Jack L. Stout is known in the EMS industry as the Father of High Performance EMS and System Status Management. Jack's concepts were developed in the 1980's as an answer to fix failing EMS systems that were expensive, unreliable and didn't meet EMS's prime directive of:
"Provide each critical patient the best possible chance of survival without disability or medical complication, given the current state-of-the-art of prehospital care technology"
An economist by trade, Jack found that applying the science, concepts, economics and techniques used in manufacturing to a service industry produced an unprecedented ability to provide high quality, highly reliable EMS systems that could also afford to provide the best prehospital medicine available.
Frequently controversial, Jack's approach also maintains that free market competition in the EMS environment is dangerous as Jack recognized that demand for EMS services is not effected by the normal market forces of supply, price and quality, but rather is based purely on mostly uncontrollable factors like population age, socioeconomics, health, education, culture, location etc. Given this, free market competition actually hurts patients as competing EMS agencies (that are typically geographically constrained to a certain service area) share a fixed demand for these services and therefore also share a fixed reimbursement pool that can not expand based on the supply of EMS resources. This, plus the fact that open market competition drives down prices, creates an environment of uncoordinated care, loses economies of scale, can not provide reliable and consistent service and is unable to provide the best clinical sophistication due to the economic conditions that occurs in these environments.
Jack's solution to this problem was the development of the Public Utility Model (PUM) and Failsafe Franchise EMS System Designs. These approaches to service delivery provide a mechanism for cities and counties to eliminate the issues that multiple competing EMS service providers bring while preserving free market enterprise to allow to compete with each other through a competitive bid process.