In 2006 Lee County EMS (Fort Myers, Fl) embarked on an aggressive plan to tackle the business of EMS.  The medicine of EMS has long been a focus, but concentrating on things that have always taken care of themselves – response times, offloads, available times, customer satisfaction and hiring process – is a new idea that has found a home for Lee County.  The management team tried a novel approach – bring Six Sigma mentality to the management of EMS.

            Six Sigma is a process improvement approach that focuses on the ability to reduce variation.  This approach has been well utilized in the retail and manufacturing sector, but applying this to an EMS service would prove to be a novel approach.  The basis of Six Sigma is the utilization of data and statistical thinking to identify and fix problem areas within an organization.  The decision making process goes from feelings and thinking that something will work to a much more sound approach toward the resolution of problems.  It has the ability to incorporate the latent talent in an organization and utilize these abilities toward equitable solutions.

            The training process incorporates many levels – white belt, yellow belt, green belt and finally black belt levels.  In May 2006 Lee County EMS embarked on training their staff at the white belt level.  This training consisted of 16 hours of basic theory behind the process.  There were 82 people initially trained at this level.  The next step was to train at the yellow belt level – this level incorporated 32 hours with more advanced theory and brought in the use of computer based tools (excel) to aid in the statistical analysis necessary.  There were 26 people trained at this level.  Green belt is where the rubber hits the road – theory and practice were then replaced with projects and team facilitation training.  There were 12 people invited into this level who were then tasked with numerous projects.  Many projects were discussed and then decided upon by the team utilizing different methods.  In order to be eligible for a project, a team had to prove that the impact on the organization would be at least $50,000.  There were six projects initially decided upon – Hiring process, CQI process, response times, offloads, revenue recovery, and customer satisfaction.

            The data are still outstanding on a few of these projects – but the data are in on offloads and response times.  Many EMS articles have been written on the recent plague called offloads – our units sitting at hospitals for hours at time awaiting a hospital bed and racking up the lost time and dollars.  The six sigma team charged with this issue came up with a two part trial plan: one systemic plan and with the help of a local hospital, one plan that required the assistance of a local ER.  The systemic plan was to utilize the EMS shift commander to answer the call of every transported patient and decide the best hospital to go to based on patient condition and current hospital situation as defined by unit presence and EM System (a locally utilized program that gives up to date information of each hospital’s status).  The hospital plan was for the charge nurse to give priority to finding a bed for the incoming ambulance.  These two plans were able to provide some substantial results.  When the trial period was complete, the following results were compiled:

            The response time pilot consisted of two pilots run over a two month period.  The first pilot was for all units to be available within 10 minutes of offloading their patients and the second was to take a core area of units and not make them available for routine transfers.  The results of these pilots had some impressive results.  Anticipated savings for this project were estimated at $165,000.  There was a significant decrease in the offload to available times – 3.5 minutes.  The decrease in average response time was 0.4 minutes (and that is with an increase in call volume).

The cost savings – with results extrapolated over a fiscal year can be:
            Available Times - $490,000
            Response Times - $70,000
Total potential cost savings - $560,000 (please note the initial goal!!!)

            The revenue recovery team has estimated that an estimated 1.5 million dollars can be caught through better documentation and signature realization. 

            Although in its’ infancy, Lee County EMS’s Six Sigma project of educating the staff toward utilization of decision making tools through statistical means has rendered some positive results.  Next steps will include more projects, educating green belts to the black belt level and then continuing the educational process within the organization and beyond to help other agencies who wish to move toward this trend.  The vision of taking a good medical EMS service, combining it with a well groomed business machine and developing an organization that will be a model EMS service well into the future is taking hold in Lee County, Florida.