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HIGH-PERFORMANCE EMS 14 NOVEMBER 2017 | EMSWORLD.com many high-performance/high-value EMS systems can operate efficiently and have great results at a lower cost, resulting in reduced taxpayer subsidies and a sustain- able funding model. The idea of SSM has, to some extent, been vilified by some in EMS. This may not be fair. It takes a very robust skill set to effectively and efficiently manage an EMS system. Without that skill set, you run the risk of creating imbalance in the system. SSM is implemented in three different ways: • Competence—People who do it right: the correct skill set, paired with the tools, data and technology to match supply to demand, working collab- oratively with the people who will be responsible for implementing and operating within the system. • Incompetence—People who think they're doing it right but lack appreci- ation for the complexities and human impact of deployment planning and execution. They're not bad people or systems, they simply don't know what they don't know. • Malpractice—People who know how to do it correctly but intentionally choose to push the limits too far, drive crews to the point of fatigue and cause systems to fail. The two latter methods of implemen- tation are most likely responsible for the vilification of SSM. The unintentional and intentional mismanagement of systems, to the detriment of employees and the com- munity, results in poor system performance. Instead of understanding how to work within the system and improve, we blame the methodology, even when it hasn't been implemented correctly. SSM does not abuse people—failure to correctly develop, implement and manage a system plan causes the abuse. Balance is achieved when people know how to man- age the system based on understanding the needs of the employees and patients. Jack Stout often asked, "How long does a unit hour last?" The answer is just about an hour—no more, no less. Unit-hour pro- duction is almost the perfect example of just-in-time production: You want to build just as many hours as you need given your demand—no more, no less. If you build your plan with an expectation that you'll produce a certain number of unit hours and fail to produce that number, the system will be challenged regardless of the operational controls you put in place. Keys to Implementation To implement SSM, you first have to com- mit to developing your leaders, have clarity on process and be willing to test chang- es in your practice. Once that underly- ing structure is present, we've learned there are three keys to effective system management: • Predict—Forecast the demand in the system, both time and space; • Produce—Produce the resources need - ed based on the forecast and goals of your agency; • Observe—Measure performance and process reliability; not just response times but all the pieces that go into cre- ating the outcome that is response time. We understand the gravity of the sys- tem management plan and its impact on our employees and customers, so we take the plan very seriously. Yes, we have all the tools, talent and resources to develop an effective plan, but we also realize we need balance in the plan to assure employee well-being and customer satisfaction. We use a cross-representative team to refine our SSM plan to make sure it remains consistent with our mission. For example, we measure post-to-post moves and other daily activities and reduce unnecessary movement as much as possible. These reviews have recently led us to an interesting discussion. EMS is still learn- ing about call prioritization. Some would say we've created unrealistic community expectations for many of our low-acuity calls. If someone with a low-acuity medi- cal need walks into an emergency depart- ment, how long would they wait to be seen? EDs queue patients based on acuity, and in some urban areas it may be hours before you see the inside of a treatment room. Yet for some reason EMS agencies have set a community expectation that even low-acuity calls need a response in 15–20 minutes. Is that realistic when we know ambulance transport to a hospital emer- gency department will not speed up care for a low-acuity patient, and that ED may not even be the most efficient or effective resource to meet the patient's need? If we think of an EMS system as a health- care system, how many "beds" (ambulanc- es) do we have available, and where are they located? We're starting to ask our- selves, "Is it OK to queue low-acuity calls to maintain resources for higher-acuity calls and decrease the stress and workload of our employees?" From Static to Flexible When implementing SSM, first, realize you're already doing it. Any EMS agency that responds to calls has a deployment model; some are just not doing it inten- tionally. Their structure may be histori- cally based on what's easy for the agency or desired by the employees. Think about your resource allocation and all the things you could do with the money saved by making more effective use of unit hours. Who wants to work for an agency that squanders money on inef- fective resource deployment when it could be better used to improve the well-being of the employees and the community? Then, start measuring calls by number and location. One of the most interest- ing questions to start asking yourself is, "How many calls did we run yesterday?" Many EMS agencies struggle with a defini- If you think of an EMS system as a healthcare system, how many "beds" (ambulances) do you have available, and where are they?