In the world today, many communities are facing expanding, aging populations and ever-stronger demands for high quality healthcare. These concepts also apply to ambulance services, which are under enormous pressure to perform better and spend less money.
The South Central Ambulance Service (SCAS) in the United Kingdom (UK) is no exception.
One challenge for UK ambulance services in particular is that of meeting the government standards for response times – the time it takes for the ambulance service to arrive at the patient’s location. Additionally, UK services operate under very tight budgets and must manage their fleets under a very high utilisation. SCAS specifically delivers ambulance services across a 9205 km2 area, serving 4 million people and responding to 600,000 calls per year. SCAS is required to manage hundreds of vehicles, such as double-crewed ambulances, rapid responders and many other specialist vehicles. SCAS also has a clinical support desk that provides high quality care through phone for the lower priority calls.
Because trial and error is not the best management philosophy when lives are at stake, SCAS obtained the Intermedix operations analytics solution Optima Predict. This software offers highly advanced, discrete event simulation capabilities to model and analyse what-if scenarios for ambulance operations. The derived insights can then be used to make high-quality, data-driven decisions.
Yet, SCAS was struggling to translate Optima Predict into the added business value they were hoping for. So, Intermedix and SCAS teamed up and tried something new: we embedded somebody from Intermedix in SCAS. That somebody was me.
Experiencing Side Effects
As an embedded resource, my first task was to set up a weekly reporting process for Optima Predict. The idea is as follows:
- Take the most recent week of incident and response data, perform analysis in Optima Predict and turn this into a weekly report.
- Use the weekly report to identify opportunities to improve performance. From there, model and simulate scenarios that improve the identified issues and implement the best performing scenario in real life.
- Once implemented, the impact of this change should be reflected in future weekly reports to verify the simulated results.
Voilà! A classic continuous improvement cycle was established.
Establishing a new process like this, however, is always challenging. There was initial resistance to overcome, and key stakeholders were spread over various offices and departments. Fortunately, the weekly report was set up successfully and it does exactly what it was meant to do. Since it was created together and is shared with various staff members, it functions as a weekly neutral discussion platform as well. Here a lot of synergy (1 + 1 = 3) is taking place, which has led to better collaboration between the offices while simultaneously accelerating the rate for new ideas to improve performance. These were two very welcome side effects! But how can one assess the impact for these ideas to improve performance?
Answering the “What ifs…?” and “Can we…?”
This is where the second process comes into play. SCAS has a vast list of initiatives for which they require impact assessments. Optima Predict is used to simulate these as what-if scenarios. For example:
- What happens to performance if we change the way we organise meal breaks? Meal break policies are not changed overnight and require approval from the unions, so any new policy needs to be a good one.
- We have proposed roster A and B, but which one will give us the best performance? Can you come up with recommendations to make the proposals even better?
- Where should ambulances and rapid responders be deployed across the region to minimise our response times? Why would this solution work better?
Coming up with a reasonable answer is not necessarily hard, but coming up with a good answer is. Also, coming up with good answers means that there needs to be very good understanding of the ‘why’ behind the numbers communicated to the stakeholders. With any communication, there is also the ‘how’ – who needs to accept the recommendations, and how can you get the change implemented?
This is why SCAS was initially struggling to get the maximum out of Optima Predict: being extremely powerful software, Optima Predict is also inherently complex and requires dedicated time from a skilled analyst who asks the right questions. This concept is something that was overlooked.
It is also worth noting that making a meaningful change in a 3000+ head count organisation like SCAS is difficult without having an influential promotor in the organisation (a ‘Champion’) and collaboration from the affected departments.
It Takes Three
When Intermedix brought in the embedded resource, this provided SCAS with direct access to technical expertise from Intermedix. Optima Predict also received support under the supervision of a strong champion in the Planning & Performance department – exactly where it should be. Over time, we have also become increasingly successful in actively including the operational leaders that need to manage and communicate changes to their staff. Involving these three stakeholders actively in any impact assessment is crucial to get recommendations supported and implemented.
This “it-takes-three” approach has taken the ownership of the recommendations coming out of the Optima Predict modelling to the next level. Instead of having to push it into the organisation, there is now a strong pull and support company wide, even up to the board level.
Working together with SCAS like we have done the past year has proven to be a win-win situation for all parties involved. For Intermedix, we now have ties closer than ever before with ambulance services, so we truly begin to understand how we can optimise the help we provide.
Most recently, the embedded resource project at SCAS has been extended and up-scaled in hours to meet demand for Optima Predict modelling. Currently, Intermedix and SCAS are preparing for the new UK ‘Ambulance Response Programme,’ which will completely redefine the way ambulance services deliver their care.