There’s good news for San Franciscans who are sick or injured – ambulance response times have increased noticeably after years of effort.
But it could have been great news.
That’s according to David Williams, a Saybrook PhD student in Organizational Systems, who is one of the nation’s leading experts in Emergency Medical Service (EMS) system. A consultant with Fitch & Associates, he works with communities to assess their emergency systems and advises them on improvements. He is also the research and author of two of the industry’s leading studies of operational and workplace practices and helped develop the leading EMS Leadership Forum called “Pinnacle.”
While stressing that he has not independently reviewed San Francisco’s EMS system, Williams says media reports indicate there’s still room for improvement – and that a more systemic, patient-centered, approach could be the answer in SF and across the country.
According to the San Francisco Chronicle, San Francisco’s first responders used to be late in one out of every 4 cases: they’re now late in one out of every five. That’s definitely a step in the right direction, Williams says. So are steps like quickly dispatching emergency units as soon as you know where the location is, while 9-1-1 callers continue talking to the patient to learn more about what’s wrong.
But those kind of small tweaks are only part of the answer and do not result in transformative change, Williams says.
“You can make small fixes like this and see small results, but they won’t likely add up to dramatic improvement,” Williams says. “That requires a systemic approach – rethinking the whole system, top to bottom, and organizing it around the needs of the patients it is intended to serve. That can lead to dramatic breakthroughs, but it’s not the approach taken by most systems facing issues like San Francisco right now.”
As with many organizations, EMS services are usually organized around the needs of the providers – in this case the drivers, dispatchers, medical technicians and others – instead of around the needs of the people who use the service. As a result, it’s difficult for the organization to achieve its intended mission because many of the delays and inefficiencies the system encounters are hardwired in: they can’t be “fixed” because they’re central to the way the organization does business.
“It’s not that people aren’t trying hard to do the right thing – for example, in San Francisco they definitely are trying,” he says. “But they may not have an awareness of how much the system can change for the better if you rethink fundamental assumptions and look at the whole system.”
A great example, Williams says, is matching the supply of available ambulances and personnel with the likely demand for their use: most systems do not do an effective job of it.
“Employees tend to like very regular schedules that match their lives like anybody else – they want to know they’re going to work weekdays, 7am – 7pm” he says. “Unfortunately, sick people don’t follow those schedules and can need help at any hour of the day. Also, people move throughout the service area as they go to work or home, which means the location they need help also changes. EMS systems need to use historical call patterns to predict where those needs for service may be and adjust continuously.”
It’s like Starbucks, he suggests: a coffee shop wants to have a lot of people on staff for the morning rush, and a lot fewer people working during the time between breakfast and lunch. Also, there are going to me more Starbucks in places where there’s more coffee drinkers.
But coffee shops staff appropriately to meet the rush: EMS services rarely do.
“A lot of EMS departments will have the same staff capacity 24 hours a day and distribute them evenly to cover the service area, but you see ebb and flows of call demand like everything else, so there’s not a good match-up between the resources you allocate and the demand you need to meet,” he says. By analyzing the data to see when people historically need help, an EMS service can reduce its response times dramatically by making sure it has the right staffing, in the right places, at the right time.
The tragedy, according to Williams, is that while there are a many ways a systemic, humanistic approach can improve performance, increase efficiency, and control costs – it’s not until the media highlights poor performance that communities take note and act. He’d much prefer they act proactively, especially in a tough economy like today.
“People just don’t think about EMS systems, your chance of needing an ambulance are significantly higher than the potential you’ll be the victim of a crime or fire, but it’s often forgotten.” Williams wishes communities would be proactive and recognize that service can be improved significantly if they looked at the whole system.