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Improving Operational Performance

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Improving Operational Performance Presented By: Jonathan D. Washko, BS-EMSA Director of Deployment REMSA President Washko & Associates, LLC – PowerPoint PPT presentation

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Title: Improving Operational Performance


1
Improving Operational Performance
  • Presented By
  • Jonathan D. Washko, BS-EMSA
  • Director of Deployment REMSA
  • President Washko Associates, LLC
  • HPEMS Public Safety Consulting
  • Partner Stout Solutions, LLC FirstWatch

2
Some Food for Thought
Late 9-1-1 Wears The Late Crown
3
Improving Operational Performance
  • Notice in this video
  • The media focused on problems created for
    9-1-1 center from this video
  • They are actually talking about EMS only
  • They are talking mostly about RESPONSE TIMES
  • They are talking about customer service and
    clinical care

4
Discussion Topics
  • Successful Performance Defined
  • Defining Operational Performance
  • Measuring Operational Performance
  • Improving Operational Performance

5
Successful Performance Defined
  • The EMS Success Triad
  • A Balancing of
  • Patient Care
  • Employee Wellbeing
  • Financial Stability

Success Triad
Patient Care
Economic Stability
Employee Wellbeing
6
EMS Success Triad
  • Patient Care
  • Response Times
  • Clinical Performance
  • Customer Service

7
EMS Success Triad
  • Employee Wellbeing
  • Retention
  • Health / Safety / Welfare
  • Satisfaction
  • Compensation
  • Recruitment

8
EMS Success Triad
  • Financial Stability
  • A/R Billing Practices
  • EMS Delivery Model / System Design
  • Operational Efficiency Effectiveness
  • Employee Compensation
  • Safety Risk Management
  • Systems Engineering

9
The Balancing Act A Quality Unit Hour
Patient Care Employee Wellbeing
Financial Stability
Public Education
Control Center
Training Edu
Human Resources
Finance
Operations
The Quality Unit Hour
Supply / Logistics
Data Analytics
Safety Risk
QI / CQI / PI
Fleet Maint.
IT / Technology
PR/Marketing
10
Defining / Measuring Improving Operational
Performance
  • Limiting our Discussion to
  • Response Times
  • Key Operational Efficiency Effectiveness
    Measures

11
Defining Response Time Performance
  • Typically System Specific
  • National Standards
  • Measured Via
  • Clock Start
  • Clock Stop
  • Measurement Methodologies
  • Average Response Times
  • Fractile Response Times

12
Defining Response Time Performance
  • Clock Start.a controversial topic (Smoke
    Mirrors)
  • Time First Received at 9-1-1 PSAP
  • Time First Received by Responding Agency
    (Secondary PSAP)
  • Time Certain Info Obtained
  • Time Dispatched
  • Time Unit En Route
  • Clock Stop (Pretty Definitive)
  • Unit Staged
  • Unit on Scene
  • Crew at Patient

13
Measuring Response Time Performance
  • Typically two types of measurement
  • Average
  • Fractile (or frequency distribution)

14
Measuring Response Time Performance
  • Average
  • Total Response Times for Sample divided by Total
    Sample Size
  • Yields roughly the 50th percentile, or ½ of your
    responses are above and ½ of your responses are
    below the average numberor 5 out of 10 patients
    are receiving this level of response
  • Old standard of measurement when we didnt care
    about this stuff as an industry

15
Measuring Response Time Performance
  • Fractile
  • Frequency distribution of time that shows
    reliability percentage of responses based on
    specific time bins
  • Many systems (and standards) are going to 90th
    percentile reliability standards (e.g. a response
    time standard of 000800 at 90 reliability)or
    9 out of 10 patients receive this level of
    response
  • Best measurement approach for Patient Care and/or
    Customer Service
  • Ability to achieve depends heavily on deployment
    methodology (demand vs. geographic based) and
    size of your pocketbook.

16
Measuring Response Time Performance
  • Response
  • Time
  • Measurements
  • Fractile
  • Measurement
  • Example

17
Measuring Response Time Performance
  • Fractile Measurement Continued
  • Response Time Exemptions
  • Calls that are exempted from response time
    calculations due to uncontrollable factors that
    would require significant financial and human
    resources to overcome
  • Examples
  • Severe Weather
  • Significant Hospital Diversions / Delays
  • MCI
  • Second Unit to Same Incident
  • Others based on financial needs
  • System Overload
  • Un-notified Construction

18
Improving Response Time Performance
  • Emergency Calls
  • Function of Volumetric and Geospatial Supply and
    Demand of Resources, Call Segment Efficiency and
    Effectiveness and Responding Unit Travel Time and
    Impedance
  • Non-Emergency (Inter-facility Transport) Calls
  • Function of Mostly Volumetric and Some Geospatial
    Supply and Demand of Resources, Effective Call
    Scheduling and Responding Unit Travel Time and
    Impedance

19
Improving Response Time Performance
  • Performance Variables
  • Call Segment Processing
  • Matching or Mismatching of Supply and Demand
    Curves
  • Deployment Methodology
  • Other System Issues
  • Support Systems
  • GIS / Mapping Systems
  • Employee Performance

20
Improving Response Time Performance
  • Call Segment Processing
  • A significant number of agencies can improve
    response time performance just by measuring and
    fixing two variables (based on how you measure
    Clock Start)
  • Call Processing Times (Received to Assign)
  • Unit Chute Times (Assign to En Route)
  • This Increases Available Travel Time which
    Improves a Responding Units Effectiveness and
    Coverage Area

21
Improving Response Time Performance
The net effect of a 2 minute improvement in call
processing / chute times on geospatial coverage
isochrones
22
Improving Response Time Performance
  • Matching Supply and Demand Curves
  • EMS Demand curves are Predictable (see next
    session)
  • Volumetric Basis (Temporal Demand Analysis)
  • Geospatial Basis (Geographic Demand Analysis)
  • Analysis of Existing Resource Supply to Demand
    curves will show if a mismatch of resources
    exists which definitely has a LARGE effect on
    response times
  • Stoutian Theory (Prediction of Demand on EMS)

23
Improving Response Time Performance
EMS Temporal Demand Static Supply
24
Improving Response Time Performance
EMS Temporal Demand Static Supply
25
Improving Response Time Performance
EMS Temporal Demand Static Supply
Lost Revenue Opportunities
26
Improving Response Time Performance
EMS Temporal Demand Temporal Supply
27
Improving Response Time Performance
  • Deployment Methodology
  • Another Significant Variable in Emergency
    Response Time Performance is your Agencys
    Geospatial Deployment Methodology
  • Fixed (Static) Geographic Based
  • Dynamic (Temporal) Demand Based
  • Hybrid (Static Temporal) Demand / Geographic
    Based
  • Effects How Response Ready You Are To Respond To
    The Next Call

28
Improving Response Time Performance
EMS Temporal Demand Static Supply
29
Improving Response Time Performance
EMS Temporal Demand Temporal Supply
30
Improving Response Time Performance
EMS Temporal Demand Temporal Supply
31
Improving Response Time Performance
EMS Temporal Demand Temporal Supply
32
Improving Response Time Performance
  • Other Variables
  • Support Systems
  • Fleet Maintenance
  • CAD
  • AVL
  • Dispatch
  • GIS / Mapping
  • GIS Data ACCURACY!
  • Reading a Map Book
  • Employee Performance
  • Culture
  • Unions
  • Management Style and Approach

33
Improving Response Time Performance
  • Overall Improvement Strategies
  • Use Effective and Efficient Deployment
    Methodologies
  • Root Cause Analysis on Each and Every Late Call
    Will Show a Pattern and Focus your Improvement
    Efforts
  • Reliability, Accountability and Measuring are Key
  • Systems Engineering that allows for Minute to
    Minute System Adjustments Based on Real-Time
    Performance Data is Vital for Success
  • Daily After Action Review Processes (from the
    military) will improve situational awareness,
    identify trends, allow the organization to
    communicate and will eventually lead to improved
    performance (on all fronts)

34
Improving Financial Performance
  • Financial Performance
  • Definitions
  • Measurements
  • Improvements

35
Defining Financial Performance
  • System Specific
  • For Profit / Not For Profit / Non Profit
  • Publicly Traded / Privately Held / Government
  • Performance Based / Level of Effort Based
  • Self Imposed / Contractually Imposed
  • Performance
  • Profitability
  • Survival
  • Growth

36
Successful Performance Defined
  • The EMS Success Triad
  • A Balancing of
  • Patient Care
  • Employee Wellbeing
  • Financial Stability

Success Triad
Patient Care
Economic Stability
Employee Wellbeing
37
The Balancing Act A Quality Unit Hour
Patient Care Employee Wellbeing
Financial Stability
Public Education
Control Center
Training Edu
Human Resources
Finance
Operations
The Quality Unit Hour
Supply / Logistics
Data Analytics
Safety Risk
QI / CQI / PI
Fleet Maint.
IT / Technology
PR/Marketing
38
Defining Operational Efficiency Effectiveness
  • A Majority of Most EMS budgets Consist of Labor
    Costs (typically 60 to 80)
  • Revenue Availability is a direct result of EMS
    system design and reimbursement methodologies
    (subsidy / billing insurance)
  • Cost Structure is a direct result of EMS system
    design, efficiency and reimbursement
    methodologies (subsidy / billing insurance)
  • Reimbursement rates are diminishing, tax dollars
    are tightening and public expectations are rising
  • Because of this, only the most efficient and
    effective properly designed EMS systems will be
    successful in balancing the Triadif not
    something will have to give eventually (Patient
    Care, Employee Well Being or Financial Stability
    / Survival)

39
Defining Operational Efficiency Effectiveness
  • Given that EMS budgets are mostly labor based,
    focusing on this area when attempting to improve
    financial performance typically gives you some
    kind of return
  • Equally important is revenue and collections, but
    for this discussion we will focus on operational
    improvements
  • Other areas of significant budgetary allocations
    are also likely candidates

40
Measuring Operational Efficiency Effectiveness
  • Service Model versus Production Model EMS
    Strategy
  • Measuring Key Performance Indicators (KPIs)
  • Quality Unit Hours Unit Hour Utilization (UHU)
  • Controlling Lost Unit Hours
  • Managing Call Task Times
  • Managing Pay Roll Leakage (or payroll UHU)
  • Manage Headcount to Control Overtime
  • Managing Response Errors
  • Benchmarking and Trending Statistics
  • Many Others

41
Measuring Operational Efficiency Effectiveness
Quality Unit Hour Definition A Quality Unit
Hour is an ambulance that is available to the
EMS System for one hour that responds to properly
triaged calls for service, is produced within a
CQI environment that uses modern technology to
collect and assess accurate data, is fully
staffed, fully trained, fully maintained, fully
stocked, properly placed in location and time,
properly funded and safely operates within an
educated population
42
The Balancing Act A Quality Unit Hour
Patient Care Employee Wellbeing
Financial Stability
Public Education
Control Center
Training Edu
Human Resources
Finance
Operations
The Quality Unit Hour
Supply / Logistics
Data Analytics
Safety Risk
QI / CQI / PI
Fleet Maint.
IT / Technology
PR/Marketing
43
Improving Operational Efficiency Effectiveness
  • Control your Unit Hours and UHU
  • Function of EMS System Design
  • Properly Allocate Supply with Demand
  • Geographic Deployment Methodology is HUGE in
    terms of efficiency and Demand Based Systems are
    usually the most cost efficient and effective

44
Improving Operational Efficiency Effectiveness
  • Controlling Lost Unit Hours
  • A Lost Unit Hour is one that is not otherwise
    available to the deployment plan if not on a call
  • Many causes
  • Start / End of Shift Procedures
  • Critical Failures
  • Hospital Diversions / Off Load Delays
  • Employee Problems
  • Poor Management Practices
  • Lowered lost hours means more available hours to
    the system
  • More available hours may allow you to reduce
    scheduled hours

45
Improving Operational Efficiency Effectiveness
46
Improving Operational Efficiency Effectiveness
  • Managing Call Task Times (somewhat controversial)
  • Highly efficient systems can run a call in less
    then an hour
  • Less time to run a call means less hours that are
    needed to meet the same response time performance
    standard
  • Less hours needed results in financial savings
    (but may unbalance the triad on employee
    well-being or patient carebe careful!)

47
Improving Operational Efficiency Effectiveness
  • Managing Payroll Leakage
  • Payroll leakage are unproductive dollars spent
    for various reasons
  • Measuring Payroll UHU against Actual UHU defines
    leakage
  • If a variance if found between these two numbers,
    then leakage is occurring or youre measuring
    wrong
  • If these numbers match or are very close, then
    leakage is more then likely minimal
  • Minimizing leakage helps to lower costs

48
Improving Operational Efficiency Effectiveness
  • Managing Headcount
  • Manage your Headcount - Dont let it manage you!
  • Perform bi-weekly headcount meetings as a means
    to anticipate attrition and therefore drive
    hiring practices
  • Ensure you allocate your employee thru put times
    into the equation
  • Also ensure you allocate proper FTEs to cover
    PTO, Sick, Vacation, LOA, FMLA, etc to avoid
    backfilling with overtime

49
Improving Operational Efficiency Effectiveness
  • Managing Response Errors
  • Systems engineering flaws
  • Unit Hour production problems
  • Deployment Plan issues
  • System support problems
  • Human Error

50
Improving Operational Efficiency Effectiveness
  • Trending and Benchmarking Statistics
  • Allows you to see where you have come from and
    where you are going
  • Can be used to adjust your system dynamically in
    a real-time fashion thus keeping costs down
  • Can be used to help predict the future
  • Can be used to help find special cause variations
    that may be effecting financial performance

51
Improving Operational Performance
  • Closing Remarks
  • REMEMBER the EMS Success Triad
  • Patient Care
  • Employee Well Being
  • Financial Stability
  • Questions
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