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Is there any experts available on applying Lean six sigma tools in Emergency service - Ambulance Services in healthcare management ?. If yes, please share your projects and its outcome. 

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HI, Vishnu  Babu .


   I am working as Medical Coder in  Omega Health  care. I  know  this  topic  ambulance services healthcare management  meaning Emergency medical services, also known as ambulance services or paramedic services, are emergency services which treat illnesses and injuries that require an urgent medical response, providing out-of-hospital treatment and transport to definitive care  . I am working  as Zotech  project . but  i am  also  learning  how  to apply  Lean  six  sigma  tools  in our  projects  also ?

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Dear Vishnu, While I am not a health care expert, for my academic interests and basis my understanding w.r.t Emergency Services, I am putting forth few pointers for your perusal. You may treat these as "Voice of Customer" as some of the inputs presented are basis my observations and experiences as heard for a desired better "To-Be" state.


While we see huge expenditure associated with Emergency Services, be it Capital Expenditure to set up the services or Operating Expenditure to run the services, which in itself provides  opportunities on cost saving projects, we shall treat that as secondary, as the primary objective of any Emergency Service is to Save Life by providing appropriate health saver services on time.


To begin with, we may want to clearly define the scope of what Emergency Services means i.e. Is it Simply moving the affected individual to the next available definitive care OR Revive/Stabilize the affected individual using required level of life support (basic, intermediate or advanced) while on move.


While this scope can be majorly driven by the local law of land or legal framework, you may use the "SIPOC Diagram" for either of the scenarios to clearly outline the required parameters which in turn can help you define your "Critical to Quality [CTQ]" metrics.


Further, on a high level, for any Emergency Service to Operate in it's basic level, given my understanding, we need the following infrastructure

  • Ambulance Services
  • A Call Center or a Command Center set up to facilitate ambulance allocation, tracking and control
  • Definitive Health Care Centers or Hospitals with required specialization and infrastructure
  • Trained staff to handle Emergency across all layers i.e. right from Ambulance Drivers to support staff in the Ambulance, Doctors at Hospitals etc.,
  • Awareness among Public on how this Service works and how to use the same i.e. where to call and how to avail the services etc.,
  • An effective governance model to ensure all the above pointers are functioning properly.

What stands key to above pointers are a very strong legal framework to drive accountability and a strong Information Management System.


What is the role of Information Management  and Knowledge Base System in Emergency Services?

Information Management and Knowledge Base system should typically help define the standards, basis expert inputs from industry SMEs and medical experts along with using bench-marking techniques to set some goals and guidelines. For example

  • Set goals for Ambulance commutation time to next available hospital basis the nature of incident e.g. An heart attack should not exceed 30 minutes, an accident with minor injuries should not exceed 60 minutes etc., 
  • Help list ambulance available from all sources (public, private, charitable trust, companies etc.,) by locality - list all health care centers by localities and by area of specialization
  • ...

PS - Numbers stated above are hypothetical to just serve as explanation


Parameters like above should help the Command Center to map ambulance from which location needs to be sent to the incident site to support the affected individual and direct to which hospital basis the nature of incident for survival or support of the affected individual at the shortest possible time available. This exercise in itself can be a good food for thought for concepts like "Design of Experiments". 


Now let us look at how we can use Lean Six Sigma on some of the infrastructure use to support the Emergency Services as listed above

  1. Ambulance Services Possible CTQs to focus - On Time Arrival of the ambulance to the incident spot, Transportation time of the Ambulance to the relevant Definitive Health Care center etc.,
  2. Command CenterPossible CTQs to focus -  Average Speed of Answer, Average Call Handle Time, Average Queue Wait Time, % Accuracy of dispatching right ambulance services etc.,
  3. Definitive Health Care or Hospitals - Possible CTQs to focus - Average Response time for emergency treatment, % redirects to other hospitals etc.,

While I have listed few CTQs by areas basis my limited understanding, each of these would clearly require a DMAIC approach or in some cases a DMADV.


Trust this serves as some pointers and thank you for this question. 

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Dear Vishnu, 


I am unable to share experiences here but I can assure you that immense opportunities exist w.r.t improvement in Emergency Services. Projects can be identified through all the three sources - 


  • Voice of customer - Expectations, Satisfaction Levels, Referal business growth, etc.
  • Voice of business - KPI performance, business growth, revenue growth, etc. 
  • Cost of Poor Quality - Lost opportunities, improved response times, etc.

Hope this helps. 


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