and competent management and organize themselves strategically. Leadership means making sure that the organization is doing the right things. Management means making sure that those things are being done right. The organization’s structure should feature well-defined relationships horizontally and vertically, formally and informally, that will help the organization carry out specific strategic initiatives. Design the organization’s processes to produce desired outputs efficiently and effectively. The organization’s culture should foster a commitment to the mission, meet mandates, create public value, and satisfy key stakeholders. Is a paradigm shift necessary to foster an environment that breeds success?
2 Clearly define the goal. What seemed to be obvious was inherently something that was overlooked. Not everyone was focusing on the same target, and the bulls-eye was different, depending on whom you asked. Make sure the team and those providing the service are all pulling in the same direction. The group concluded that the mission critical approach was to ”deliver superb patient care while providing transport capability to the appropriate hospital.” As part of the readiness assessment mentioned above, the group identified the existing barriers that would limit or prevent success, the expected costs and benefits of achieving the goal, and the criteria for determining if the plan should proceed.
3 Acknowledge and address interrelated challenges. Recognize that many internal and external dynamics are affecting the service delivery environment in which you operate. In most cases, these factors exist in an overlapping pattern that affects the final outcome of your clearly defined goal. On the surface, you may conclude that these considerations stand alone and should be addressed individually. You will find that each section, like a symphony, must function in concert for the entire system to produce harmony.
Considerations include the following:
- Service delivery area (geographic size, density, infrastructure).
- Logistics (transport units, maintenance, apparatus replacement plans, equipment and supplies).
- Training (skills needed, certification, testing and release).
- Personnel (staffing, hiring, volunteer providers, private providers).
- Communications (911 center procedures, dispatch response protocols).
- Population growth and business expansion.
- Technology (GPS, mapping, electronic records).
- Data review to develop trend analysis and call predictability.
- Mutual aid (available to you and what you provide to other locales).
- Med-flight and mass-casualty capability and response.
- Seasonal effects (concerts, amusement parks and state fairs, sports events).
- Human impact (morale, burnout, scheduling, work-life balance).
- Quality of service provided (basic life support vs. advanced life support).
- EMS fee-based services (should you charge for EMS transport services?).
Assemble cross-functional stakeholders (including citizen representatives) with a “can do” attitude. Too many times, we make the mistake of including representatives who bring years of baggage to the table. You want to strive to develop a balance between historical thinking and cutting-edge creative idea enthusiasts.
Are you providing EMS services from a fire-based platformambulances in fire stations and fire apparatus providing fire and EMS response capability? This is critical as you design solutions that address the interrelated challenges noted above. Several blueprints exist; select the best foundation on which to build your system.
Foster relationships with the medical community, including the hospitals to which you transport. Also, capture urgent care and patient clinics, physician offices, and assisted-living and convalescent facilities. These service “customers” will provide in-depth insight into current and future needs as well as look for ways to be more efficient when requesting services.
This is a key component.
- Understand who has the authority to support or reject your plan.
- Know what their position is and who they represent.
- Identify any preconceived notion or stance they may have.
- Determine if an individual makes decisions or wields influence.
Prepare for questions and comments from the review panel.
- Identify areas that impact change, and communicate to reduce the emotional reaction.
- Have data that support your proposals and statements.
- Minimize situations that derail the topic of discussion. Stay on point.
Are you too close to the issue? Maybe so. As you look at your challenges from an internal perspective, you may find that your solutions are handicapped by your past experiences. Seek help from experts or independent consultants. The work group mentioned above developed a partnership with a local university, which provided resources that applied statistical analysis and modeling to all aspects of the strategic goals to be accomplished. They examined past trends and compared them with performance objectives and used mathematics to formulate proactive planning responses.
EXAMINE THE DATA
Departments always seem to have a lot of data, captured through the 911 CAD system, a run-reporting database, or insurance billing documents. This situation was a double-edged sword for the work group, as the members had plenty of information but no uniform way to interpret its meaning, or conflicts existed from one format to the other. Several lessons learned included the following:
- Rely on one central data-collection system for capturing and reporting information. It is recommended that the 911 CAD system be tailored to accomplish this goal, since it is already designed to time-stamp critical benchmarks in the incident process. Several commercial software programs available work well in recording the specific information you want to measure.
- Understand that a one-size-fits-all solution may not be successful based on the host of service delivery challenges mentioned earlier.
- Trends will develop that will allow you to proactively predict EMS call patterns, locations, and peek demands based on time of day and day of the week. This will allow you to predeploy or stage appropriate resources with the right levels of certification in the demand sectors.
By following a structured process for creating and implementing a strategic plan, you can use a systematic approach to achieve success. You can now replace the traditional reactionary mode of addressing critical conditions in the EMS service world with an objective approach. This objective approach creates a paradigm shift in how decisions are made and how those decisions affect the organization, the people served, and the human resources and assets that provide the service.
Bryson, J., F. Alston. Creating and Implementing Your Strategic Plan, Second Edition (San Francisco, Calif.: John Wiley & Sons Inc.). 2005.
JEFF SIMPSON, a 25-year veteran of the fire service, is a battalion chief of operations with Hanover (VA) Fire-EMS. He has progressive degrees in engineering and management and is certified as a Virginia state fire instructor and officer. He has been teaching leadership, engineering, and strategy courses to corporate businesses and departments for the past 20 years. Simpson teaches at the Hanover County Fire Academy and was the lead H.O.T. instructor for “Training for Railroad Emergencies” at FDIC 2008. He has also contributed several articles to Fire Engineering and is a 2006 Governor’s Award Finalist for Excellence in the Virginia Fire Service.