1. Process Improvement Team “Response Times” February 23, 2007

2. Project Team Team Members –Jim Pettit, Paramedic –Vince Macias, Paramedic –Mike Martin, Paramedic –Rob Sewell, EDC Lieutenant –Kathy Giardina, EMS Lieutenant Team Facilitators –Warren Panem, EMS Shift Commander –David Wheaton, EMS Shift Commander Sponsor –Mary Kim Dickerson, EMS Operations Chief

3. Define Phase Problem statement EMS is constantly challenged to maximize efficiency by minimizing response times. Quicker and more appropriate responses by needed units will serve the citizens and visitors of Lee County by serving them to the best of our ability. The goal of responding to emergency calls less than 8:59 > 90% of the time is not being met.

4. Project Impact Define Phase Alignment to County’s goals and objectives Goal 2: Make Lee County Government the benchmark county in Florida for innovation and excellence in customer service and technological operations. Objective 1: Continue assessment of organizational practices through continuous improvement techniques. Objective 3: Continue to actively pursue technology systems that increase productivity and efficiency, and decrease costs.

5. Project Impact Define Phase Project goal County Ordinance - Response time average below 8 minutes or responses <8:59 at least 90% of the time. Our goal - Anticipated savings based on a reduction in unit hours necessary = $165,000 annually by minimizing response time.

6. Project Scope Define Phase In scope All emergency calls and type I transfers Out of scope Calls cancelled prior to arrival and Type II or III transfers

7. Process Flow Chart Measure Phase

8. Measure Phase

10. Critical Performance Indicators Analyze Phase

12. SIPOC Diagram Analyze Phase Call dispatche d Response Time Unit arrives on scene SuppliersInputsProcessOutputsCustomers (Providers of the required resources)(Resources required by the process) (Top level description of the activity)(Deliverable s from the process) (Stakeholders who place the requirements on the outputs) FleetFleet:RequirementsOut of chuteRequirementsPatients LogisticsKeep Units 10-8Available units Enroute timePatient:Operations Human ResourcesProvide VehiclesUnit hours Fast EMTsLogistics:Equipment and Reliable ParamedicsSupplies Competent Training DivisionClean equipmentPersonnel Emergency Care Recruitment Available equipment Competent Operations: UnionHR: Road ready OOC<120 ER Bed AvailabilityCleared recruits Good work conditions <8:59 Public RelationsCleared promo empQuick offloads LaborAppropriate calls Training Division Initial Training Competencies Con Ed QA

13. Analyze Phase

14. Listing of root causes –Offloads – non-value added time awaiting unit availability –Transfers – 5% of total call volume – being treated as emergency calls –Clock stops upon Paramedic arrival – outlying medics arrive on scene, fire department medics on scene –Peak Demand issues Staffing – too many units at night – not enough during the day Roaming Units – peak demand with no designated zone

15. Improve Phase Solution Prioritization Matrix Accomplish GoalCost effectiveMeasurableTotalRank Specific units don't do transfers0.370.280.100.340.280.100.290.210.06 0.2612 Add additional Peak units0.370.240.100.340.070.020.290.330.10 0.223 Combination of both ideas above0.370.130.050.340.150.050.290.160.05 0.154 Hire staff to sit in ERs0.370.070.020.340.190.060.290.120.03 0.125 All units available within 10 min0.370.280.100.340.320.110.290.170.05 0.2631

16. Improve Phase Pilot Program: February 15-28 – Shift command will place units available 10 minutes after offload except trauma alerts and priority one calls March – Medics 1,2,3,4,7,18 will not provide any interfacility transfers April – Add 2 peak load units

17. Improve Phase Results from pilot – will not be available until May 1 Preliminary data to be continually shared

18. Control Phase Identification of process owner –EMS Shift Command

19. Control Phase What to measure

20. Hand-off Issues (Parking Lot Issues) Peak load staffing Static deployment Accuracy of AVLs

21. Questions?