Situational Analysis

Mecklenburg EMS Agency (Medic) in Charlotte, NC recently embarked on a project aimed at completely revamping the Agency’s ambulance design. The need for this work was driven by newly released ground vehicle safety standards as published by the Commission on Accreditation of Ambulance Services (CAAS). The Agency also sought a more comfortable and ergonomically designed patient care module in addition to a vehicle platform with a lower total cost of ownership. This highly successful project was led by Medic employees and the improved design was completely based on input received from more than 200 caregivers who make these ambulances their office each and every day.

Implementation began in June 2015 with a work team tasked to develop the replacement strategy. The first step was a needs assessment which extended inter-departmentally throughout the Agency. Using feedback provided from patient care providers, fleet technicians, and operations support personnel a list of 19 chassis was identified. The next step was to test each of the 19 chassis, which looked at 43 different characteristics such as serviceability, installed air conditioning, LED lights, and interior cab lighting etc. Once the three month testing phase was completed the work team narrowed the list of 19 chassis to five. To finish, the reaming five chassis underwent a second three month evaluation process. Ultimately, the team collected a substantial amount of data and after a series of assessments determined the Type 1 Dodge 4 d was the best chassis for the needs of the Agency.

Goals

The aim of the project was: Reduce the overall cost to purchase and operate fully outfitted ambulances while meeting or exceeding the new CAAS safety standards. An additional caveat for the project, which was deemed important but secondary to the primary objective, was to also improve patient and crew comfort.

Planning & Implementation

Medic’s approach to improvement work is derived from the methodologies taught by the Institute for Healthcare Improvement (IHI). The intent is to ensure the true aim of any improvement project is crystal clear and that the appropriate stakeholder input is collected to ensure optimal outcomes with minimal unintended consequences or oversights.
This approach led Medic to assemble a cross functional work team that would be tasked with tackling the project. The team consisted of representatives from field operations, fleet, quality improvement, operations management, operations support, and senior leadership. This team embarked on a very deliberate six month process to:
• Define the specific improvements that needed to be made
• Assess the various available options
• Gather stakeholder input at multiple intervals
• Develop recommended solutions
• Test the viable options with stakeholders
• Adjust plans based on feedback
• Price the desired changes
• Arrive at a final set of recommendations

The team had a six month window in which to do the work leading up to a final recommendation. From there, the team had an additional three months to conduct field testing on an actual ambulance that was built to the specifications as recommended by the team.

Results

Using this innovative process, Mecklenburg EMS Agency created an ALS ambulance design that satisfied:
• All new CAAS safety standards
• Increased provider and employee patient safety
• Improved ergonomic function
• Increased employee satisfaction
• Maintained fiscal responsibility
The total cost of ownership for the newly designed ambulances is conservatively predicted to be $28,000 less per vehicle over its eight year lifespan. The expected cumulative savings for Medic’s entire fleet of 64 ALS vehicles is predicted at $1,792,000 every eight years.

Additionally, the following improvements were realized through this project:
• Upgrades to suspension electrical system and air-conditioning system
• Improved patient stretcher mounts
• Insulation for sound
• Ingress and egress to reduce risk of injury
• Allow for providers to be seated and belted during transport

Impact

This project gives rise to an ambulance design that exceeds CAAS safety standards, provides a safer work environment, and is estimated to reduce cost of ownership. It balanced Agency department needs, front line employee input, unique testing methodology, and new safety standards with fiscal demands. The program was low cost to implement and could be adopted by other agency’s seeking to update their ambulance fleet. The use of cardboard mock-ups validated design ideas and reduced the need for change orders once the new design was manufactured. It also improved the ergonomic function of our ALS ambulances resulting in improvements in both comfort and safety for patient care providers. The Agency’s ALS ambulance redesign project has several merits that render it worthy of recognition.

Budget

As one of the Agency‘s core values, fiscal responsibility heavily influenced the processes and decisions made throughout the entirety of the ambulance remodel. The principal expense came from the cost of manpower totaling $9,700 for employee focus groups and overtime for team members. The second largest expense, totaling $900, came from the purchase of cardboard and construction supplies to build the ambulance mockup. As the majority of the program was completed internally, the final development cost was at a minimal $15,000.