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28 ISE Magazine | www.iise.org/ISEmagazine In 2013, Navicent Health's emergency medical ser- vices was a well-established provider in the state of Georgia with a strong focus and reputation for clinical excellence. However, it was experiencing a variety of operational inefficiencies, including an outdated pay system and a mismatch between staffing levels and call volume. This let the local competitor snap up numerous calls per month, costing Navicent revenue. Navicent Health EMS is a fast-paced, 911 hospital-based, advanced life support provider licensed by the state of Geor- gia as both an ambulance service and neonatal transport service. Its 911 call volume exceeds 40,000 calls per year in its four-county service area, which includes urban, rural and suburban geographical response zones. The ambulance service dates back, most believe, to the early 1900s when Navicent Health was a small community medical center called the Macon Hospital. The service provider has more than 100 staff members, a centralized communication center and staffs up to 20 ambulances per day for emergency responses, along with various community assignments. In addition, Navicent EMS transports nonemergent interfacility patients across the state and beyond. The EMS service provides advanced life support to all patients suffering any and all medical- traumatic emergencies, ranging from neonate to the oldest geriatric. Navicent's management decided to tackle the EMS ser- vice problem by deploying a lean Six Sigma team for a black belt project, adding administrative changes to optimize the system. In 2014, Navicent Health's first black belt led this interdisciplinary group of EMS leaders, administrators and human resources leaders down the path of continuous im- provement by way of DMAIC (define, measure, analyze, improve, control) to reduce variation and optimize other operational key performance indicators (KPIs). The emergency services optimization black belt project for this multicounty 911 EMS system used lean and Six Sig- ma to improve critical-to-quality elements drastically, in- cluding emergency response times, turnaround times, cus- tomer satisfaction, cost of poor quality and wasted motion. In addition, this black belt project saved a significant amount of money and optimized the system. The project positively impacted tens of thousands of customers across the multicounty service area, significantly reduced opera- tional costs, improved employee satisfaction and reduced various types of unwarranted variation. Define The EMS system was experiencing a number of issues, in- cluding an outdated pay and staffing system structure where staff worked 24-hour shifts in all service areas. The pay sys- tem and staffing model were no longer competitive based I