Foundations
The ideas the rest of ODS is built on, in the order the method uses them: how a system is structured, how its requirements rank, what it can afford, how it is deployed, how it is measured, and how readiness can be bought.
System Structure#
The subsystems#
An emergency system has five subsystems:
- Public: recognizes the emergency, intervenes, and activates the system
- Communications: answers the call, triages it, gives pre-arrival instructions, and dispatches
- First response: rapid assessment and intervention in life threats, stabilizes the patient for transport
- Patient transport: responds, treats, and conveys the patient to a definitive care destination
- Definitive care: the receiving facility, which prepares for, accepts, and treats the patient
The subsystems depend on one another: when one is slow to accept the patient, it consumes the readiness of the one upstream.
Readiness and response#
Readiness and response are the two halves of each subsystem and are measured separately.
- Readiness
- is the amount of time that qualified personnel, serviceable equipment, and supplies are properly deployed.
- Response
- is the collection of activities associated with a specific request for services, from the moment the request is received until the responders are available again.
Readiness is counted in unit hours: one unit, qualified personnel with serviceable equipment and supplies, properly deployed for one hour. It is perishable: a unit hour that goes unused cannot be stored and spent later.
A framework that measures only response leaves readiness unmeasured. ODS measures readiness in its own right and reports it beside response.
The three parties#
Three roles are in play in the subsystems where readiness is bought (communications, first response, patient transport, and definitive care): a regulator that sets the standards and evaluates the system, a procuring entity that decides how much readiness to buy and pays for it, and a producer that produces it. One body may hold more than one role and the same body may hold different roles in different subsystems.
Fire, private, hospital, volunteer, and mobile integrated health producers are all reasoned about, financed, and held accountable with the same structure, each answerable for what it controls. The framework does not favor one of them over another.
The value chain#
A value chain is a way of seeing an organization as the set of activities that create its value, so that each activity's cost and contribution can be examined on its own (Porter, 1985). Primary activities produce and deliver the service: bringing inputs in, operating, delivering the output, letting customers know it exists, and supporting them afterward. Support activities make the primary ones possible: infrastructure, technology, people, and purchasing. System Structure applies the chain inside each subsystem, so any activity in an emergency system can be placed, costed, and assigned to whoever controls it, and adapts the chain where emergency response differs from other work.
The Decision-Making Rubric#
Requirements bind in order: legal, credentialing, accrediting, contract, insurance, political, mission and vision, and budget. A higher level bounds every level beneath it, so no requirement is satisfied by violating a higher one. ODS operates inside that stack and cites each level as best practice; it never competes with them. The Decision-Making Rubric fixes that order and every later choice in the framework is made within it.
Financial Sustainability#
What readiness costs and what transport collects are different things. Transport revenue might cover the cost of readiness, but not necessarily. Whether it does depends on the type and quantity of the readiness and on payer mix, collection rates, jurisdiction, contract terms, and scale. The same call volume can be solvent or underwater depending on who is covered.
ODS works the two out separately. The cost side starts from the standard the system is held to, usually an operational response-time standard: how many unit hours it takes to meet it and what each added unit hour buys. The revenue side starts from transports: how many there are and what each one collects. The two meet in one decision, made with ordinary financial tools, that answers whether the system can be produced and sustained. Financial Sustainability is that method.
The Deployment Plan#
A system that can afford its readiness can then plan its deployment: a schedule of unit hours, a posting plan for where that readiness is distributed, and the criteria for assigning units to calls. ODS mandates no deployment model. The strategy is chosen by the procuring entity on the values of those charged to deliver care and bounded by what the system can afford. Demand is used to price the options and does not by itself dictate the schedule. Crew fatigue is a design constraint that can override coverage.
Measurement & the Score#
Measurement has two parts: activity and performance. Activity is what happened: it counts and does not judge. Performance is that activity assessed against a standard.
Accountability follows scope of control: each party answers for what it controls and no party answers for another's results.
Measurement & the Score rolls the measurements up into the optimal deployment score. The score feeds the next cycle of the framework.
The Readiness Market#
In the readiness market the procuring entity and the producer are different parties. The procuring entity buys readiness from producers at an agreed price. The provider of record bills for the transports. Producers are paid for the readiness they deliver, not for transports, so they no longer carry a transport-revenue risk they do not control. Producers are accountable only for their scope of control.
The market may be non-exclusive: fire, private, hospital, volunteer, and mobile integrated health producers can all sell into it.
The Readiness Market is the economic model ODS encourages, though everything else in the framework works without it.