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Executive Officer Leadership: Incorporating Performance Metrics into Agency Culture and Analysis

Fire agencies that provide transport services—either ALS or BLS—should look into performance metrics. Performance metrics are necessary to establish expected levels of performance.

Without such measures, an organization may drift along and have no perception of quality performance. Without substantiating data, any perception they do have would ultimately be just an opinion.

There’s no doubt that most fire agencies providing EMS and transportation of patients are becoming more sophisticated with the mechanics of collecting and analyzing data related to EMS. However, many performance metrics are derived from what each agency perceives as an important bit of information.

Implementing and using performance metrics in EMS is not a new concept. However, there’s still a wide variance in which measures are recorded and analyzed from agency to agency. Slowly but surely, fire-based EMS is adopting many performance metrics in a structured format that allows advancements in skills and equipment use and displays advantages and disadvantages. Several organizations, associations and accrediting bodies have put a lot of effort and energy toward a set of common performance metrics that could be implemented throughout fire-based EMS systems.

My fire-rescue agency, by virtue of some specific and helpful recommendations from a Commission on Accreditation of Ambulance Services (CAAS) onsite review team, has implemented many performance metrics. The concept isn’t new, but the accreditation recommendation allowed our team to focus on and hold ourselves accountable for collecting data and, more importantly, using the data collected.

Lessons can be drawn from this, best summarized in these system-analysis categories:

  • System utilization (trauma, CVA, ACS)
  • Agency (personnel- and community-related cost)
  • Safety
  • Response and skill use

One of the most notable findings we found was that the use rate of specific paramedic skills is relatively low, but performance of these skills is routinely satisfactory. The process for determining whether a performance metric is satisfactory involves setting a benchmark, determining the proper avenue for collecting data, then collecting and analyzing that data.

We routinely monitor the identified metrics and convene a committee every month to review results and report them. This committee has become very beneficial by providing insight into how to improve when performance metrics aren’t met; more notably, it provides a continued effort to ensure satisfactory measures are validated and maintain a positive trajectory.

For agencies that haven’t yet adopted performance metrics or aren’t certain which metrics to include, some comprehensive tools are available:

Performance metrics have the potential to validate an agency’s performance against acceptable industry norms. Awareness and leadership are the keys to driving fire-based EMS toward consistently measured and applied performance.

Ultimately, an agency’s opinion of its performance will be nothing more than that: an opinion. The entire healthcare community has already made tremendous progress toward measuring performance.

It’s inevitable that fire-based EMS has to measure its performance in a consistent and valid manner. This will ultimately allow facts to measure actual performance while also allowing comparison between agencies and regions to determine real-world trends.

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