1.  D efine M easure A nalyze I mprove C ontrol Six Sigma [Green Belt Project] Continuous Quality Improvement Purchasing Justification Process EMT-P Jason Ausman FTO Jim Bonham LT. Michael Hamel EMT Robert Hofstetter EMT-P Angela Holbrook Team: Sponsor:Chief Chris Hansen Facilitators: DC Kim Dickerson Capt. Art Garcia

2.  D efine M easure A nalyze I mprove C ontrol Problem Statement The current CQI process is inconsistent with new product evaluation, justification, implementation, and validation.

3.  D efine M easure A nalyze I mprove C ontrol Business Case Develop a process that involves research justification of a demonstrated need for new equipment. The process will include timely training as well as periodic evaluation and validation. Alignment to Business Strategy BoCC FY 2007 Goals

4.  D efine M easure A nalyze I mprove C ontrol Business Case Goal 2 Make Lee County Government the benchmark county in Florida for innovation and excellence in customer service and technological operations. Objective 1 – Continue assessment of organizational practices through continuous improvement techniques.

5.  D efine M easure A nalyze I mprove C ontrol Business Case Goal 4 Answer: “What is the business of Lee County Government?” by identifying and defining, periodically evaluating, and maintaining, core levels of services that can be shared and understood by the public. Objective 2 – Early on in the annual budget development process, identify – through a fact based analysis – a target percentage for operational increases for the coming fiscal year that will be communicated, as a goal, to county departments an Constitutional Officers. Objective 6 – Continue fiscal solvency by monitoring, evaluating and maintaining core services. Assure a full and complete evaluation of any changes in levels of core services, including budgetary impacts.

6.  D efine M easure A nalyze I mprove C ontrol Define Phase Previous Expenditures CCEMT-P course $30,000 budgeted Actual expense closer to $300,000 11/05 5 Students CCEMT-P Pittsburg, PA $18,830.20 1/06 5 Students CCEMT-P Augusta, GA $15,320.75 4/06 2 Students CCEMT-P Augusta, GA $ 7122.48 Total $41,273.43

7.  D efine M easure A nalyze I mprove C ontrol Define Phase Previous Expenditures Narcotic Bags- 8/2005 50 Narc.Personal/Safe Boxes (Koons Locksmiths) @ $11.95 ea $597.50 No provision for cost to continue program No implementation evaluation/validation

8.  D efine M easure A nalyze I mprove C ontrol Define Phase Previous Expenditures Ambulance Cameras 40 Kodak Easy Share C310 Digital Zoom Camera $87.00 Each $3,480.00 40 Kingston Flash Memory Card-128MB-SD $14.50 Each 580.00 Total $4,060.00 No provision for cost to continue program No implementation evaluation /validation

9.  D efine M easure A nalyze I mprove C ontrol Preliminary Goal To develop a process that results in enhanced patient care, demonstrates fiscal need and provides for long term sustainability. Result = risk avoidance

10.  D efine M easure A nalyze I mprove C ontrol The Project Scope Request made to purchase the Auto Pulse Do we really need it? How will it make a difference? Is it financially achievable and sustainable? Periodic evaluation and validation.

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13.  D efine M easure A nalyze I mprove C ontrol Previous Expenditures Cameras: Mandate – No Patient care/employee driven – Trauma Services request Immediate implementation required – No Evidence based – questionable Non-evidence based – Trauma Services opinion Refer to CQI committee – no Financial resources available – non-budgeted item Other financial resources – July spending Recurring resources accounted for - no Training/Educational resources – minimal Can we get what we need in a timely manner – yes Acceptable overall risk - yes Purchase - yes

14.  D efine M easure A nalyze I mprove C ontrol Previous Expenditures Narcotic Bags: Mandate – No Patient care/employee driven – Pine Island and Alva deployment Immediate implementation required – Yes Evidence based – questionable Non-evidence based – Opinion generated Refer to CQI committee – no Financial resources available – non-budgeted item Other financial resources – July spending Recurring resources accounted for - no Training/Educational resources – minimal (non-budgeted) Can we get what we need in a timely manner – yes Acceptable overall risk – yes (questionable at this time) Purchase - yes

15.  D efine M easure A nalyze I mprove C ontrol Previous Expenditures CCEMT-P course: Mandate – No Patient care/employee driven – Pediatric Services request (LMH) Immediate implementation required – No Evidence based – questionable Non-evidence based – Pediatric Services opinion Refer to CQI committee – no Financial resources available – $30,000.00 budgeted Other financial resources – none Recurring resources accounted for - no Training/Educational resources – not accounted for Can we get what we need in a timely manner – yes Acceptable overall risk - yes Purchase - yes

16.  D efine M easure A nalyze I mprove C ontrol Measure Phase Auto Pulse $15,000 per unit $750,000 for 50 ambulances $125 per chest strap $7 bio-shield 526 cardiac arrests in 2006 $69,432 disposable cost

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18.  D efine M easure A nalyze I mprove C ontrol Conclusion Define Project Implementation: March 1, 2007 Measure Project Completion after 25 Cardiac Arrests Analyze Analyze data collected against current process of manual CPR during the same time frame Improve Determine justified need for purchase Control Project referred to Continuous Quality Assurance/ Improvement Committee Design By: FTO Dominick C. Watts, NREMT-P, FP-C