Strategic Planning for EMS Agencies

Original Contribution

Strategic Planning for EMS Agencies

April 2005

You are the EMS director for a small municipal EMS third service that provides both ALS and BLS services. One day, the town supervisor calls you into his office. During the conversation, he mentions that he has noticed an increase in the number of commercial ambulance services in the area. Considering this, as well as the decrease in billing reimbursement your ambulance service has been experiencing, he wants to know what the short- and long-term goals and objectives of the EMS department are, as outlined in your strategic plan. Taking in your silence and quizzical expression, the supervisor offers to set up a workshop with a local EMS consultant to help you develop a plan.

After the meeting, your mind is spinning. You know that the supervisor is “on your side” but you’ve never even thought about strategic planning before, let alone had to assist in writing and implementing a plan. Immediately, several questions come to mind: What is a strategic plan and what does it encompass? How do you write one? Is it difficult to implement? The task seems daunting, to say the least.

Many EMS managers may not have been exposed to a strategic planning process. But regardless of size, all prehospital organizations can benefit from this common business management tool. When we hear news of a private EMS service going out of business due to an inability to weather economic downturns, or a volunteer ambulance squad failing to recruit or retain sufficient numbers of volunteers to staff its operation, rarely is it considered that one of the significant contributing factors may have been the organization’s lack of focus and direction. Perhaps such events would not occur if an agency had a well-thought-out, long-term strategic plan.

Definitions

Strategy in business is defined as “the pattern of objectives, purposes or goals and major policies and plans for achieving those goals, stated in such a way as to define what business the company is in or is to be in and the kind of company it is or is to be.”1 A strategic plan, according to one state health department, is defined as “a document that defines the needs of an organization that will enable the organization to realize its vision and mission.”2 Another definition, from the Internet Nonprofit Center, states that strategic planning is “a disciplined effort to produce fundamental definitions and actions that shape and guide what an organization is, what it does and why it does it, with a focus on the future.”3

Strategic planning is rooted in future-oriented, proactive thinking that anticipates change and adopts long-term strategies to meet the demands of that change.4 In other terms, a strategic plan is a “master plan” for your EMS agency. It is a management tool that will assist your organization in focusing its energy. There are both short- and long-term strategic plans. The objectives can be immediate (accomplished within one year), short-term (two to five years) and long-term (more than three years to initiate and less than 10 years to complete). The scope of this forecasting should focus on multiple facets of your agency, including, but not limited to, finance, personnel, logistics, operations and administration.

Mission Statement

In crafting a mission statement, you should seek to summarize the what, how and why of your organization. Your mission statement should represent a guiding set of ideas that can be articulated, understood and supported by the organization’s stakeholders, board, staff, members, customers and other key players. The importance of the mission statement to the overall strategic plan is that it provides direction by answering the “what is our business?” question, as well as providing a basis for goals and strategies.

A good example of an EMS-specific mission statement is that of Boston (MA) EMS:

Boston Emergency Medical Services is a community-based public health and public safety service that provides and manages the integrated prehospital care system for the city of Boston to improve the health of the community.6

This mission statement is inspiring, yet it reflects attainable goals. Your own mission statement should be broad enough to allow flexibility in implementation, but not so broad as to permit a lack of focus.

Vision Statement

A vision statement is a declaration that conveys the image of how the organization wants its future to look. A vision statement expresses what the organization would do or how it would function in an ideal world. A vision statement is important to the strategic plan because it allows all levels of the organization’s personnel to keep an overall direction in sight, as well as to know why they are working and what they are working toward. It provides a mandate for change, inspiring an EMS agency to become better and not stay satisfied with the status quo. And it allows all levels of personnel to align their day-to-day decisions to achieve the future envisioned state.

An excellent model of an EMS-specific vision statement is that of Austin/Travis County (TX) EMS system:

Austin EMS is committed to responding to the changing needs of an expanded service area and being a recognized leader in innovative, cost-effective, clinically sophisticated delivery of comprehensive emergency medical services.7

The vision statement should utilize key adjectives to draw a clear picture to all involved of what you feel your agency can become.

Strategic Objectives

Appropriate, well-written mission and vision statements make an organization commit in writing to the reason for its existence and to what it will do and be in the future. In doing so, these statements assist in the formulation of goals and objectives, the next step in the strategic planning process.

Goals can be grouped into three timeframes. These are:

Immediate—accomplished within one year
Short-term—accomplished within two to five years
Long-term—requiring more than three years to initiate and less than 10 years to complete.

Goals are the overarching desired end-points. They are what the strategic plan is attempting to achieve. In other words, they are how the mission and vision get realized. Goals focus on ends, rather than means.

These goals will be unique to your organization, whether you are a BLS fire department service looking to begin ALS first response; a volunteer agency facing the possibility of transitioning into a career department; or a commercial service seeking to exploit opportunities for operational growth.

Objectives are the means to the end. They ask the question: How are you planning to attain your goal? Objectives are clear, realistic, specific, measurable and time-limited statements of action that will move toward goal achievement.

For example, let’s say a commercial agency with many 9-1-1 contracts has come to the realization that it needs the higher reimbursements that come from nonemergency transports if it is to remain financially stable. One of its strategic objectives would be to find a better balance between 9-1-1 and nonemergency business. This goal could fit into the short-term objectives category.

Additional questions will arise as agency managers think about what else will need to be done to make these changes. For example: Will the agency need to hire more staff (line employees, supervisors, billing personnel, etc.) and obtain more vehicles in order to maintain its level of customer service during the expansion? Will there be more bases of operation needed to keep response times within established limits?

The answers to these questions will comprise your organization’s strategic objectives. Remember that the objectives support the overall goal. Within each objective you will need to create several action steps (or tasks) to help attain it, leading to the accomplishment of the agency’s goals. It’s important to identify timelines for the accomplishment of these objectives.

Finally, when developing your organization’s objectives, make sure they align with your mission and vision statements and address the most critical issues facing your agency. Also remember that the approaches being considered must be viable—financially and otherwise.

Action Plans

The outline of an action plan is one of the final steps in the strategic planning process and comes just prior to the implementation phase. An action plan—or work plan—lists a specific goal and objectives, along with the detailed actions (tasks) needed to achieve them within a definite time frame. Each strategic goal and objective should have an action plan, as well as a schedule with deadlines, for their implementation.

Action planning typically includes deciding who is going to do what, by when and in what order. The design and execution of the action plan will depend on the nature and needs of the organization. The structure and type of your EMS agency (e.g., volunteer or career, etc.) will obviously affect the method of carrying out this step.

Implementation

Now that all your plans have been carefully outlined and assessed against the organization’s mission, it is time to set them into motion. The implementation phase of a strategic plan can be as difficult as the planning and writing phases. More important, poor implementation has the potential to undo all of your hard work. Here are some basic steps that are critical if your strategic plan is to be successfully introduced to both line- and management-level personnel:

Components of the plan must be explained so personnel can see their impact and benefits as they relate to their specific needs.
Relatively complex planning tasks must be able to be broken down into smaller, more manageable elements.
To the extent the plan may break with tradition, successful implementation occurs as a natural evolution of experience and understanding. Be patient with resistance, but firm regarding the need for change.
There must be a well-defined, readily identifiable point person for each planning and implementation task (this also relates back to the action plan phase).
Finally, there must be a realistic assessment of resource needs. This includes, but is not limited to, making necessary staff and support facilities available, and providing necessary budgets for training, meetings, equipment and implementation.

Conclusion

Every day organizations suffer due to a lack of understanding of the type of careful planning that the delivery of emergency medical services truly requires. The work involved in conducting a situational analysis; writing mission and vision statements; and developing strategic goals, objectives, strategies and action plans is not easy and cannot be accomplished in a short period. It will take time and effort to formulate, but strategic planning is well worth the investment.

The benefits include assisting EMS agencies with focusing on the need to change, both in the present and future, and utilizing plans as a means to identify and focus on these changes. Strategic plans can also be used to provide comfort to outside entities (e.g., governing bodies) by helping you communicate the strengths of the organization.

Once you have finished the strategic plan, your results should be formally bound and made accessible to all of your employees. As the document that spells out who you are, what you have learned, what you have accomplished, where you are going and how you plan on getting there, the strategic plan needs to be a visible part of your organization’s operations. Including a basic review of it during every new employee/member orientation would further solidify not only your organization’s connection to its strategic plan, but also give the new employee/member a look at the organization’s future and, possibly, their personal future with the organization. If your EMS organization has a vision of where it wants to be and how to get there, everyone in the organization should know it.

As you embark on creating and implementing your strategic plan, you and your organization should also keep in mind what a strategic plan is not:

Strategic planning does not predict the future or make decisions that can’t be changed. If an unexpected shift occurs, major strategic decisions may have to be revisited sooner than they would in a typical three-to-five-year planning cycle.
Strategic planning is not a substitute for the judgment of leadership. The data analysis and decision-making tools of strategic planning do not make the organization function—they can only support the intuition, reasoning skills and judgment that people bring to the work of their organization.
Strategic planning is not always a smooth, predictable and linear process. No one should be surprised if the process feels less like a trip on a train and more like a ride on a roller coaster. But roller coaster cars will arrive at their destination, as long as they stay on track!8,9

By definition, a good strategic plan will be challenging but achievable.10 There will be significant personal and organizational effort needed in order to meet the various goals set forth. EMS has traditionally—with few exceptions—employed a “shoot from the hip” approach in regard to planning. Due to the nature of our business, we usually operate in a reactive, rather than proactive, manner. Changing this mind-set is paramount to developing and sustaining a healthy organization. Having your agency establish a deliberate, well-thought-out blueprint for its future today may be what helps to keep it around for a long time to come. As a wise strategist once said: If you don’t know where you’re going…you’ll probably end up somewhere else. That was Confucius.

References

Collins E, Devanna MA. The portable MBA. Strategic Management. New York: John Wiley & Sons, Inc. 1990, Chap 11.
Virginia Department of Health, Office of Emergency Medical Services (OEMS). EMS Agency Management Series. EMS Strategic Planning. June 2001.
Internet Nonprofit Center website. www.nonprofits.org.
Porter R. Strategic planning. JEMS. Feb 1996, 33–34.
Menkin H. Strategic planning. Ambulance Industry Journal. July/Aug 1997, 18–29.
Boston EMS. Mission statement. www.bostonems.com/mission.html.
Austin/Travis County EMS. Vision statement. www.ci.austin.tx.us/ems/mission.htm.
Allison M., Kaye J. Strategic Planning for Nonprofit Organizations, New York: John Wiley & Sons, 1997.
CompassPoint Non-profit Services. www.compasspoint.org/index.html.
Porter R. Strategic planning. JEMS. Feb 1996, 33–34.

Additional References

Simon L, Becknell J. The challenge of strategic planning. www.merginet.com. Feb 2001.

Strategic planning. EMS Best Practices. 1(1):5. Sep 1998.

Writing a Strategic Plan

Writing a strategic plan begins with researching and delineating a series of components that will form a framework for the strategy. At a minimum, this includes:

A situational analysis
A mission statement
A vision statement
A list of strategic objectives
An action plan

By breaking the plan into smaller pieces, tasks associated with developing a strategic plan become more manageable. Addition-ally, larger organizations may want to take a particularly complex component and break it down into two or more subcomponents.

Situational Analysis

Sometimes referred to as a SWOT (strengths, weaknesses, opportunities and threats) analysis, the situational analysis looks at the current status of your organization as well as the factors that have the potential to change that status. It is an examination of the internal (in the form of strengths and weaknesses) and external (in the form of opportunities and threats) forces that have the potential to impact your organization.

Who are you?

What type of organization are you? Is your agency for-profit or not-for-profit? Are you a commercial EMS service with a significant amount of nonemergency transportation business, or are you a municipal EMS agency that responds only to 9-1-1 calls? Are you a volunteer agency, a career agency or a hybrid? Are you fire department-based, police department-based or hospital-based? Are you a specialty EMS agency with a limited service area (such as a college or airport EMS)? The basic question that needs to be answered here is: What is the agency’s overall mission? You cannot establish a direction for the agency until you ascertain its mission.

Where are you right now?

What market are you serving, and is this market stable? Questions like these will lead you to understand your market viability: Are you financially stable or in constant threat of closing your doors? Are you a medically driven organization with well-written policies, procedures and protocols, and minimal past litigation, or do you constantly have policy issues and lawsuits hanging over your heads? What have you accomplished as an organization? What is your level of customer satisfaction? (This should include an analysis of your relationships with both your external and internal customers.) How do your employees view the agency and its mission? What have you done well and—just as important—what have you done not as well?

Where do you want to be?

What are your organization’s goals? What are its objectives? This includes both short- and long-term goals and objectives. Think about what plans you want (or need) to be realized in the next year, three years, five years, etc. Developing a list of needs and desires for your organization—however large or small—will lead you to understand your future goals, as well as develop the correlating objectives appropriately.

Can you achieve these goals?

Are your goals realistic and attainable? Are they operationally sound? Can you achieve them with your current revenue stream and financial outlook or will you need additional finances? What capital expenses do you foresee arising in the next three, five or 10 years? You will need to consider contributory factors from both inside and outside your EMS agency to answer this question adequately.

How do you actually achieve these goals?

What steps need to be taken in the short and long term to achieve these goals? Do you need to start hiring additional personnel or acquiring new ambulances? What about real estate for future bases of operation? Which resources are currently available and which are needed for sustained future growth? From where will the necessary funding come? If the goals are realistic and have been formulated by the answers to the questions above, then there is a good chance they can be achieved.

How do you begin the strategic planning process?

As with most change, the first step is realizing and admitting that a strategic plan is needed. Next is the establishment of a multidisciplinary group from within the agency to begin the process—field-level personnel and supervisors, as well as people throughout the management and administrative structure. Another option is to hire an industry-specific consultant to lead the effort. Creating a team with a good cross-section of line employees, supervisors and managers can assist senior management in this difficult process, as well as “sell” the plan to the rest of the company.5 As with any effective quality-improvement or customer-satisfaction plan, including all levels of personnel in the development of the plan is an integral component for agency-wide acceptance, and ultimately the plan’s success.