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From the Officer’s Desk: What’s Adding Value?

EMS officers must be well informed about the day-to-day business activities that have a direct impact on their service. This requires understanding what activities are necessary to support core services, determining if they’re truly adding value, and having the flexibility to adjust if they’re not. So what’s the best way to identify essential business activities that add value? 

Hub-and-Spoke Model

A business model that has been widely used to maximize organizational efficiencies and optimize transportation networks is the “hub-and-spoke” model. Although many organizations use it to distribute goods, services, and people to endpoints from a central location, it is most commonly seen in the airline industry.

Airline companies will have a hub, or central airport, from which numerous flights depart and fly different routes (spokes) to get passengers to different destinations. Having several hubs throughout the country allows the company to maximize the flow of passengers to specific locations from which it can maximize the number of different routes departing.

Note, though, that the flow of service does not only travel in one direction from hub to spokes. Passengers may begin at a spoke destination and travel to the airline’s hub to connect with a flight that takes them to another spoke destination. Therefore, understand the hub-and-spoke model as a system of interconnecting networks in which the hub is a central pass-through point, rather than just a point of origin.

Applying It to EMS

EMS systems may already use the hub-and-spoke model in certain operations—for example, the distribution of supplies and equipment from a distribution center to field stations; communication center dispatching of emergency requests for service (from a central hub) to EMS stations or field units; and the dissemination of policies and procedures from headquarters to field personnel.

We can use it also to consider the EMS organization as a whole and the activities that support its core services. Here spokes can be operational or administrative activities, processes, systems, culture, employees, or anything else that contributes to the overall service of the organization. For example, the training division would be considered a key spoke that adds value to the organizational hub it supports. The fleet division and specific resources used to repair emergency vehicles are another. If either of these spokes fails, the organization will find itself in a difficult position.

EMS officers must assess spokes from both “macro and “micro” views to determine if they add value, need adjusting, or need to be eliminated altogether. Let’s use fleet services as an example. The macro (wide-angle) view would consider whether it’s more-cost effective to employ mechanics, purchase space where ambulance units can be repaired, and purchase all the necessary tools needed to repair them, or just outsource the responsibilities of the fleet division. Which option adds the most value to the organization? The micro (specific) view would ask if the current processes of ambulance maintenance add value—e.g., how long does it take to get a unit back in service after it’s delivered for repair? The time it takes to repair the ambulance impacts how effective the organization is in providing service to the community. If there are no units available to respond, not only will the service not be provided, but there will also be a liability issue. Therefore, the EMS officer must evaluate anything that impacts the organization’s service delivery, understand its role as an organizational spoke, and determine whether it is worth keeping.

Not all spokes may add value, and others may have at one point but no longer serve a purpose. These spokes, if left in place, will cause the organization to be unproductive and stagnate. When identified, they must be reviewed and either revised or eliminated.

Other necessary and value-adding sections/spokes include finance, human resources, logistics, medical direction, operations, dispatch, and information systems. An organizational spoke can also be a nontangible component, such as culture, collaboration, or communication. If an organization has a positive working culture, its likelihood of achieving positive outcomes will be much greater than it would be in a negative working culture. Therefore, a positive working culture is a value-added spoke.

Spokes are also interdependent. For example, a problem with the finance section could easily spill over and affect the fleet section, which would in turn impact the operations section if vehicles are unable to respond to emergencies. Similarly, if the training section is inadequate, repercussions may be seen in the human resources section through high employee turnover, in the dispatch section through insufficient training, and in the operations section if response skills are not practiced and updated. Strength in all spokes is critical for the sustainability of the organization’s service.


The hub-and-spoke model can be used in many ways, from the transportation and distribution of goods, services, and people to weighing activities that add value and support an organization’s core service. EMS officers and other organizational leaders must be familiar with their organizational spokes and ensure they add value to ensure quality service delivery.

Orlando J. Dominguez, Jr., MBA, RPM, is assistant chief of EMS for Brevard County Fire Rescue in Rockledge, Fla. He has more than 30 years of EMS experience and has served as a firefighter-paramedic, flight paramedic, field training officer, EMS educator, and division chief. He has authored two books, including EMS Supervisor: Principles and Practice, and is a certified Lean Six Sigma Green Belt. Follow him at @ems_officer. 





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