Acadian Ambulance started operation in Lafayette, LA, in 1971 as a fledgling service with two ambulances and eight medics. Today, Acadian is the largest private ambulance service in the nation, covering more than half the state of Louisiana and two counties in Mississippi, and serving a population of more than 2.4 million people. Acadian's service area encompasses more than 21,000 square miles, which it serves from 98 different stations. Over 1,000 medics care for emergency and convalescent patients, assisting more than 241,000 individuals each year from 185 ground ambulances, six helicopter ambulances and two fixed-wing aircraft.
To respond to the needs of this large population, Acadian's scheduling unit coordinates the vast amount of human resources required: staff to operate the vehicles, dispatchers to facilitate their movements and maintenance personnel to keep the fleet in repair.
"The better planned our resources are, the better we are able to serve our population," says John Ritter, an operations manager for the agency.
Scheduling is vital to providing appropriate coverage and improving ambulance response times.
"If we're going to save lives, it's important to hit the ground running," asserts Ritter. To ensure a rapid response, appropriate levels of staffing and equipment are needed in the right places at the right times.
The Challenge of Scheduling
Scheduling EMS crews is a massive undertaking, requiring a great deal of precision and time. It is extremely difficult to manage resources in a complex environment with uncertain demand. A tremendous amount of data is required in order to create schedules based on estimates of actual demand. Gauging demand once was done by manually leafing through logs of calls and then using pushpins to plot call locations over certain periods on a wall map. In recent years, Acadian began creating reports from its computer-aided dispatch system and importing that data into a spreadsheet. While this has provided improved estimates of demand, schedulers are still faced with a lot of guesswork in trying to estimate the resources needed, since they are unable to examine the types of calls in conjunction with their time and place.
The assignment of staff to the schedule structure is also very challenging. Management must not only fill the ongoing schedule with medical personnel, but also communicate these schedules in a timely manner. For years, the EMS industry has struggled with manually creating and filling medic schedules. Schedules were typically created by hand and maintained with pencil and paper.
"This was an insanely time-consuming task, requiring hours and hours for each two-week period for each of the major divisions," says Ritter. "Our staff would have to plot 19 rotating shifts on a blank calendar and then deal with varying staffing levels and requests for time off and vacation."
This process left a lot of room for human error.
In recent years, calendar programs and spreadsheets have been used to keep schedules. While these methods offer a minor improvement, any simple change to the schedule could still throw everything off. If an employee is on vacation, calls in sick or is absent for any other reason, that employee must be replaced. This translates into pulling someone off of their schedule to fill in for the missing employee, and then rearranging other schedules to make sure all shifts are covered.
Acadian has an especially challenging scheduling environment because it provides emergency services not only to metropolitan and rural areas, but also to the most remote parts of Louisiana's swamps and oil installations in the Gulf of Mexico. The division that provides service to offshore drilling rigs operates very differently from the ground divisions, since, due to transportation constraints, its schedules must be matched to those of the rig workers. Although the ground and offshore services are operated separately, the offshore medics often fill openings in the ground schedule when they are home between hitches.
On top of that, medic schedules everywhere have become more complicated in recent years. Traditionally, schedules consisted of 12- and 24-hour shifts. However, in order to maximize coverage and ambulance utilization and keep employee expenditures low, companies have begun creating complex schedules. Providing a variety of scheduling options is also vital to meeting the needs of employees who head single-parent families, pursue education or have other personal demands. Schedules must also be designed to comply with federal and state labor laws.
There are complicated schedule rotations for the majority of Acadian's crews. One particular schedule rotates every 49 days. Crews start work at different times and locations. In Acadian's Central Division, 14 of the crews work a combination of 10- and 24-hour shifts. Twelve of these crews are always assigned to the same two ambulances, depending on whether it's a 10-hour or 24-hour ambulance. So, to maximize ambulance resources, the division has two crews working the same rotation who are not assigned to the same two ambulances. The crews rotate between several ambulances, which requires them to report to work at different locations at different times.
The schedulers at Acadian had long recognized the need to improve their scheduling system. However, due to the complexity of many of their schedule rotations, computerizing the process presented a challenge. "We reviewed several systems over the years," says Ritter, "and none of them could accommodate the complex rotations that were required."
After several years of searching for a packaged solution, Acadian teamed up with the ISERA Group, of Santa Barbara, CA, to create a scheduling system that could meet its unique needs.
ISERA developed Quick Response Deployment Planner (QRDP), a program designed to assess appropriate staffing and resource levels to meet fluctuating demand in volatile environments. Acadian purchased a license for this system in 2000. Using statistical calculations embedded in the system, Acadian could analyze minimum, average and peak demand values. These demand values were then used to forecast future call volume, which became the basis for shift development. This allowed schedulers to gauge times when they were overstaffed or understaffed and alter shift plans accordingly.
In response to a need identified by its personnel who had experience in emergency services, ISERA also developed a prototype program to generate EMS schedules. This product, Quick Response Crew Scheduler (QRCS), was shown to Acadian's regional schedulers and used to identify and formalize specific rules and constraints that go into scheduling. In addition, the limitations of Acadian's current processes, such as the inability to generate schedules on demand and make real-time personnel changes, were also reviewed. ISERA identified the critical elements for functionality, then began developing the product as a Web-based application customized for Acadian and the EMS market in general.
Some of the schedulers' desires included the ability to add shifts on the fly, to modify start and end times and to permanently replace an employee with another on the schedule without having to modify every shift individually. In addition, Acadian wanted the system to be integrated with its time sheet and payroll systems.
"The focus from the start was on making Crew Scheduler a user-customizable product," says ISERA President Joe Grimes. "The application is capable of building shift plans that incorporate agency-specific requirements, personnel skills and qualifications, and availabilities of individual employees. It is able to optimize the schedule with respect to the user's needs.
Today, Crew Scheduler allows Acadian to plan operations, schedule shifts, specify staff availability, view calendars and communicate internally. Employees are able to view their own scheduled shifts or all the shifts in their region from any computer with online access. They can request shifts or time off, while managers can plan for future events, prepare alternatives, evaluate efficiency and run "what if?" drills. "What used to take hours," says Ritter, "can now be accomplished in minutes. Schedules can be generated on command, and human error has been virtually eliminated."
The technology allows personnel to be assigned to shift patterns, which can then be repeatedly scheduled as far out as desired. Personnel can also be assigned to individual shifts on a daily basis, if necessary. Schedulers can swap employee shift patterns at any time, and the system will propagate that change as far into the future as desired by the user. The system also facilitates last-minute adjustments to the schedule due to employee illness, injury, status change, equipment failure or any other reason by assisting the user in finding available qualified personnel for shift slots. Furthermore, shift location and vehicle assignment can be associated with a shift type or pattern, which can then be applied to a repeated pattern in a schedule. The vehicle assignment can be changed later to accommodate unexpected situations such as equipment failure. In addition, reports are generated daily listing current schedules and employees available to fill in in case of an emergency. This ensures that schedules can still be maintained if the system goes down.
The product was also designed to assist with administrative aspects of business. Information such as pay schedules and shift patterns worked, derived from the planned schedule and exception log, can be exported to the electronic time sheet program. Employees can log differences between the planned schedule and the executed schedule to show unplanned overtime or shift overlap due to calls late in the shift. The logged exceptions then must receive managerial approval before export to the payroll system.
The ability to better gauge staffing demands and automatically generate schedules has greatly assisted Acadian.
"It has allowed us to adjust the times and locations of our resources, making us more efficient in saving lives and money," says Bob Richardson, the service's software development manager. "In addition to providing better overall coverage and improving response times, we're able to alter schedules and respond much more quickly to catastrophic events such as a hurricane or pileup on the highway."
Financial benefits include the more efficient use of employees, being able to minimize overtime and maximize use of lowest-cost salary scales, and the improved tracking of all resources and personnel.
Beyond these benefits, employee satisfaction has also been greatly enhanced. Employees enjoy the greater stability of their schedules through the elimination of mistakes made with the old methods.