Process Improvement Team “Response Times” February 23, 2007
Dec 31, 2015
ProcessImprovement Team
“Response Times”
February 23, 2007
Project Team
• Team Members– Jim Pettit, Paramedic– Vince Macias, Paramedic– Mike Martin, Paramedic– Rob Sewell, EDC Lieutenant– Kathy Giardina, EMS
Lieutenant
• Team Facilitators– Warren Panem, EMS
Shift Commander– David Wheaton, EMS
Shift Commander
• Sponsor– Mary Kim Dickerson,
EMS Operations Chief
Define Phase
• Problem statement EMS is constantly challenged to maximize efficiency by
minimizing response times. Quicker and more appropriate responses by needed units will serve the citizens and visitors of Lee County by serving them to the best of our ability. The goal of responding to emergency calls less than 8:59 > 90% of the time is not being met.
Project ImpactDefine Phase
• Alignment to County’s goals and objectives
• Goal 2: Make Lee County Government the benchmark county in Florida for innovation and excellence in customer service and technological operations.
• Objective 1: Continue assessment of organizational practices through continuous improvement techniques.
• Objective 3: Continue to actively pursue technology systems that increase productivity and efficiency, and decrease costs.
Project ImpactDefine Phase
• Project goal County Ordinance - Response time average
below 8 minutes or responses <8:59 at least 90% of the time. Our goal - Anticipated savings based on a reduction in unit hours necessary = $165,000 annually by minimizing response time.
Project ScopeDefine Phase
• In scope All emergency calls and type I transfers • Out of scope Calls cancelled prior to arrival and Type II
or III transfers
Process Flow ChartMeasure Phase
Lee County Emergency Medical Services
Response TimesProcess Map
Unit Acknowledges Receipt of Call
Call Dispatched
Medics Respond to Unit
(OOC)
Locate Call Via Mobile Data Computer
(MDC)
Press Enroute To Call
Drive to Call Location
Begin Physical Response
Start
End
Yes
No
Unit Arrives on Scene
Press Arrival on Scene
No
Were Tones Received?
No
Does Unit Start?
No
Is Unit Closer to Another Call?
Yes
Critical Accidental or Mechanical Failure?
Yes
Measure Phase
Response Time - MinutesJanuary 2007
5.0
5.5
6.0
6.5
7.0
7.5
8.0
North Cape West South Central Total
A Shift
B Shift
C Shift
D Shift
E Shift
Measure Phase
% Response < 8:59January 2007
75.0%
80.0%
85.0%
90.0%
95.0%
100.0%
North Cape West South Central Total
A Shift
B Shift
C Shift
D Shift
E Shift
Critical Performance Indicators
Analyze PhaseLCEMS Response Times
OOC until Arrived
6.3
6.6
7.0 7.1
6.6 6.6
66.26.46.66.8
77.2
August Sept Oct Nov Dec Jan
Total - Response Time - minutes
Critical Performance Indicators
Analyze Phase
% Response < 8:59
83.5%82.7%
81.7% 82.0%
80.6%81.5%
78.9%
0.760.770.780.79
0.80.810.820.830.84
July August Sept Oct Nov Dec Jan
Total - % Response < 8:59
SIPOC DiagramAnalyze Phase
Call dispatche
d
Response Time
Unit arrives on
scene
Suppliers Inputs Process Outputs Customers
(Providers of the required resources) (Resources required by the process)
(Top level description of the activity) (Deliverables from the process)
(Stakeholders who place the requirements on the outputs)
Fleet Fleet: Requirements Out of chute Requirements Patients
Logistics Keep Units 10-8 Available unitsEnroute time Patient: Operations
Human Resources Provide Vehicles Unit hours Fast
EMTs Logistics: Equipment and Reliable
Paramedics Supplies Supplies Competent
Training Division Clean equipment Personnel Emergency Care
RecruitmentAvailable equipment Competent Operations:
Union HR: Road ready OOC<120
ER Bed Availability Cleared recruitsGood work conditions <8:59
Public Relations Cleared promo emp Quick offloads
Labor Appropriate calls
Training Division
Initial Training
Competencies
Con Ed
QA
Analyze Phase
Analyze Phase
• Listing of root causes– Offloads – non-value added time awaiting unit
availability– Transfers – 5% of total call volume – being treated as
emergency calls– Clock stops upon Paramedic arrival – outlying medics
arrive on scene, fire department medics on scene– Peak Demand issues
• Staffing – too many units at night – not enough during the day
• Roaming Units – peak demand with no designated zone
Improve PhaseSolution Prioritization
Matrix
Accomplish Goal Cost effective Measurable Total Rank
Specific units don't do transfers 0.37 0.28 0.10 0.34 0.28 0.10 0.29 0.21 0.06 0.261 2
Add additional Peak units 0.37 0.24 0.10 0.34 0.07 0.02 0.29 0.33 0.10 0.22 3
Combination of both ideas above 0.37 0.13 0.05 0.34 0.15 0.05 0.29 0.16 0.05 0.15 4
Hire staff to sit in ERs 0.37 0.07 0.02 0.34 0.19 0.06 0.29 0.12 0.03 0.12 5
All units available within 10 min 0.37 0.28 0.10 0.34 0.32 0.11 0.29 0.17 0.05 0.263 1
Improve Phase
Pilot Program:February 15-28 – Shift command will place units
available 10 minutes after offload except trauma alerts and priority one calls
March – Medics 1,2,3,4,7,18 will not provide any interfacility transfersApril – Add 2 peak load units
Improve Phase
• Results from pilot – will not be available until May 1
• Preliminary data to be continually shared
Control Phase
• Identification of process owner– EMS Shift Command
Control PhaseWhat to measure
% Response < 8:59
83.5%82.7%
81.7% 82.0%
80.6%81.5%
78.9%
0.760.770.780.79
0.80.810.820.830.84
July August Sept Oct Nov Dec Jan
Total - % Response < 8:59
Hand-off Issues(Parking Lot Issues)
• Peak load staffing
• Static deployment
• Accuracy of AVLs
Questions?