LGFCU Excellence in Innovation Award Project Evaluation

Transcription

1 LGFCU Excellence in Innovation Award Project Evaluation Project ID Title of Program Program Category Submission Date County Employee Employee title County Department Phone Address 200 East Main Street GG 11 Durham County EMS Recruitment and Retention Design Thinking Project General Government 5/31/2017 3:57:34 PM Durham Rafael Baptista Strategic Initiatives Analyst County Manager Durham, NC County Manager Wendell Davis Supervisor Michael Davis Implementation Date 8/1/2016 FLSA Designation Exempt Project Team Members Rafael Baptista, Strategic Initiatives Analyst Caley Patten, ICMA Local Government Management Fellow Description of Productivity Improvement Durham County, North Carolina needed a strategy on how best to address challenges in recruiting and retaining high quality caregivers for the County's Emergency Medical Services (EMS) department. For a number of years, Durham County EMS continued to see high turnover rates coupled with low employee morale. At the request of County Management, the Durham County Strategic Initiatives team recommended and utilized a design thinking approach to gather both quantitative and qualitative data to help EMS command staff and County management better understand the various challenges and learn how best to prioritize limited resources to deal with these challenges. The design thinking firm IDEO describes design thinking as a "process that starts with the people you're designing for and ends with new solutions that are tailor made to suit their needs." Essentially, design thinking flips traditional problem solving in local government on its head by intentionally talking to front line employees and creating solutions with them, not for them. The County Strategic Initiatives team and a few County leaders were trained in design thinking through a training offered by the Duke University School of Public Policy. In this training County staff saw the value design thinking offered when solving complex problems by intentionally inviting employees and other stakeholders to help define the problems, develop ideas together, and test solutions. For this first time approach, Durham County leadership and staff were interested and

2 excited about the potential to better understand the needs of the EMS department by engaging frontline caregivers in a direct way to explore problems and consider solutions. For the first of its kind project at Durham County, the design thinking process included conducting surveys of employees, spending extensive time in the field with caregivers, analyzing various data sets (i.e. salary, turnover, exit surveys, etc.), and facilitating four departmental idea generation sessions which included front line to management level caregivers. The final product of the project was an EMS playbook (copy attached) that outlined prioritized recommendations to implement with correlating costs. Beyond improving vacancy rates, the significant outcomes of this process included: better informed decision making for County leaders on how best to allocate resources to improve recruitment and retention issues, creative ideas that would not have been considered otherwise, buyin of solutions from all levels within the department, strengthened relationships between supervisors and frontline caregivers, a culture shift on how to solve problems, and ultimately better service delivery to all residents. Description of why this project was initiated A variety of connected problems prompted the need and development of the EMS design thinking project. The EMS department was facing a large turnover of EMTs and Paramedics with a 19.77% turnover rate as of August 1, Due to low staffing levels, the County did not have sufficient ambulances during peak call volumes, frequently only being able to staff 13 of the 19 required ambulances. With low staffing levels, morale at Durham County EMS was suffering as most caregivers had to work many hours of overtime. An internal employee satisfaction survey found that 60% of EMS employees said morale was very low or low. To improve strained services, a comprehensive strategy was needed to understand why Durham County was not retaining or recruiting EMT's and Paramedics. In June 2016, Deputy County Manager Jodi Miller requested that the Strategic Initiatives Team apply design thinking to help the Durham County Emergency Medical Services department create solutions to address their recruitment and retention challenges. The timeline for this process was to have a complete report and problem solving approach ready by end of December This six month design thinking process included conducting surveys of employees, spending time in the field with caregivers via ride alongs, analysis of various data sets (i.e. salary, turnover, exit surveys, etc.), and facilitation of four idea generation sessions with the department which included front line to management level caregivers. The extensive research and facilitation that occurred over the sixmonth period resulted in a strategy report for County leaders that included a variety of solutions that were deemed high priority from the idea generation sessions. Implementation is ongoing and will essentially be an iterative process as some ideas are prototyped, tested, and evaluated on their effectiveness per the design thinking process protocol. This type of problem solving approach utilizing design thinking was completely new for Durham County. It was an innovative and new way of thinking on how the County solves problems that are complex and require a holistic approach that includes solutions that may or may not require additional resources. Overall the objective of this new problem solving approach was to provide better information for decision making on how best to allocate resources to improve recruitment and retention challenges, to create ideas that may not have been considered otherwise, encourage buy in

3 of solutions from all levels within the departments, strengthen relationships between supervisors and frontline caregivers, and demonstrate a culture change on how to solve problems. There are a number of steps within the design thinking process itself. The design thinking framework follows an overall flow of understanding the stakeholder's experiences, exploring innovative solutions, and then testing these solutions. Once a problem is identified, design thinking begins by understanding and working with the stakeholders, to creating key themes and insights and generating ideas, to finally testing some of the ideas. Ultimately the stakeholders in this process were the EMTs and Paramedics within the Durham County EMS department. By going on multiple ride alongs with these caregivers, Strategic Initiatives' Analysts Caley Patten and Rafael Baptista were able to understand the stakeholders' experiences and better understand the underlying problems they were facing. The foundation of design thinking is to intentionally talk with people who are affected by the policies, procedures, and environment in which they operate to see what it is they really want or what solutions might be most effective. Once field research was complete, the Strategic Initiatives team facilitated four idea generation sessions in which the stakeholders themselves came up with the solutions (pictures attached). This process may seem obvious, but so often leaders can jump into planning and implementing ideas or solutions without talking with end users and stakeholders to see how these ideas might impact or affect them. At the idea generation sessions, stakeholders came up with over 150 ideas on how to improve the varying recruitment and retention challenges. From there ideas were ranked and prioritized based on need and effectiveness. The ranked ideas were then compiled and accompanied with analysis and potential costs into a final playbook report (see attached). From the field research and idea generation sessions it became very clear that providing higher pay alone would not help the County retain caregivers in the long term. Employees were feeling under valued, overworked, and unheard from their department's leadership. A variety of the ideas from the final playbook have been implemented, or are in the process of being implemented, which include the following: Improving employee recognition through a piloted reward program and ongoing recognition and certificates at annual banquets. Improving relationships and communication between command staff and frontline employees by creating an accountability schedule of command staff ride alongs once a month with front line caregivers. Testing an extended Basic Life Support (BLS) deployment system. Creating comprehensive career ladder that would create a new non supervisory rank as well as allow caregivers to promote in specialized, non supervisory tracks of clinical, instructional, special operations, community education and administration. Working with shift captains to ensure that when some crews are in need of rest after running a high volume of calls that they shift with those who have been stationed in lower call volume areas to provide others some rest time. Piloting a cellphone app to provide easier access to updated protocols that were traditionally hard to keep up with and in paper format. Involving Field Training Officers (FTO) more intentionally in academies to better prepare participants to successfully work in the field upon academy graduation. Quantifiable results (sustainability, cost savings, cost avoidance and/or a higher level of service). Indication of what resources were used and what was done with any accrued time savings

4 The three primary metrics that Durham County used to assess the impact of this project were: EMS vacancy rates, unit hour production ratio, and the response time standard for emergent calls. In August 2016, when work began on this program, the vacancy rate for EMS caregivers was 19.77% resulting in 34 unfilled EMT and Paramedic positions. These vacancies equate to being down 3.5 ambulances automatically on any given day, and when combined with callouts and vacation leave, this usually meant the system was down 6 ambulances at peak times. Resulting from those vacancies was a low (74.71%) unit hour production ratio which is the percentage of "authorized" (budgeted FTEs) ambulance unit hours produced. These two measures resulted in EMS only meeting the response time goal for emergency calls 52.5% of the time. As of April 2017, the three primary metrics have improved in the following ways: EMS vacancy rate dropped more than 6% from 19.77% to 13.64%. The vacancy rate improvement restored an entire 24/7 ambulance back to the system while remaining at the current funding level. The unit hour production ratio increased from 74.71% to 91.81% which illustrates the service level increase of having fully equipped and staffed ambulances available to respond to calls. The County experienced a 22 second improvement in response times, a measure that will continue to improve in summer 2017 when the County releases 16 EMTs to field duty. Beyond measurable results, EMS also experienced a significant culture change and embraced a new problem solving methodology. Acting EMS Director Kevin Underhill shared, "The design thinking project allowed our caregivers to share their concerns and ideas with our command staff while also providing command staff an opportunity to communicate how and why some system decisions were made that affected the caregivers. The design thinking project engaged caregivers that historically had not participated in large group discussions which gave them an opportunity to shape the organizational culture. The group of new and seasoned caregivers along with the command staff that generated ideas and recommendations significantly helped improve the morale, culture, and operational performance of Durham County Emergency Medical Services." The principal cost of developing and implementing the program was staff time, which staffers estimated was about 131 hours over a six month period. Durham County made the intentional decision to make use of an intensive process that included 72 hours of ride alongs by Strategic Initiatives staff members. In addition to the ride alongs Strategic Initiatives staff spent 9 hours hosting idea generation sessions with line staff and 50 hours doing research, analysis, and implementation. The cost estimate for the program was only $3,500 but the cost can be much lower for counties that spend less time in the field. Previously, the County would have used a consultant to do similar work at a much higher cost. Other descriptive information The primary outcome of this program was the creation of a replicable process that led to better informed decision making by County leaders on how to best allocate resources to improve recruitment and retention challenges for the EMS department. County leaders now have strategies that can be utilized now and referenced in making future decision. The strategies are based on the experiences and input of supervisors and frontline caregivers which allows a much greater level of buy in from all levels of the department. When asked to reflect on this project Assistant Chief

5 Brandon Mitchell stated, "Design thinking fueled a supportive environment for EMS, budget, and human resource employees to work together on solving problems within the organization. The process helped foster relationships between all levels of staff within County Government while solving problems. We will continue to use this extraordinary and effective process." Overall, this project showed the power of engaging employees in problem solving, the importance of building relationships, and the value of not jumping to conclusions on how to fix the problem. Through the stakeholder interviews and ride alongs, front line caregivers felt that they did not see EMS leadership enough. Although EMS leadership had an open door policy for caregivers to drop in anytime, their downtown office locations along with demanding shift schedules did not allow for the level of interaction caregivers desired. To address this concern, EMS command staff have started riding along with caregivers at least once a month. Additionally, since frontline caregivers did not frequently see leadership they felt that they were not recognized when going above and beyond the call of duty. To address this gap, the County created a High Five award that command staff and midlevel supervisors can use to recognize employees when they perform exceptional work. Again, the department is now more proactive in solution generation and testing, is doing more to engage employees in problem solving and is more willing to experiment with large, potentially systemschanging ideas. A great example of this was the idea to pilot a transition from an all Advanced Life Support (ALS) system to a hybrid system that includes Basic Life Support (BLS) only units. This was a huge systems change for the department as this approach had never been done before in Durham. The data clearly showed that the department had sufficient EMTs applying to the department but struggled to recruit and retain paramedics who are required to run an ALS unit. The combination of not enough paramedics and high call volume was burning out the remaining caregivers and increasing response times. Through the design thinking project, EMS staff came up with the idea to pilot the creation of BLS only units to respond to fewer emergent calls that do not require the attention of an ALS unit. This pilot begins in summer 2017, and the County anticipates being able to improve staffing levels by hiring more EMT's and reducing response times by having additional units on the streets serving Durham residents.