As EMS systems face down the global economic crisis and headlines scream daily of departments scrambling for what to do, questions emerge about the ways we run our systems and utilize our existing resources. Are more resources needed, or must we do a better job with what we have? It's a common question on the minds of EMS managers and elected officials.
For this month's column, I spoke with David Williams. Dave is a senior consultant with the well-known EMS consulting firm of Fitch & Associates. He is an EMS systems expert and process improvement advisor, and has served as a provider, educator, researcher and leader in almost every size and model of EMS organization. Before joining Fitch, he was quality management commander for Austin-Travis County (TX) EMS.
Williams is an alumnus of Springfield College in Massachusetts and the University of Maryland, Baltimore County, where he respectively earned undergraduate and graduate degrees in Emergency Health Services Management. He is currently writing his dissertation for a doctorate in Organizational Systems from Saybrook University. His research is focused on patient- and customer-centered EMS system design.
Where would limited financial resources best be directed to improve an EMS system—toward additional manpower and equipment, or toward better systems development/research?
In a recent national survey, EMS organizations large and small from across the United States reported the economy is affecting them, and half had experienced budgets cut by as much as 10%. What a lot of people don't realize, though, is these decisions were made when the impact of the economy was a prediction. Next year's cuts will be a result of reacting to the true, experienced shortfalls, and more is expected. It is critically important that everyone be focused on meeting the challenges in the coming years. Unfortunately, many systems continue to repackage or tweak themselves, but few are evolving to their already-changed environment. The current economic situation will bring out either the worst in those who are unable to change or the best in those who are.
When a leader suggests the answer to an improvement problem is more people, more resources or more money, there's a strong chance they're not getting it, because those are rarely the true fixes. EMS leaders who get it start with a strong understanding of their core mission. This was recently wonderfully articulated at the Fire Rescue International conference by Renton, WA, Fire Chief and IAFC leader I. David Daniels, who made the case that the fire service's primary mission has shifted to EMS over the last 30 years, and that EMS was his No. 1 business. He argued fire departments needed to be focused on being necessary and community-oriented.
Strong EMS leaders have clear aims for moving forward based on objective thinking. In the coming months, they will be reevaluating their organizations from top to bottom. With every position, activity and line item, they'll ask themselves, "What am I trying to accomplish?" and "How does this directly benefit our patients/customers?" If the answer isn't clear or directly tied to the core mission, then they must responsibly determine how to change, give away or discontinue it. Only through studying what's needed and what works and then redeveloping the system can you navigate the waves of the economy.
EMS systems need to reliably deliver the most appropriately trained person to the patient's side in a timely manner. Sadly, a large number of EMS systems (even those with all the resources, money and people power imaginable) can't deliver this on a daily basis. The answer is rarely more, but rather to use objective data, peer-reviewed research and current best practices to design systems and processes around the needs of those who call for help. Sacrificing what we want or think for what the data says or what's directly important to the next patient is the right answer.