Triage gets complicated when there is second door for patients that come in ambulances. These patients skip the triage nurse and may have their first assessment by the emergency room nurse or physician. This second door may allow a patient who is less sick than one who is driven to the emergency room to see a physician faster, or at least be placed on a gurney in an emergency room corridor.
Further complications exist in the case of natural disasters, mass-casualty accidents, and suicide bombings all of which may overwhelm the capacity of the medical facilities available. Then the choices become even more daunting. Instead of just choosing which patient can wait to be treated, the triage process may have to decide who is too injured to try to save and for those that it can save what organ/limb must be sacrificed for expediency in order to save even more lives given the available resources. Medical care in Haiti following the earthquake was like this as limited facilities, supplies and medical personnel forced some horrific decisions to amputate limbs that could have been saved in a medical environment that was not so stressed.
The decision by the Postal Service to eliminate one day of delivery is equivalent to a decision that a business in triage makes. Given the substantial losses, even discounting the retiree issues, the Postal Service had no choice but to find a way to cut costs faster than its current cost cutting efforts had produced. Specifically, it needed to find a way to cut costs by between $2 and 4 billion above and beyond existing efforts in order to survive.
In its business triage, the Postal Service faced the question, "How can it cut costs in order to save the business without harming the brand and relationships with customers?" The decision to eliminate one day of delivery is equivalent to an amputation. It may save the business but it will create new challenges for it going forward. Decision-makers had confidence in this decision because posts in other countries had made similar changes and their brand and customer relationships survived intact.
In the next year the Postal Regulatory Commission will review whether the Postal Service made the correct decision in its triage process, in the equivalent of a pre-amputation second opinion. The focus of the PRC will likely be checking to see whether the cost savings projected are realistic and evaluating the likelihood that the impact on customers will be a form of business gangrene or benign.
One of the biggest challenges facing the PRC will be putting the decision to eliminate 5-day a week delivery into context. The Postal Service made the decision to develop a 5-day a week proposal as part of a business triage process in the fall of 2008 that also generated some additional efforts to cut costs. These included:
- Preparing a proposal to offer a Voluntary Early Retirement Offering;
- Preparing a case to close post offices;
- Completing preparations to complete plant consolidation studies;
- More intensive efforts in carrier route evaluations; and
- Preparing a proposal for 5-day delivery.
The PRC's evaluation of post office closures is nearing its end and the list of post offices that will be closed has shrunk from more than 3,000 to less than 200. The potential cost savings has most likely shrunk as well. The failure of the Postal Service to eliminate all of the corporate offices that it wanted reflects both the need to continue to provide service in the communities affected and the lack of a ready strategy to replace corporate offices to be closed with contract or franchised offices in those communities.
Plant consolidation study announcements were publicized in earnest from the spring till fall of 2009. These consolidations were chosen based on the knowledge and experience of local management. A national strategy to restructure the bulk mail network was begun and then expedited after the initial efforts both improved service and reduced costs. Even without PRC review, plant consolidation proposals take a full year to complete the entire process meaning that efforts begun in 2009 could not begin producing savings for a full year.