When David Miller trained to be a paramedic in the late 1970s, he didn’t know that he would be a pioneer. But change was afoot in the emergency medical services industry.
For the most part, emergency transport worked the way it had for decades: People dialed the seven-digit number of an ambulance company, and that company responded, regardless of whether the ambulance was close or best able to deliver the patient quickly.
Miller, a newly minted paramedic fresh from taking his board exams, had been hired by Waconia Hospital’s ambulance service. He was part of the group that first defined primary service areas for Minnesota’s ambulance companies, dividing the state into state-licensed territories. This was the basis of the 911 system as we know it today.
Soon Miller was hired by the somewhat busier Divine Redeemer Hospital ambulance service, and then ultimately by one of Allina’s predecessors. Within a year, he was named president of the EMS department. He hadn’t yet gotten his MBA, but it was starting to strike him that the world of emergency medicine was not terribly well thought out.
“We changed that when we introduced what’s called System Status Management,” he recalls. “We were able to move ambulances, based on time of day, into a position that readied them for the next call that statistically would come in.”
This innovation caught the eye of higher-ups, and soon Miller was also overseeing the emergency departments at Allina. Eventually the president of United Hospital asked him to leave urgent care in order to be vice president of operations. The challenges, it turned out, were much the same. One of the biggest issues was balky patient flow, resulting in a perpetually clogged emergency room.
Immediately, Miller drew an analogy between his old job and his new one. “I saw the same situation I had seen in the ambulance company,” he explains. “So I got some of the nurses, and doctors, involved in a system that can predict who’s coming in. If we can staff the right number of nurses, we’ll have enough beds, and we can get the flow going.”
Miller put in place an information system that time-tracks every patient and every bed. Then he enabled the same kind of high-performance dispatch system he’d used in the ambulance company, this time dubbing it the Care Traffic Control System.
Meanwhile, Miller helped the hospital realize some of its other goals: a new neuroscience center, a state-of-the-art laboratory, and a cancer center. He has brought in robotic surgery and best-of-breed medical imaging equipment. And United has just broken ground on a larger, better-designed emergency department.
“A lot of work that I do is demonstrating how you create return on investment,” he muses. “But the part I think I am most skilled at is being able to work with the medical teams. I think that goes back to my roots. I know what it’s like to care for the patient.”
