Q&A with Todd Stout

Having worked in positions ranging from CEO for a major metropolitan EMS authority to senior manager with a public safety communications software company, Todd Stout had a vision when he started FirstWatch 15 years ago. Computer-aided dispatch systems were growing increasingly more sophisticated, thereby allowing for more detailed 9-1-1 data to be captured. At the same time, expectations for what public safety, fire and EMS should deliver was growing. Stout saw the potential for a company that would harness information technology to help customers in public safety make better and more efficient use of their resources to improve emergency care and safety. In 1998, he founded Stout Solutions, which became FirstWatch in 2002, and currently serves more than 240 agencies throughout North America. Initially focusing on real-time biosurveillance of weapons of mass destruction or outbreaks of SARS, H1N1 and other potential pandemics, FirstWatch has transformed itself into an organization that finds ways to improve operational performance and efficiency, from reducing hospital drop times to identifying other issues facing public safety and EMS. The following excerpted interview can be found in its entirety at emergencybestpractices.com.

Your father is Jack Stout, the designer of the original high-performance public utility model, such as MAST in Kansas City and EMSA in Oklahoma. What is his lasting legacy?

It’s really three things. One is the perspective of delivering results. Another is system status management, and the third is the public utility model.

During my father’s time, most private and public EMS agencies were really focused on doing the best you can with what you’ve got. They might measure average response time, but that was about it. There was no way to measure their performance. At that time, things were also simpler in terms of the demands and what you could do with data. My dad moved us toward focusing on results and outcomes, and introduced concepts such as the fractile response time. Instead of stating responses as an average, organizations would measure performance based on percentages—for example, responders should arrive on scene within eight minutes, 90 percent of the time. Now the outcomes we measure are more sophisticated, more clinical and more patient-focused, and people are discounting response times. Now we know that if you get there faster, it doesn’t necessarily help the patient so some people believe it’s silly to measure response times. But the only thing sillier than measuring response times is measuring nothing at all.

You work with a lot of EMS agencies and fire departments all over the country. What common priorities are you seeing?

The obvious one is that people have to do more with less. What I hear from leaders is they need an easier way to know what’s going on, to quickly put information together, at the moment, at a glance, without futzing around with details.

Improving response times is a big issue. A lot of departments are having to do brownouts and close stations, and they need to be able to figure out immediately what the result of that action is, not wait until six months later to do an analysis. There aren’t enough resources to get to each patient in eight minutes. So they are trying to figure out which patients they really need to get to in eight minutes.

Another issue is clinical performance and measuring and improving actual patient outcomes.

What themes are emerging as newly important?

Community paramedicine and what EMS can do differently than just responding to emergencies and taking people to the hospital. EMS has the potential to play a big role here, because we’re already out in the community.

Frequent users is another one. We’re working with Dr. Jim Dunford in San Diego on the Beacon Project. They have identified a group of people who are ‘super users’ of EMS. Many of those people have underlying health, social or addiction issues that the system is not handling well; the goal is to work with frequent users and get down to what these people really need.

Our role is creating triggers in FirstWatch to identify them and their responses. We alert the Beacon team, which includes the University of California San Diego, San Diego Medical Services and the county, that one of their case-managed people has been picked up and taken to the hospital so that a case worker can respond quickly.

We keeping hearing about the need for more data, the need for better data and the need for more useful data. What’s going on?

The issue is there is more and more data coupled with less time to deal with it. I think the missing piece is how to make the data useful and easy to work with so that people can figure out where the problems are in a timely manner. Let’s say I have a problem in my system because medics are starting to overuse one hospital. If I don’t find out about it for a few months, I’ve got a system habit that can be hard to break. If I can find out about it right away, we can act on it quickly and fix it before I have to retrain 100 people.

What are the most common mistakes that people make with data?

The most common mistake is probably not looking at the big picture. Let’s say I’m looking at response times. I see a call where paramedics are late because they got lost. I’d ask them, ‘What happened?’ I’m approaching it from the standpoint of, Here’s a problem and you should fix it. But what if I knew the context, and when I looked at that paramedic unit I could see they only get lost 1% of the time, while others are averaging 5%? I may say, ‘You’re already rocking it, so I’m not going to go beat you up about that one call.’ Instead I should be looking for the paramedics who are getting lost 10% of the time and get them into a map-reading or navigation course.

Jenifer Goodwin is associate editor of the monthly newsletter Best Practices in Emergency Services.