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Measuring What Matters Most

Performance measurement isn’t a new concept, particularly in the business world; processes and outcomes in business are the driving force behind profits and shareholder success. In the fire and emergency service, performance measurement is important because often the processes being measured are critical in nature for both firefighter and civilian survival as well as for loss control.

However, measurements have predominantly centered on response parameters. This type of performance measurement is required through accreditation processes and examines how quickly calls are processed and primary units and full-alarm assignments arrive.

These types of measures are typically response-driven; successful organizations utilize a balanced-scorecard-driven approach that not only measures response performance, but also focuses on process results that are critical to on-scene success.

Health-care systems have been further driven by process and outcome measures, largely as a result of accreditation standards, funding payments, customer demands and enhanced customer knowledge and expectations. These measures are typically outcome-related and driven by the disease processes in particular, such as door-to-cardiac catheterization to reduce the time the heart is ischemic or without oxygen flow.

Why has the fire service in general not progressed to a corresponding level of performance measurement and benchmarking beyond response times?

I would suggest that the underlying answer is that what’s expected is inspected and fire service organizations are still transitioning, in many cases, from data collection to results-based performance metrics systems.

Examples of results-based outcomes measures for the fire service include

  • time from arrival on scene to water on fire
  • arrival on scene to fire out 
  • arrival on scene to completion of primary and secondary searches for victims

These then can be assessed against industry comparators and benchmarks.

How many departments measure how quickly they perform each activity and then work to improve their times and share their experiences as lessons learned and best practices? It’s been demonstrated that the larger a crew size is, the more effectively and efficiently the crew accomplished its tasks. So in the current environment, why aren’t we measuring these critical process or outcome measurements on every response?

Fire-based EMS has advanced further in measuring clinical performance, mostly driven by the link to such health-care performance systems as the Joint Commission Accreditation of Hospital Organizations. In fact, many health-care facilities are compared against each other and industry practices. Such measurement systems are typically clinical in nature and measure successful out-of-hospital resuscitation from cardiac arrest, reduction in prehospital pain scores and improvement in patients breathing as reported subjectively.

The American fire service must further evolve its performance-measurement systems: they need to move from being predominantly based on response time to being based on performance upon arrival. Furthermore, identifying fire-prevention measures of success and then collecting data for those measures give strong support to your department’s efforts to reduce fire risk in your community before it causes injury, death or damage.

Establish simple, easy-to-capture performance-based targets that surround everything you’re trying to achieve on the fireground. This may be as simple as measuring the time to get water to fire, complete a primary search and knock the fire down or put it out entirely.

You may be surprised by the results; they may validate department performance or identify areas for improvement, such as in training, staffing or requiring additional resources.

In conclusion, those organizations that don’t measure performance are more inclined to institutionalize mediocrity and not even know it!

Todd LeDuc, MS, CFO, CEM, MIFireE, is an assistant fire chief for Broward County (Fla.) Sheriff Fire Rescue. He’s also a director at large for the Safety, Health and Survival Section and a member of the IAFC On Scene editorial advisory board.

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