Founders -- of companies, nonprofits, enterprises of every type -- sometimes have a shelf life: ask new gas/Chesapeake Energy phenom Aubrey K. McClendon, who "retired" last week.
Steve Williamson, CEO/founder of Green Country's quasi-governmental, Emergency Medical Services Authority is a gifted leader/public entrepreneur and a nationally renowned figure in emergency services. EMSA provides ambulance carry and a bundle of related medical services to more than 1.1 million people (over 130,000 carries last year) in Tulsa, Oklahoma City, and the surrounding areas, and -- if a host of sources are correct -- is one of the very best enterprises of its kind in the country. EMSA's signature effectiveness issues from Williamson's strong leadership and the high expectations culture he has masterfully crafted.
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And the agency is driven by state-of-the art ambulance deployment algorithms, superior on-the-spot catastrophic care, a premier paramedic contractor, and a pioneering mobile telemedicine system. EMSA also rocks because of Williamson's peerless success at demanding and getting, the taxpayer dollars needed to run a great public service. In EMSA's case, these dollars are essentially high-level admin/management funds: most EMSA runs are actually covered by via EMSA's special out of pocket arrangement -- funded via water bill fees -- but mostly via regular third party insurance providers.
Why EMSA Matters
EMSA is a rarity: a public agency with an almost cult-like following. The DNA that animates the emergency service "shop" is a way-pointer to leaner, smarter public services. The agency shows how horse-and-buggy local government operations -- ones that haven't changed in decades -- could be rebuilt using network-centric systems, lean staffing, strong work cultures, and predictive mathematics.
At its core, EMSA uses a propulsive, area wide digital model to prepositioning ambulances: all driven by advanced statistical emulation of emergency cases and historic ambulance runs. This hyper-agile response model could be embraced, with variation, by Tulsa's fire service and by parts of the Tulsa Police Department. The RAND Corporation and the Urban Institute have done elaborate studies on rescaled, redefined urban services -- that look like EMSA.
Somewhat less obviously, EMSA's nimble, off-the-grid, architecture could fuel a wildly more responsive bus service for Tulsans at some point in the future: a "bus rapid transit" system of this sort would look more like a late-stage Jackson Pollock painting then the classic, fixed routes that drive Tulsa's current bus system.
The Reckoning
EMSA's ham-fisted handling of a tiny set of customer billing mistakes has gotten outsized attention in the Tulsa World and on T-Town TV since February 2012. These demonstratively trivial errors (apparently less that 0.2 percent of all patient encounters) got far more attention than merited. But recent revelations of high handed outlays and an apparently suspect giant "tax haven" for a long-standing, essential EMSA contractor sparked the current controversy.
And sadly the whole episode is also a leadership failure. Where is Mayor Dewey Bartlett, as the latest phase of our EMSA "crisis" rolls on -- he was on tap earlier, where is he now?
But here's the tragic thing: it looks like Williamson has forfeited the right to run a venture that he brilliantly engineered and shepherded for nearly three decades. And his board isn't far behind: they've failed to see or quench the now challenged raft of smallish but embarrassing "imperial" expenses, the huge contractor tax haven matter, and a couple of arguably serious conflicts of interest. All illuminated via a recent Tulsa World investigation, a City of Tulsa/Management Review examination and a recently completed state audit -- one oddly called for by EMSA itself.
Cross Winds
Having superb, un-hobbled leadership at EMSA just now couldn't get any more important: the agency has fevered, complicated challenges that will surely have tumultuous impacts on its operating future. Two examples:
1) The impact of thousands of additional insured people spawned by the new Obama healthcare insurance requirement may impact ambulance service calls -- because insured people will arguably no longer be frightened by the cost of ambulance pick up and on the spot care stabilization.
But healthcare policy professional/nursing exec Jan Figart of Tulsa's Community Service Council reminds me that any uptake in ambulance/emergency room usage by newly insured Obamacare users will surely be counterbalanced by the stout incentives in the Affordable Care Act to get providers to push down use of emergency care, including EMSA services. Importantly, overuse of emergency care is a dysfunctional driver of Americans' healthcare cost/outlay explosion. Bottom line -- a larger population of insured persons and the pending "switch up" of Obamacare will surely have combustive impacts on EMSA operations, at least in the middle term.
2) A sea change in the way that healthcare pros and consumers monitor personal health dynamics is afoot. We may soon enter a deeply "entangled" period in U.S. medicine -- some call it the "Quantified Self" revolution. People will be routinely tethered, some observers believe, to an array of biosensors and remote-sensing gear, together with smart phones, to continuously track blood pressure, heart rate, blood chemistry metrics, and other key metabolics. We'll use these gizmos and cheap, "everywhere" wireless to convey these details to physicians and for our own use. For people with chronic or volatile conditions, this new world, together with the breakout healthcare info tech initiative managed by OU's David Kendrick and private sister efforts, could be a huge opportunity -- or a monster disrupter -- for EMSA. How the agency responds to this looming transformation might determine its future and profoundly shape health care in Green Country.
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The Path
For the sake of EMSA's future, the excellent service it provides to thousands annually, and its outsized value as a model for rethinking other public services in Green Country, Williamson and the bulk of his oversight board -- which arguably hasn't been doing much oversight of late -- need to go.
There is a path forward: Williamson should be asked to retire immediately and simultaneously be retained for six months as a consultant to EMSA while a newly constituted board searches for his successor: one that he could help identify. And in the process, Williamson can transfer some of his deep, unique insight to his junior peers at the agency. Hiring Williamson as a temp consultant, mind you, isn't a golden parachute sop: it is a deeply practical concession to the fact that he's been the only helmsman, the only principal at EMSA; continuity here is incredibly important. Williamson's brilliant "child" and T-Town deserves one more round of his engagement.
Send all comments and feedback regarding Cityscape to rpearcey@urbantulsa.com