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by Jonathan Washko

What you can learn from Jack Stout's legendary career

Jack Stout received the Pinnacle Lifetime Achievement Award for his pioneering management concepts that continue to resonate

By Jonathan Washko

On July 22, Jack Stout received the Pinnacle Lifetime Achievement Award in honor of his pioneering contributions to the EMS profession. He accepted the award at the 2014 Pinnacle EMS Leadership Forum. Stout's series of articles in the 1980s introduced the concept of the public utility model, fractile response times, system status management and high-performance EMS. For the next 15 years, through his writings and conference presentations, he worked tirelessly to explore new thinking about how EMS is delivered. His work has been archived at, and his concepts continue to resonate today.

“Our moral obligation to pursue clinical and service improvement is widely accepted. But our related obligation to pursue economic efficiency is poorly understood. Many believe these are separate issues. They are not. Economic efficiency is nothing more than the ability to convert dollars into service. If we could do better with the dollars we have available, but we don’t, the responsibility must be ours. In EMS, that responsibility is enormous — it is impossible to waste dollars without also wasting lives.” — Jack L. Stout

It was in a college classroom in 1990, during an EMS Management 101 class, that I first heard about the concepts of system status management, high-performance EMS, the public utility model — and the name Jack Stout.

We were learning about EMS system design as part of an undergraduate degree in EMS Administration. Our instructor Willie Krasner used Jack's theories as the cornerstone of the course, touting them as the science behind the best systems in the U.S. at the time.

Even today, 24 years later, most EMS management programs teach some form of Jack's concepts (whether they give him credit or not) and many communities still use elements of Jack's original performance-based contracts for their own — typos and all.

So why did Jack's theories resonant on such a fundamental level that they permeated our secondary education system and are at the heart and soul of today's most respected and successful EMS systems?

It comes down to a fundamental EMS leadership competency that my colleague John Becknell so well identifies in his teachings — managing scarcity.

Creating an EMS toolbox

Jack taught us how to manage scarcity, and do it very well indeed. Jack identified that given the economic variables associated with EMS reimbursement, infrastructure management and desired service outcomes, EMS was just like a public utility company, and could therefore operate much the same as one, reaping the benefits of economies of scale and quality reliability through market regulation and performance guarantees.

Jack also showed us that EMS service demand was predictable, and therefore resources could be matched to this demand in order to provide more reliable services at a lower cost.

What set Jack apart from others was that he didn't just sit back and rest on his academic laurels. He implemented his ideas and theories in the real world, in places like Oklahoma City, Tulsa, Kansas City, and Pinellas County, with measurable outcomes that have impacted millions of lives.

Identified as high-performance EMS systems, they were able to deliver quality care that was highly reliable and economically efficient, to the great benefit of the communities that adopted his concepts.

Unfortunately, much of Jack's work has been demonized over the years as nothing more than better, faster, cheaper at the expense of the people in the field. This is so far from the truth.

What Jack did was create a set of tools that converted a limited set of resources (dollars) into the highest level of service and quality possible. Just as any tool can be used for something good (like using a hammer to build a house) or something bad (like using a hammer to bludgeon someone), it's the tool's end user who makes all the difference in terms of outcomes.  

Many well-respected communities and EMS agencies with the courage and stamina to change have used Jack's theories and concepts with unparalleled results. Countless lives have been positively impacted while multiple millions of taxpayer dollars were saved.

Ahead of his time

As irony would have it for the naysayers, much of what Jack dedicated his life's work to in the 1980s and 1990s is what all of health care is aggressively seeking today: finding a way to simultaneously balance economic efficiency, quality patient care and employee well-being.

Why? Because health care is starting to experience the early forms of scarcity, driven by health care reimbursement reform and consumerism, due to our nation's unsustainable and highly ineffective systems of care delivery.

Jack's ultimate achievement and gift to society was recognizing that many of the pioneering concepts used by manufacturing for process improvement — like Deming's Total Quality Management, Six-Sigma, and Lean Manufacturing — could be translated for use in a service industry like EMS to improve outcomes.

This is also what we see happening at the root of health care reform, which promises eventual sustainability and improved reliability and quality. 

The triple aim of health care reform, as defined by the Institute of Healthcare Improvement, is not far removed from Jack's original vision of balancing patient care, employee well being and economic efficiency.

Jack's lifetime of accomplishments shows us that even with limited resources, we can achieve amazing results that can reliably and effectively improve service outcomes — and most importantly, enhance the lives of the patients we serve. 

About the author

Jonathan Washko as been involved in the EMS industry for over 27 years and has held progressive leadership position with small, medium and large EMS systems in government, private, for-profit and not-for-profit entities. He is considered the leading industry expert on EMS system design, high performance EMS concepts, industry best practices, EMS deployment, lean business processes, system status management and is often called upon by EMS systems in crisis as well as those considered at the top of their game, in order to help transform these organizations to become the best they can be. Contact him at
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Alicia Burns Alicia Burns Sunday, August 03, 2014 1:41:59 PM SSM was so controversial when it first came out, scoffed and literally laughed out loud at! I mean predicting ‘the next heart attack, really?’ But, no one could deny the effective results! These days, when I hear about the latest in ‘predictive analytics’ and ‘trending’ I just shake my head, thinking all they had to do, was listen to Jack for these 20+ years, and his son Todd, who has continued the effort (FirstWatch). His work, is one of the best and most effective process improvements in Public Safety, ever! May it continue to inspire a new generation, as it has me. Congrats!
David Shrader David Shrader Monday, August 04, 2014 8:19:28 AM Great Article Jon! Jack deserves the accolades and has been one of the fews people to truly change our industry. Many people are just now learning about his concepts from the early 80's. He's a great man, has a great mind and been an awesome friend. I wish I could have been there for his award, but one of the reasons I could not, was that I was trying to teach his concepts to a couple of clients. His work lives on through Todd, you and others. Thanks!
James McNichols James McNichols Thursday, August 07, 2014 11:36:33 AM I truly wish I could have been at this event. Every EMS system I visit, I see Jack Stout's fingerprints all over. Even most recently the efforts of the new Community Paramedic programs!. Kudos to you my friend! Kudos to Todd as well. A real chip off the ole block!
Scott Lancaster Scott Lancaster Sunday, August 10, 2014 12:43:21 PM SSM may be a cost savings, but it is a moral killer which can be just as costly. There are many high performing systems that have decided against SSM, and do a very good job. SSM became a large peg, that many tried to fit into areas where it wasn't needed, or wouldn't work. It wouldn't be an issue if communities would fund their EMS services as needed. An anecdotal thought: I have never seen a fire truck posting because of predictive analysis about where the next call would be. EMS should be similarly funded.

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