The Phoenix in Fort Worth
What MedStar can
teach us all.
By Alan Perry
3/1/2015
I chose to visit MedStar Emergency Medical services to
examine what makes their system work, not just the mechanics of operations and
program development, but also its culture –the people and attitudes that make it work. Some would suppose that I
should be more interested in their high-performance EMS system or their advances
in the field of mobile healthcare. These are compelling interest as well;
however I doubt they would exist without a firm foundation.
My first impression came through a brief examination of
their website and an email I sent to Matt Zavadsky, Public Affairs Director. I introduced myself and explained that I intended to visit their
operations as part of another trip I was making to Dallas. I also requested
some detailed information about their operations and how he thought a
Fire-based EMS system might best proceed, as well as several other questions
relevant to my regions unique EMS structure. I was pleasantly surprised to
receive a reply within a day with detailed and unguarded answers to my
questions. His very candid responses reinforced several things I already
suspected and cleared up some misconceptions. This entire exchange set me off
with high expectations.
MedStar EMS has a story that began with struggle, the Area
Metropolitan Ambulance Authority was established in 1986, and was responsible
for contracting ambulance services with vendors while maintaining infrastructure
and communications assets. In 2005 after multiple months of poor performance
from vendors, the authority cancelled the contracts and took on the
responsibility of the daily operations. The rest is history; they took the
opportunity to rise from the ashes, apply best practices for EMS delivery, refining
and developing their system into the high-performance system that it is today -an
ongoing process.
To make my visit official, I scheduled a ride-out with an
EMS supervisor rather than an ambulance crew or the administrative tour, hoping
to get into the nuts and bolts of the operation and have time to discuss the
daily operations with mid-management. The MedStar facility is an impressive
sight to behold, the afternoon I arrived was sunny and 60 with a light breeze,
their beautiful facility on the top of a hill with the sun reflecting on the
glass backlit the flagpoles on the front walkway. I believe a figure of twelve million was
mentioned in later discussion for the approximately 85,000 square foot
facility. This facility houses the administrative offices, a training facility
on par with a good community college, a state-of-the art dispatch center, an
apparatus repair and maintenance shop, logistics & supply, break rooms, a
quiet room, library, and a soon-to-be employee clinic. The facility also houses
their supply vendor in a leased space. It’s hard to believe that this type of
facility and operations require no taxpayer support. That’s
high-performance the public can appreciate.
After a visitor pass was issued, I was escorted to the
offices of the Shift Supervisors in the middle of the building, with the
offices of the MIH medics and related support personnel. I rode with Brian White,
a senior medic who worked his way up through the organization; he is well
acquainted with the history and operations of the organization. In his position
he manages scheduling of crews, filling holes, shepherding crews through their
tours and responding to significant calls requiring additional personnel or
equipment. I soon found that the location in the middle of the building was no
accident and was representative of the organizations structure. The structure
is nearly flat with frequent and liberal lateral communication; this seems to
be what makes the organization so nimble at addressing new challenges and
achieving such high efficiency. As Mr. White took me through the facility and
introduced me to various staff members it became apparent the he was not the
only one knowledgeable about the organization, everyone he introduced me to was
eager to tell me about what they do and how the organization functions, the
enthusiasm was truly contagious.
The administrative space houses the director’s offices, the
billing staff, business development and the OMD’s offices in a very roomy and
classy environment with lots of light and windows. The dispatch center is
located in a separate space with multiple dispatch consoles, using Pro QA for
medical call screening. Units are deployed using system status management and
call prediction software that anticipates calls based on historical data. The
number of units staffed is based on historical call volume and ranges from 22
units at night to 44+ during the day. Shifts are typically 12 hours with
employees self-scheduling using E-pro net scheduler. Discipline is managed
using the “just culture” model for serious events.
Logistics are housed on the ground floor and include supply
and maintenance areas. A complete repair facility with full time technicians
manages the repair and maintenance of the vehicles. A rigorous preventive maintenance
program is in place that keeps the units productive and reduces maintenance
cost through failure avoidance. A bin stocking system is used to uniformly
stock each ambulance; the bins are inventoried, refilled and replaced at the
end of every shift. A logistics vehicle is staffed to resupply units at the hospitals;
it carries EMS supplies, oxygen, spare batteries and vehicle maintenance items.
The supply room keeps two days of stock on hand; items are reordered and delivered
via conveyor from the vendor housed on the second floor. As units return from
their tours they are cleaned, washed and restocked by the logistics staff and
placed back on the ready line. Units are garaged indoors when not in use.
Training facilities and training staff offices are in their
own space away from operations, logistics and administration spaces. The spaces
are comfortable and flexible for various types of instructional methods and
classroom configurations. The AV equipment, computers, software and simulation
aids are current or new reflecting the best technology available –on par with a
good community college. The organization offers continuing education for
providers in a classroom setting, certification programs for EMT through
paramedic and MIH, and has its own AV production unit. The training unit provides training to administrative
and support staff as well.
It appears that efficiency is valued by the organization as
its responsibility to its patients and the general public. Efficiency improves
patient care as much as it makes effective use of public funds. Every aspect of
EMS system design and delivery has been carefully thought through and
implemented to maximize utilization, reduce waste, and maximize the use of
precious resources. The cost of providing this type of service to traditional
or Fire-based EMS systems is not a monetary one; it may be the dismantling of
existing command and management structures, and drastic changes to the
organizational culture. This is the future of EMS, high-performance EMS is here
to stay and is what the public deserves from both a quality of care perspective
as well as fiscal responsibility. I thank all the staff at MedStar for taking
time to hear my questions, for caring and having the commitment to move the
profession of EMS so far forward. Great job MedStar!
AP
