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?