Paul St Clair
Assistant Director of A&E Support Services,
East Midlands Ambulance Service NHS Trust
Tel: 0115 929 6151
paul.stclair@emas.nhs.uk
Summary:
Understanding the factors affecting 999 activities for the East Midlands Ambulance Service (EMAS) is key to proactively delivering services. Capturing the drivers for variation, for example, historic activity, weather conditions, public events and staff cover, evaluating how they affect service provision and over what timeframe are prime factors for preparing an effective response plan.
In 2004/2005, we developed a computerised ‘Demand and Resource’ modelling system allowing EMAS to reliably predict demand patterns, align resources efficiently and respond to 999 calls effectively. The model is over 85% accurate and we have since shared it with a broad range of public authorities.
Abstract:
The aim of developing this ‘Demand & Resource’ model was to provide an easily useable and understood business tool to recognise what issues (internal and external) affected service delivery and patient care by EMAS. Our goal was to develop a dynamic tool that shows the impact of these issues and grade them to give an overall ‘Demand & Resource’ score out of 100. We use the results to inform EMAS managers of potential demand levels and resource availability. This allows decisions to be taken on key actions to improve or escalate our response to safeguard patient service delivery. A total of 20 issues or factors were chosen (based on research) to inform the planning model.
Two programme champions; one each from Modernisation and Operations Directorates developed the model. Data provided from EMAS’ Computer Aided Despatch system (CAD) was used to evaluate profiles of patient demand. External influencing issues or ‘demand drivers’ were also identified and prioritised by impact effect. This information was then analysed using Statistical Process Control (SPC) tools, linked to advanced spreadsheet computer technology. This information is presented in tabular form, using linear and logarithmic analysis for grading of service impact. The outputs are simplified using a 6 colour escalation code linked to a measurement scoring system comprising of 20 separate elements each scoring between –5 and +5. These are then totalled to give an overall performance score for each day / week / month.
This system now forms a pivotal part of the EMAS’ performance monitoring and management system. The results are communicated to operational managers twice weekly. In 2006, we aim to provide the information in live format on EMAS’ Intranet site so making the data available to a far wider audience.
Initially this model was developed following difficulties in providing the correct level of service to patients particularly at times of high 999 demand and where unexpected factors affected service delivery. Using a basic ‘Demand Model’ and sharing this information with Primary Care Trusts (PCT) colleagues, other UK Ambulance Services and representatives of the A&E and other NHS service user departments, we were able to refine the programme to its current state of development.
The model has allowed EMAS to utilise its resources, vehicles, equipment and staff in a more planned and proactive manner, targeting particular areas (where necessary) in a cost effective manner.
Workforce development has been affected on two levels as a result of the project. Firstly, in terms of developing greater forward looking analytical skills within the ‘Performance Management Team’. We also involve staff from other groups such as rota planning, clinical services and fleet maintenance to contribute data to refine the accuracy of the model.
Secondly, to inform EMAS of where resources need to be placed and what type of resource that should be. This has supported the development of new roles such as Community Paramedic and Ambulance Technician Fast Response Vehicles, creating greater career opportunities for staff in EMAS.As our knowledge and holistic approach to ‘Demand and Resource’ management is unique, it has been difficult to benchmark this work against other UK Ambulance Trusts or Emergency Service providers. However, the number of similar organisations who now want to use this model (as it is so adaptable, simple to understand and implement) has in fact surprised us. The model’s performance showed an accuracy level of greater than 85%, (and rising) in its first full 9 months of operation.
Prior to introducing this model, the data it uses was not captured, analysed or ranked in terms of the risk to patient service provision. Neither was the overlapping impact of multiple demand and resource factors that clearly have a unique and potentially dramatic effect on service delivery.
The improvement to patient experience can be shown by the higher performance in all categories of EMAS’ 999 response. But, more importantly, we have raised performance standards in geographical areas where we have historically experienced difficulties. This is further supported by feedback through performance monitoring of Service Level Agreement with the PCTs in our area. Also, we have experienced a reduced level of complaints about 999 response times from service users and gained positive feedback from other healthcare professionals accessing EMAS services.
EMAS’ ‘Demand and Resource’ model is now in its second stage of development and has been refined to recognise the diversity within county and city areas. This has allowed EMAS to adapt the resources it deploys to better suit the communities, population and types of (patient) conditions that may require our services. This has been demonstrated by EMAS using the model to inform decisions on where to introduce and deploy specific Fast Response Vehicles (to improve response times in key geographical areas). Also, it allows us to ensure that staff skill levels meet the needs of patients resident in these areas.
Due to its simplicity, the concept can be easily adapted for local use by any organisation and we have shared our novel approach with PCTs in our area, UK Ambulance Services, Nottinghamshire Police, Nottingham City Council and the HM Treasury in London.
The holistic approach of our model covers the patient pathway from initial telephone contact with EMAS to their arrival at hospital. The model also captures resource and equipment needs, such as vehicle availability, specialist equipment deployment and crew skill levels to cater for patient needs.
To the best of our knowledge, EMAS pioneered this holistic approach to ‘Demand and Resource’ planning and we believe our systematic process results in improved patient care.
Furthermore, we can demonstrate that the system allows EMAS to provide front line services that are tailored to harmonise with all influences that affect performance.
