10 Tips to Stay on Top of Your EMS Game

Recently, at EMS World Expo in Nashville, TN, I was challenged to deliver a session on my thoughts about what high-performing EMS systems should be doing to stay on top of their game. I focused on key elements of business practice, organizational performance and clinical excellence required for any high-performing system, EMS or otherwise. Each of my points could be a full essay in its own right, but in summary my top 10 tips are as follows:

1. Embrace Economic Efficiency

From an economic sense, the mission of EMS—and any healthcare organization for that matter—is to “convert the amount of available budget money into high-quality healthcare in order to produce excellent clinical outcomes.” Money is too tight to mention right now and the days of well-padded budgets are a thing of the past. Municipal coffers are shrinking for the public sector, collection rates and reimbursements are down for private EMS, and charitable giving and the donation of free time is fast disappearing in the volunteer sector. In other words, no matter the type or style of your organization, it must be run as a business, with an eye on the bottom line and a realization that EVERYTHING costs something.

2. Manage Data

In this day and age it’s difficult to believe some EMS organizations think they have little or no management information. The actual situation is quite the contrary and individual data mines are bottomless. Information is freely available, from call volume to patient condition to mean times between failures of vehicle components. When collected, collated and analyzed, this information becomes a valuable intelligence product that can be acted upon to improve the next cycle of response, care and administration.

3. Analyze Demand

System status management (SSM) is the science of being in the right place with the right resource at the right time to meet the patients’ need. Some say it’s the practice of placing ambulances on street corners, but the crucial thing we must remember is the patient is having the emergency so we must be poised to respond with minimal delay and maximum impact. SSM takes the intelligence products of demand analysis of both time and space, and matches manpower and availability to deploy a responder as close to the patient as possible. This achieves a minimal response time for the patient, and reduces time spent running under emergency conditions for the crew—not to mention distracted pedestrians!

4. Engage Your Medical Director

So far all the planning and data crunching has been devoted to the first 10 minutes, or approximately 1/6 of the patient response episode. It’s ironic that some organizations set their store in, and are judged on, their response times alone. It’s not “high-performing” if you are good at racing to the scene, only to be incapable of delivering the clinical goods on arrival. A well-trained workforce that has sufficient preception, mentoring and training, and is clinically current, is an absolute requisite for success. To achieve this, the involvement and active engagement of the operational medical director (OMD) must occur—often.

5. Run a Lean System

EMS is not only response, treatment and transport; the back office and support functions are the “power behind the punch” of service delivery. The creation of lean, efficient and measurable systems is the key to success. An example of this is a high-functioning fleet service. If your vehicles fail on the way to calls, then so does the mission. Keeping your organization well serviced and maintained is an arterial function and performance could hemorrhage if you can’t get to where you need to go. The swift conversion of treatment to bill to income is also an essential function. Remembering the economic requirement that we turn the amount of available funds into quality healthcare requires the generation of said funds to keep the EMS circle of life turning. While those in support functions are not delivering life-saving and patient care, they keep the organization alive and healthy.

6. Develop a Culture of Safety

The Culture of Safety is, surprisingly, still a new concept to some quarters of U.S. EMS. This is nationally apparent by the stream of line of duty deaths (LODD) and devastating vehicle accidents that result in well-publicized photos of ambulances splayed like bananas after impacts with both moving and static objects. An environment of cultured safety seeks to establish the root cause of these issues then put techniques, practices, procedures and philosophy in place to create a safe environment for all.

7. Make Friends with Public Health

When I go out to speak, I often ask the audience if they know who their public health director is. Many do not, which is shameful. EMS enjoys its role in public safety and recognizes its place in the house of medicine, but fails to realize it is an essential member of the public health camp. Prevention is better than cure every time, so understanding the aims and objectives of the public health system is essential. The current Ebola crisis has reinforced the point that we are joined solidly to public health and we must interact often and well.

8. Advocate for Innovation and Research

To continue to push the boundaries of the EMS world, we require evidence-based practice, outcomes and data to trump industry anecdote and tradition. To progress we can’t simply hide behind the mantra of, “We have always done it that way.” Organizations should consider researching, collaborating, capturing, and presenting studies and good practices. It doesn’t have to be major projects or massive patient studies, but perhaps a series of “small cycle testing” that relies on a  “Plan,  Do, Study, Act” (PDSA) cycle. Large change can occur from small tests. Writing these up, complete with supporting evidence, can effect change not only in the researchers’ organizations, but in the wider industry.

9. Get Out in the Community

The evolution of community-based programs here is almost anthropological in nature. Community paramedicine, or mobile integrated healthcare, is evolving and forming according to local environmental and political conditions. No two programs are the same, which is technically good, as they are shaped to meet the needs of the population for which they are intended to serve. The bottom line for many of these programs to be successful and attain longevity is to be actuarially sound and generate income to be self-sustaining.

Sadly many programs to date have operated on a loss-leading footing and, unless sustainable income is forthcoming  via legislative changes, some could fade as quickly as they initially shone. That said, some community-based activity is already part of normal daily EMS practice and could rightly be classed as “paramedic in the community” activity.

Understanding who your “frequent service users” are, and managing their whole system use and creating case conferences, is a great community activity. Fostering relationships with other local care organizations such as behavioral health, social services, faith-based groups and both the primary and secondary care sectors may lead to the creation of cost-effective and sustainable programs. This level of liaison also assists in the breaking of barriers and removal of care silos.

10. Ensure Your Voice Is Heard

Internally, “if no one is following, then you are not leading.” Externally, if you don’t broadcast your message, then no one will hear it! A key communication strategy should be a major corporate activity. Some say it takes 10 good news stories to trump one bad story. Having an active communication plan that involves providing your local media with positive stories (to get your 10 good ones in the bank) is a good investment in time. Good news stories inform the public as to the quality of your agency and instill a sense of pride within the service. In the social media age, it is now relatively easy to place news. A photograph and a descriptive paragraph can quickly be crafted and posted on your organization’s social media sites or sent to the editor of a national trade magazine for both national and international coverage.

A Bonus 11th Point: Know the Four Words that Count Most

EMS organizations are usually one degree of separation away from politics. Public sector organizations are governed by councils or boards of supervisors; private sector companies have shareholders and executive boards. If those who lead our EMS organizations are not politically aware and astute at navigating the rocky waters of achievement and funding, then the organizations—regardless of how good or efficient they actually are—can be overturned by four political words: “All those in favor.” If you have an inability to influence those who govern, then be prepared to be out-voted or worse—voted off the island.