commentary FossilMedic on 29 Jul 2008 09:01 am
Information Age Deployment
Fredrick Winslow Taylor was fascinated by the developing Industrial Revolution and, instead of going to Harvard, started a four year apprenticeship at a small Philadelphia pump factory in 1874. He then went to work for Midvale Steel, where he rose from laborer to chief engineer in twelve years. During that time he obtained master and doctoral degrees in mechanical engineering.
The Principles of Scientific Management was published in 1911. Taylor described the breakdown of work tasks into constituent elements; the timing of each element based on repeated stopwatch studies; the fixing of piece rate compensation based on those studies; and standardization of work tasks on detailed instruction cards. These actions dramatically improved productivity, using the one “best” way.
While Taylorism increased factory output by up to 300%, overenthusiastic application reduced humans in the factory to carbon-based machines. The use of stopwatches was often protested and led to a strike. After Congressional hearings, the federal government banned the use of stopwatches by civil servants in 1913. This administrative law remained in effect through 1949.
EMS SYSTEM STATUS MANAGEMENT
EMS witnessed a version of Taylorism when economist Jack Stout researched the ambulance industry for the University of Oklahoma. In 1984 he proposed System Status Management to better allocate ambulances within a community.
SSM is a data driven system where historical call data is used to deploy the ambulance fleet for optimal response times and to predict where the next cluster of calls is likely to occur. Using time-of-day and location, response data for the previous 20 weeks are analyzed. SSM system managers believe that they can predict when and where calls will occur …or at least establish trends.
Like Taylorism, the enthusiastic application of SSM in the late 1980s lead to terrible working conditions for paramedics and emts. Some would spend their entire 8 to 12 hour work shift sitting in a cramped ambulance on a street corner, using fast food bathrooms. There was no recreation, training, physical fitness or recovery (nap) time.
THE NEXT GENERATION
Three years ago, Jay Fitch, founding partner of the EMS consulting group Fitch and Associates, started the Pinnacle leadership forums. It provided sessions in advanced and sophisticated issues affecting emergency medical services. http://www.pinacle-ems.com/
SSM morphed into “high performance ems systems,” and some of the young gun SSM gurus from the late 1980s used the first Pinnacle conference like a 12-step recovery meeting. They admitted that they aggressively applied SSM to get the last percentage point of productivity at the expense of the employees. Amazing what 40-something learns from his 20-something experiences.
HIGH PERFORMANCE EMS IN THE INFORMATION AGE
For me, the most fascinating area is the evolution of SSM in the Information Age. Using the geographic and time information generated by computer aided dispatch systems, automatic vehicle locators and geographic information systems an agency can redeploy scarce resources to where they are needed the most.
I spent Monday in a conference room, manipulating ems response data in a Pinnacle workshop. The idea was to get a three-dimensional understanding of ems volume, demand and supply. The ems industry is too small and specialized to get custom software, so we slogged through a year’s worth of data using Excel, Access and MapPoint to develop ems deployment decisions.
Example of incident workload
We have almost come full circle. When the RAND Corporation was hired by New York City in the late 1960’s, the ground-breaking work on fire department deployment analysis was restricted to service areas defined by circles or diamonds. Forty years of information management improvements allow me to use a laptop to provide a street-by-street, hour-by-hour, season-by-season deployment analysis for a fire department.
As we look at the continuing shrink of municipal revenue, maybe it is time for the fire department to adopt some of the deployment practices honed by the large non-fire high performance ems agencies.
