Benchmarking for fire-based ems organizations means more than proving who responds the fastest. To compete against private-sector providers, you need to know what your customers want most and how to provide those services the best.

In today's competitive world, it's more important than ever for businesses and organizations to document the performance and service level they provide to their customers.

This is especially true now that so many formerly sacrosanct, regulated monopolies, such as airlines, electric utilities and public works operations, have become competitive battlegrounds. To survive, both private-sector and government institutions need to know the costs of their operations and how their performance compares to their competitors' in the eyes of their customers.

For fire-based ems agencies, the desire to be seen as a better choice than private-sector firms has renewed interest in performance measurements and benchmarking. In fact, many local governments no longer see performance measurement as an option - it's a requirement.

As evidenced by their continued use over the past few years, performance measurements and benchmarking aren't just more fads or budget tools. They're worthwhile concepts that are likely to be around for a while. Successful ems operations will have to employ both, adjusting their service delivery as needed to maintain their edge.

Definitions and distinctions To start with, performance measurement evaluates accomplishments in relation to a particular standard, and benchmarking determines how well a unit or an organization performs compared to other units in the organization or to external competitors.

When establishing performance measurements for an ems system, the first question that arises is "What do we need to be measuring?" There are four key areas that can help answer the question:

1) Response time,

2) Effectiveness,

3) Workload and

4) Cost, including collection rate.

These areas then need to be broken down and detailed further. Listed below are just some of the measurements that departments currently involved in ems performance measurement are tracking.

* Average response time in minutes.

* Response time in minutes to city, suburban and rural areas.

* Percentage of responses in eight minutes or less.

* Percentage of responses in five minutes or less.

* Response time in minutes to have Basic Life Support on the scene.

* Response time in minutes to have Advanced Life Support on the scene.

* Percentage of extrications achieved in less than 15 minutes.

* Transport collection rate.

* Number of successful cardiac defibrillations.

* Number of ems complaints and compliments.

* Number of successful resuscitations.

* Average time from arrival at the scene to arrival at the hospital.

* Average time from arrival at the hospital to transfer of patient to the emergency room.

* Number of responses per medical response unit.

* Average amount of time to complete an ems call.

Of course, there are many other performance measures that a department could choose to track. The key is to choose the ones that meet the needs of your particular organization.

Service expectations Now, some of these measurements may be more important to your organization than others. The best way to determine which you should be tracking is by seeing what services the local government and citizens are demanding. Once you know what your customers want, take a step back and look at what your organization is already doing.

One of the first things people discover when establishing performance measures is that they provide more services than they were aware of. This is a key point to consider, because when fire departments try to compete with private-sector providers, they often fight the battle by the competitor's rules. When this happens, benchmarking focuses solely on patient transport instead of the many other aspects of ems.

As full-service emergency providers, fire departments need to consider the entire range of ems they offer. They should conduct a service-level audit to adequately identify and market all of the services being provided. For example, when Seminole County (Fla.) ems/Fire/Rescue was in a competitive bid process with two private providers, the department conducted a service level audit of a wide range of activities. The final audit considered:

* als first response and transport, including als engines.

* bls first response and transport.

* Aeromedical service.

* Auto extrication.

* Rescue, including water, below-grade, trench, high-angle, hazmat and confined-space.

* Environment- and event-specific ems, including wilderness, disaster, shelter, special needs population, hazmat and multicasualty response.

* Special event response/standby.

* cpr training.

* Community emergency response team ems training.

* Community-based ems (ems delivery on a walk-in basis at fire stations).

* Blood-pressure evaluation and inoculation program.

* Community health assistance program (visitation for shut-ins needing blood-pressure evaluation and safety checks).

* ems education.

* Across-the-board emt or paramedic training.

* Critical incident stress debriefing.

* Internet presence, including an interactive Web site for medical self-help and Web-based ems protocols.

* ems reporting.

As you can see, the services provided go far beyond just the transport portion of an emergency medical alarm. Focusing on who's fastest is only part of the benchmarking battle; meeting the needs of the community is the other. It's important to measure performance in the areas that are valued by the people you serve.

As in any service business, it's important for ems providers to have a clear picture of their customers' expectations. Focus groups can be convened to solicit input on what people want and their impression of the services being delivered. These groups can go a long way in matching service level with customer expectations, a key ingredient for success. In a recent focus group poll, our citizens identified the following ems service priorities, in order of importance:

1) Quick response by well-trained personnel.

2) Fast transport to the hospital.

3) Good apparatus and equipment.

4) Caring attitude.

10 steps for the future Even when you know what to measure and examine in terms of the service you provide, setting up a performance-measurement program can still be daunting. Here are 10 steps you can take immediately to help position your organization for the future.

1) Collect data and start measuring performance. Make an assessment or your best guess as to what information you'll need to justify your program, then begin collecting data as soon as possible. Even if you don't follow up on a defined program for several months, you'll still have gathered valuable information to plug into your performance measure reports. Choosing a few performance measures and starting the process will pay big dividends.

2) "Cost out" your operations. In any competitive environment, you'll want a good idea of what it costs you to deliver a particular service. Have your budget staff develop a cost measurement of the various services you provide.

3) Conduct a service level audit. Every organization should conduct an audit of the various services they provide. This clarifies all of the benefits that the public is receiving for their tax dollars.

4) Build a strong connection with the public you serve. This can't be emphasized enough. Strong public support for your programs can outweigh many political challenges to your operations. Ways to develop a good relationship with citizens include:

* Providing excellent service,

* Creating a customer-first attitude among your personnel,

* Holding focus group meetings with citizen groups and

* Presenting an annual report to the people you serve.

5) View your operations as if you were a competitor. By looking at your emergency services delivery from this standpoint, you'll quickly see where your weaknesses are. You'll also develop good justifications for your programs that can be used if you have to validate the services you provide.

6) Monitor your potential competition. It's important to monitor the organizations that could become competitors for the services you provide. This can be done by surfing the Internet, reading publications, participating in professional organizations, and attending seminars and conferences.

7) Create a business plan. Successful businesses in the private sector develop business plans to guide their organization. With the use of commercially available computer software, it's easy for public service providers to do the same.

8) Dovetail the performance measures and business plan with your accreditation goals. Many organizations are looking toward accreditation processes to measure and further promote the services they deliver. Setting performance measurement goals and developing a business plan should mesh well with your accreditation goals, allowing you to establish where your organization is now and where it's heading.

9) Develop partnerships. It's more important than ever to develop partnerships for the delivery of service. Sharing resources and working toward common goals can create a synergy that will carry you further than you could have gone on your own.

10) Designate a planning person in your organization. With everyone so busy, looking toward the future often gets sacrificed to the tyranny of the urgent. It's important, therefore, to hire or designate someone in your organization as the planning person. They should be assigned the previous steps that will help prepare your organization for the future.

Make no mistake, performance measurement and benchmarking will take some time. In the competitive environment that ems delivery organizations are now operating in, it's no longer a luxury but rather an essential requirement to know how well your operation is performing. The oracle at Delphi maintained that one should "Know thyself" - advice that's applicable to ems organizations, too.

There are a number of excellent resources available for getting started in performance measurement and benchmarking.

Measuring Up: Governing's Guide to Performance Measurement for Geniuses (and other Public Managers). Jonathan Walters. Governing Management Series, Governing Books: Washington, D.C.

One of the best resources on the market for learning about the performance measurement process is this gem of a book, which takes readers through the process of performance measurement in an interesting and fun way. Walters identifies eight excuses for not conducting performance measurement, such as "We already did that," "Performance measures are going to be used to beat me up," "There's no way to measure what I do," and then explains why you have no choice. Visit .

ICMA MIS Report: Benchmarking - Achieving Superior Performance in Fire and Emergency Medical Services. International City/County Managers Association. Vol. 25, No. 2, Feb. 1993.

Although somewhat dated, this is still a valuable resource on benchmarking for fire and ems operations. Visit .

Prince William County (Va.) Budget and Citizen Satisfaction Survey.

Here you'll find the best sample of a wide range of performance measures for a fire department, including ems operations. The format is excellent and includes other components of a good performance measurement system, such as a mission statement, organizational chart and more. Visit .

Review of Emergency Response Statistics. Office of the City Auditor, Portland, Ore., April 1998.

Oregon is at the forefront of performance measurement and benchmarking in government. Visit .

Contracting for Emergency Ambulance Services: A Guide to Effective System Design. American Ambulance Association.

Developed primarily for the private ambulance sector and local governments, this guide provides details on how to contract for emergency ambulance services. Visit .