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Can Emergency Services Lean on a Manufacturing Model?

3 comments

Ruminations on outcome based research

Spent time as a first-line supervisor on a haz-mat rescue company, when being a "glo worm" was new and cool.

The first response with the rescue was weird. A box alarm dispatch to a mid-rise senior facility was sending four engines, two trucks, an ems unit and the rescue … and my crew was S-L-O-W-L-Y walking to the rig.

Was this a test for the new officer?

Welcome to the Toast Patrol

The chauffer explained that they ran this address two to four times a day. The first due company is a few blocks away.

On almost every incident the first engine is returning the box alarm assignment within a minute.

It would be the first of hundreds of times the rescue would pull out into traffic, with me wailing the 2QB and stuttering the air horns. We drove the length of the shopping center parking lot next to the fire station before going in service.

Pretty dumb – why not just send the first engine and truck?

Apparently, we used to … until a 1+1 dispatch during a severe winter storm became a two alarm fire with rescue of an occupant in the fire apartment.

Looking at the details

The mid-rise facility was constructed in 1973, before fire sprinkers were required by the code to be installed within the apartments.

Built in an "in-field" property, truck company access to the rear of the building is tight.

The facility has almost 300 bedrooms.

A smoke detector is mounted in the kitchen, near the refridgerator. Every extra crispy toast and overbrewed teapot generated an alarm … breakfast, lunch and dinner.

Lean Manufacturing Model

Dylan Scott, writing in the February 2012 issue of Governing magazine, described the application of best practices by Patricia Gabow, MD, to improving Denver Health operations.

The lean manufacturing model is based on five principles, according to the Lean Enterprise Institute:

  1. Identify the value of the product for the customer
  2. Map the process for creating the product and eliminate elements without value
  3. Create a flow for the value-creating steps
  4. Let customers pull value from that flow
  5. Begin the process again and seek perfection.

Put more simply, it’s about eliminating wasteful actions. Anything that doesn’t add value for the ultimate customer is considered wasteful. “The philosophy is that waste is disrespectful to humanity because it squanders scarce resources, and waste is disrespectful to individuals because it asks them to do work with no value,” Gabow says. “We’ve added that waste is disrespectful to our patients because it asks them to endure processes with no value.”

Denver Health Becomes Profitable After Using Toyota As A Template

It it valuable to send seven fire companies two to four times a day for extra-crispy toast?

Wonder what the cost comparison and risk analysis would be if we placed a fire-rescue person at the facility to immediately respond to activated fire alarms? Maybe an ems credentialed responder with AED?

An example from Denver Health Medical Center:

Lean also inspired a restructuring of the Denver Health Medical Center’s rapid response system for patients who go into cardiac arrest. At most hospitals, a dedicated team is on call 24 hours a day, seven days a week for rapid response, and temporarily assume care of those patients from their primary nurses and doctors.

But in applying the lean principles, the medical center’s staff recognized an opportunity to cut costs while ensuring continuity of care. A regular assessment schedule was established for nurses to monitor their patients, and criteria were developed for nurses to determine if a patient was at risk. Then a specific protocol was outlined for staff to follow if a nurse made that determination, providing guidelines for moving up the chain of command if the immediate attending physician is not available or the patient’s condition did not improve.

An analysis by Denver Health staff found that the number of non-ICU cardiac arrest incidents decreased significantly following the implementation of the new procedures. And it bestowed rapid response responsibilities on staff members who were already working, rather than requiring an entirely separate team.

Mike "FossilMedic" Ward

This post dedicated to Technician Mark Baban, Rescue 401, B-shift. You left too soon.

Also on FireGeezer…

Posted by on February 7, 2012 • Filed under: Administration & Leadership, Command & Leadership, Fire Rescue Topics, Firefighting Operations, HazMat, Urban Commander • Tagged: , , , , , , , , , , , , , ,
  • Sean Brooks

    Hey mike, nice article.  Before becoming what I am now, I earned a degree in Industrial Engineering, of which “Lean Manufacturing” is but a part.  The whole issue is clouded by a couple of factors:
    1) Most fire departments have sunk costs, or at least act as they do.  The public demands a fire station staffed 24/7, might as well make those guys put down the weights and do something.  While this is the perception among the fiscal hawks, its’ probably not all that true in this day of EMS response and All-hazards training.  I think fatigue management will also chip away at this mode of thinking, but when it comes down to it, the marginal costs of sending a box alarm vs. an investigation aren’t much, certainly less than even one FTE to sit at the site.  The exception would be if the units involved were so busy that they justified the addition of units to share the workload.  Or, put another way, can we close companies/units and RIF FTEs if we change the dispatch procedure?
    2) CYA.  It doesn’t cost me anything send companies, and it might cost me my job if I send an investigation that comes up wanting.
    3) There’s not a lot of overhead available for Operations Research in most Fire Departments.  We don’t have a lot of economy of scale, since each fire department is generally it’s own fiefdom, with it’s own set of stove-pipe careers.
    4) Most FD management personnel are either uneducated, or are educated from a very limited set of courses of study.  Guessing, most have some sort of fire science or possibly public management degree, obtained part-time, with the minimum set of electives.  The fire service has a very non-diverse educational background.
    5) People barely recognize response times, much less operational performance. There’s almost no public consequence for a poorly performing fire department.  Consequently, there’s almost no demand for an ‘excellent’ fire department.  People move for jobs, schools, and to avoid crime.  Everything else is ‘hygiene’.  As long as it’s not in the news, everything must be fine.
    6) Even with good evidence, it’s all politics.  

  • http://www.firegeezer.com/ Mike “FossilMedic” Ward

     Sure, Sean, bust my bubble :)

    Later I was the engine officer at Tysons, the 1st due company.

    If we moved the single station smoke detectors out of the kitchen, the toast patrol would crumble.

    Thanks for the response!

    Mike

  • http://twitter.com/firehat firehat

    This is easily the best and most thoughtful comment I have ever seen on a blog.