ISE Magazine

FEB 2017

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30 ISE Magazine | www.iise.org/ISEmagazine Optimizing emergency services with lean Six Sigma on industry standards related to cost, service and utilization. The pay system was inconsistent with current industry trends for a number of reasons. First, staff members were paid a premium rate (time and a half ) for each hour of paid annual leave, which result- ed in staff being paid more money per hour for each hour of paid annual leave than for each hour worked. Second, staff members earned an overtime rate after eight worked hours in each shift. So at Navicent, an employee was earning 16 hours of overtime in each 24-hour shift. Obviously, in some instances this meant that yearly salaries climbed to rates that were excessive compared to industry benchmarks. The location where those staff mem- bers worked made a difference in their utilization, which had high levels of variation. Urban staff members who worked 24-hour shifts experienced ex- cessive call volumes, ranging from 16 to 24 calls per shift on average. This imposed high safety and risk factors and obviously led to excessive response times, delaying service to pa- tients. Crews became fatigued and were not satisfied, which led to excessive turnover and poor service to customers. One key metric is unit hour utiliza- tion. In the urban area, it exceeded 0.5 and often was above that, whereas the industry standard is 0.4 dependent on the service area. Rural staff averaged two to five calls per shift, which resulted in underutilization. In those areas, the unit hour utilization levels were below 0.2. A reasonable industry rural standard is 0.2 or greater per unit for that metric. Navicent's deployment plan was flawed, continuously pulling and push- ing ambulances among the four-county service area. This resulted in excessive fatigue, prolonged emergency response times, wasted motion, reworks and ex- cessive fleet expenses. These inefficiencies, of course, came with a financial cost. Navicent's EMS system gave away dozens of emergency calls per month to the local competitor due to these problems. The suboptimal staffing capacity across the system de- layed service, lost revenue and resulted in unfavorable public relations. The black belt team set out to improve emergency response times by 10 per- cent, optimize utilization (namely unit hour utilization) of resources to indus- try standards, eliminate paying excessive wages, improve the quality of care and provide safer services to the communi- ties served – all within six months. The project scope related to staffing redesign was focused on the urban ser- vice area of Bibb County, and the pay system conversion was intended to be applied to staff in all service areas. The critical-to-quality focus was on emer- gency response times, unit hour utiliza- tion per unit and cost savings. Measure To measure the current state and future improvements, the team focused on the following operational KPIs: emergency response times, turnaround times, unit hour utilization, out-of-chute times and the hourly call volume demand analysis. The response, turnaround and out- of-chute times were measured on a fractile basis, with 90 percent consid- ered the minimum acceptable standard. Also, due to state-imposed zoning re- quirements, Navicent Health EMS was required to give emergency calls to the local competitor if no ambulances were available within two minutes of receiv- ing the emergency request. These calls given to the competitor represent reworks and revenue loss for the service, as shown in Figure 1. The figure also indicates that the actual KPI measures were underperforming to Navicent Health's goal in all categories. Analyze After the actual KPIs were measured and compared to goal, control charts and a histogram were configured to analyze whether the overall processes related to emergency response times and calls given to the local competitor were in or out of control and capable. The process was in control and capa- ble (i.e., sigma level > 3) for emergency response times, but it was not optimized based on the KPI measures noted in Fig- ure 1. The process for calls given to the local competitor was out of control and not capable (i.e., sigma level < 3). This resulted in delayed service, reworks, rev- enue loss and dissatisfied patients. FIGURE 1 Not up to measure Navicent Health's operational problems in various key performance indicators were giving up calls and revenue to competitors. Actual Goal Emergency response times • Average per month = 10:57 • Fractile % = < 12 minutes 67.09% Emergency response times • Average per month = < 12 minutes • Fractile % = < 12 minutes 90% Unit hour utilization • 0.56-1 Unit hour utilization • 0.35-0.4 Calls given to competitor • Average per month = 30.5 • Average per year = 366 Calls given to competitor • 0 per month • 0 per year Out-of-chute times • 1:30 minutes Out-of-chute times • < 1:29 minutes • Fractile % = 90% Turnaround times • Average per month = 29:39 • Fractile % = < 25 minutes 38.9% Employee call outs (average per day) • Average per month = < 25 minutes • Fractile % = < 25 minutes 90%

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