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32 ISE Magazine | www.iise.org/ISEmagazine Optimizing emergency services with lean Six Sigma analysis identified significant opera- tional gaps, the team focused on several initiatives that were designed to improve the situation. All EMS staff members were con- verted to the 40-hour pay system, which paid fair market rates competitive with EMS industry standards. Overtime was paid only after 40 hours of work in a workweek for all areas. Urban staff members were provided alternate rural pay rates so they would be paid properly if they chose to work overtime shifts with lower call volumes on 24-hour shifts. The rural staffers also were given alternate urban pay rates so they would be compensated properly if they chose to work overtime shifts in the urban area with higher call volumes on 12-hour shifts. Paid annual leave was no longer paid at the time-and-a-half pay rate. Shift differentials were modeled after in- hospital compensation, which paid for nights, weekends and other hard-to-fill shifts. This alleviated staffing shortages and improved service levels. One year after implementation, the EMS system was approximately $800,000 favorable to budget for salaries. EMS staffers in the urban area of Bibb County with excessively high call volumes were converted from 24-hour shifts to 12-hour shifts. They worked a staggered rotation of seven total shifts per 14-day pay period with days off be- tween shift sequences. All staffers were polled prior to the shift changes and were allowed to sub- mit shift preferences that would work FIGURE 4 Pleasant results All emergency response metrics improved after the black belt project. Before 40-hour system change After implementation of new system Emergency response times • Average per month = 10:57 • Fractile % = < 12 Minutes 67.09% Emergency response times • Average per month = 9:20 • Fractile % = < 12 minutes 79.84% Unit hour utilization • 0.56-1 Unit hour utilization • 0.37-0.415 Call volume range per truck per shift • 21 Call volume range per truck per shift • 10 Out-of-chute times • 1:30 minutes Out-of-chute times • 00:51 minutes Employee call outs (average per day) • 1 Employee call outs (average per day) • 0.3 Test of hypothesis (paired comparison small sample) dbar: 1.15 Standard deviation: 0.4 Sample: 7 Alpha: 0.01 t test: 7.607 1 tail t table: 3.143 2 tail t table: 3.707 Conclusion: T test > T table (1 tail test); reject null and accept alternative hypothesis. Response times were reduced after optimization at the 99% confidence level. Training for continuous improvement Navicent Health is a 6,000-employee health system/academic medical center that serves 800,000 residents in Central and South Georgia with 830 beds for medical, surgical, rehabilitation and hospice purposes in more than 30 locations. The medical system began its continuous improvement journey in 2013 when management created a continuous improvement cost center. The center included a chief quality officer who also was a master black belt. The quality officer taught cohorts of lean green belts internally in classes accredited by the Institute of Industrial and Systems Engineers. Early in the following year, Navicent began its first Six Sigma black belt cohort. Fifteen leaders completed the rigorous training and successfully executed an internal black belt project within one year of class completion to earn their black belts. Since the inception of the program, Navicent Health has trained nearly 700 lean green belts and two cohorts of Six Sigma black belts for a total of 26. In addition, Navicent invested in 23 other staff members by training them in a change acceleration process course sponsored by a partnership with GE. Most recently, Navicent Health created its Center for Disruption and Innovation, which focuses on enterprisewide continuous improvement, research, project management and commercialization. This center is led by the chief strategy and innovation officer.