ISE Magazine

FEB 2017

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February 2017 | ISE Magazine 33 best for their families and lifestyles. More than 90 percent of the staff members re- ceived their first preference, which sig- nificantly helped satisfy the workforce. Detailed unit hour utilization reports per crew for all service areas were built with goals of 0.2 for rural areas (24-hour shifts) and 0.4 for urban areas (12-hour shifts). All rural area crews' unit hour utiliza- tion was increased to and maintained at 0.2, while in urban areas utilization was reduced to and maintained at approxi- mately 0.4. This ensured that crews were adequately productive while reducing overutilization, fatigue and other things that led to a dissatisfied workforce. In turn, service levels and response times increased. Staffing levels for all areas were ad- justed based on specific hourly demand analysis data using the 90th percentile, along with a staffing buffer of one to two ambulances per hour based on the service area. Temporal demand was addressed with temporal staffing structures to ensure more ambulances were available during peak call hours, leaving fewer available during nonpeak call hours. This helped improve and maintain emergency re- sponse times. Geographical software analysis was conducted to determine the best place to locate EMS substations in all counties in the service area. This determination was based on historical call volume data and risk analysis. This statistically placed the on-duty ambulances in areas with the greatest probability of call locations, which contributed to faster response times and higher levels of service. Figure 4 details the summary of re- sults after implementation, which shows significant improvements systemwide in emergency response times (12 percent improvement), unit hour utilization (30 percent reduction in the urban area), call volume variation per ambulance (50 per- cent improvement), out-of-chute times (40 percent improvement) and employee call outs (70 percent reduction). The improvements saved more than 37,000 minutes in emergency response times, and in this industry, time equals lives. The lean Six Sigma team used test of hypothesis (paired comparison small sample) to test the improvement of emergency response times post-im- plementation, which also is summarized in Figure 4. Control After implementation and verification of the successful results, the changes have been controlled by monitoring real-time dashboards and analytics for emergency response times per county, out-of-chute times per crew, turn- around times per crew, unit hour utili- zation per crew and hourly call volume demand analysis to ensure optimization is achieved and maintained. Figure 5 shows the current performance of emergency re- sponse times over one-year post- implementation. This is evi- dence of sustainability. Lessons learned The Navicent Health lean Six Sigma black belt team learned a number of great lessons that can be applied in any enterprise. First, designing real-time dashboards and utilization re- ports were essential to imple- menting and sustaining positive change, as these statistics guided the team each step of the process. Next, the team learned early on that change is much easier and more likely to be sus- tained if customers (both external and internal) are engaged and have a voice in the process from inception through implementation. Finally, well-defined goals and key performance indicators (KPIs) that can be measured in real time are essential to realizing long-term sustainable change over large geographic areas. Casey Bedgood is a black belt leadership fel- low i Navice t Health's Ce ter for Disrup- tio d I ovatio . I 014, Bedgood be- came Navice t's first i ter ally trai ed Six Sigma black belt via the I stitute of I dustri- al a d Systems E gi eers. He also was the admi istrative leader for the Navice t Health EMS departme t from 2013 to 2015. He spe t the previous 16 years servi g Navi- ce t Health i arious EMS roles, i clud- i g as a merge cy medical tech icia , cardiac tech icia , paramedic, field trai i g officer, ma ager a d operatio ma ager/ director. Bedgood is certified as both a Geor- gia a d Natio al Registry paramedic. He ear ed a AS i aramedic tech ology, a BBA mag a cum laude from Mercer U i- versity a d a PA from Georgia College a d State U iversity. He also is a ISE lea ree elt, is CAP trai ed via GE a d is a member of the America ollege of Healthcare Executives. FIGURE 5 One year later … Navicent Health's emergency medical services response times continue to trend down one year after the black belt project.

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