“Building a Vision of Service” -...
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Riverside County Strategic Planning Project “Building a Vision of Service” W E L C O M E
Transcript of “Building a Vision of Service” -...
RiversideCountyStrategicPlanningProject
“BuildingaVisionofService”
W E L C O M E
County of Riverside EMS System AssessmentOBSERVATIONS & RECOMMENDATIONS
PREPARED BY THE ABARIS GROUP
DECEMBER 2, 2013
Riverside CountyEMS System Improvement
Overview
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April 2014
Phase I
EMS System AssessmentComplete by December 2013
Identifying Best Practices in EMS
Evaluating Threats Facing the EMS System
Evaluating Opportunities Facing the EMS System
Evaluating Strengths in the EMS System
Evaluating Weaknesses in the EMS System
The costs of the system's current inefficiency underscore the urgent need for a system‐wide transformation. The committee calculated that about 30 percent of health spending in 2009 ‐‐ roughly $750 billion ‐‐ was wasted on unnecessary services, excessive administrative costs, fraud, and other problems. Moreover, inefficiencies cause needless suffering. By one estimate, roughly 75,000 deaths might have been averted in 2005 if every state had delivered care at the quality level of the best performing state.
Institute of Medicine: “Best Care at Lower Cost: The Path to Continuously Learning Health Care in America” (Sept. 6, 2012)
Potential Roadblocks
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Phase 2
EMS System Strategic PlanningComplete by June 2015
County and Stakeholder Feedback
Ursala Sanders
Preparing for the Future of Riverside County’s EMS
A 10 Year County EMS System Strategic Plan
Questions/Comments
What is next?
Change Careers
Riverside County EMS Strategic Planning Process – Work Groups
Session Two (April 23)• Present SWOT Analysis by
Opportunity• Complete SWOT Analysis• Design Goals, SMART
Objectives/Goals & Timeline for each opportunity via group process
• Group consensus on Mission/Vision & Goal Statement
• Develop action necessary to achieve• Notify participants re: online survey
purpose & deadline
Session One (March 26)
• Rollout of Detailed EMS “As Is” Analysis• Present Feedback Top five (5) areas for focus for the
county region Benefits/Challenges Health Reform & Impact
• Respond to Top Areas for the future? Where are the gaps? What are EMS System characteristics
needed? What are the risks/threats? What will be needed for the future?
SURVEY
Session Three (May 21)• Present online survey results (depending on
response rate may need to do mini prioritization exercise)
• Identify who, what, how & success measures for priority items via group process
• This is the reality check session with the potential for national content & experience (optional) to discuss what factors are needed for success & resources available with stakeholders in roundtable discussions
Session Four (June 25)• Present DRAFT Strategic Planning
Document• Implementation Development• Strategic plan leadership (who)• Resources/Budget (what)• Timeline (when)• Communications (how)
INPUT FROM THE COMMUNITY, WRITTEN BY
THE CONSULTING/PLANNING TEAM
VALIDATE DRAFT WITH
“ADVISORY GROUP”
DRAFT STRATEGIC
PLAN
ROLLOUT STRATEGIC PLAN
Town Hall MeetingsStakeholder Groups
Site VisitsGuest Speakers
Health and County Leadershipand Other
Key Policy Makers
Prepared by The Abaris Group on 3/03/14, revised on 3/25/14
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The Paperclip
SmallGroups
• Needatimekeeper• Evaluatethepaperclip• Developupto25ideasonwhatthispaperclipcanbeusedfor• Notalkingforfiveminutes!• TableDiscussion
• Furtherdiscussion• Takethetopfiveideasandpresentthem• Needtoidentifyapresenterandbepreparedtopresenttothe
group
• Questions
SmallGroups
• CreateaSMARTGoal• Individualsfillouttheworksheet• TableDiscussion
• Pleaseidentifyafacilitator,timekeeperandnotetaker
• TableDiscussionProcess• Cometoanagreementonthegoalstatement• Filloutmasterworksheet• Bepreparedtopresenttothegroup
• Questions
StrategicPlanVisionStatement(draft)
To create a collaborative, accessible, high‐quality and culturally‐competent EMS and health delivery in Riverside County that is
outcome‐based and sustainable.
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MissionStatementOverview
A MISSION STATEMENT IS A STATEMENT OF THE PURPOSE OF A COMPANY, ORGANIZATION OR PERSON,
ITS REASON FOR EXISTING.THE MISSION STATEMENT SHOULD GUIDE THE ACTIONS OF THE ORGANIZATION, SPELL OUT ITS OVERALL GOAL, PROVIDE A PATH, AND GUIDE DECISION‐MAKING. IT PROVIDES "THE FRAMEWORK OR CONTEXT WITHIN
WHICH THE COMPANY'S STRATEGIES ARE FORMULATED."
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‐ KEY MARKET – WHO IS YOUR TARGET CLIENT/CUSTOMER?‐ CONTRIBUTION – WHAT PRODUCT OR SERVICE DO YOU PROVIDE TO THAT CLIENT?‐ DISTINCTION – WHAT MAKES YOUR PRODUCT OR SERVICE UNIQUE?
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MissionStatementOverview
A “commercial” mission statement consists of three essential components:
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ValueStatement
Categories of the “value” statement for EMS consists of three essential components:
QualityConsistencyComprehensiveServiceAdaptabilityCommunityOutcomeOthers
EmergingSWOTIssuesRiversideCounty
• Leadership• Collaboration• Communications/Dispatch• EMS‐ED capacity• Care coordination for patients
• Identifying strategies to reduce patients unnecessarily EMS & ED use• Better partnerships between hospitals, public health & health care in
general• IT – Communication – Data integration• Funding• Culturally appropriate patient education on lower‐cost choices• Developing options for community health
Questions
SMARTGoals• ToachievetheimplementationofHealthReforminRiverside
County
• Specific:Goalmustbeclearandunambiguous• Measurable:Cleardatapointthatispre/post‐measureable• Attainable:Goalsmustberealistic(highleverageandhighyield)
andattainable(within18to24months)• RelevantorRealistic:Goalsmustbeanimportanttoolinreaching
thestrategicplan• Time‐bound:Goalsmusthavestartingpoints,endingpoints,and
fixeddurations
Summary of Key EMS Study Recommendations
1. The County and EMS stakeholders should commence an EMS Innovations Project (Phase II of this project) to better position the community for changes occurring both in the community and in healthcare with Healthcare Reform ‐‐The Affordable Care Act (ACA).
2. The County of Riverside should continue the reinstitution of a state‐of‐the art Continuous Quality Improvement (CQI) and medical‐control program (e.g., enhanced medical direction) consistent with the recommendations of the report.
3. The County, along with its cities and fire entities, should collaborate to document opportunities to create an EMS system where the most appropriate and available EMS resource responds to an emergency request regardless of geographical jurisdiction: Such a system would study the impact of “boundary‐drop”
mutual‐aid systems (i.e., Orange County boundary‐drop system) throughout the county
This collaborative group would also address first response‐time standards identified in The Abaris Group’s report including their documentation and accountabilities
4. Explore and develop improved efficiencies for EMS services provided to mental health patients: Investigate alternatives to 72‐hour holds (Welfare and
Institutions Code Section 5150) for mental health patients
Consider additional mental health training for EMS and law enforcement
Determine if alternative destinations can be developed for mental health patients
5. The “EMS‐to‐ED” off‐load ambulancedelays should be addressed in the form of a multidisciplinary collaborative: There should be substantial key executive leadership
involvement from all appropriate stakeholders with a clear mandate to reduce and eventually eliminate ambulance off‐load delays
6. The County should adopt stronger inter‐facility transport (IFT) requirements and monitoring processes as follows: Conduct felony background and Medicare “excluded‐provider”
checks and disclosures of all current or past Office of Inspector or other payer investigations
Insist on current audited or “reviewed” financial statements from ambulance permits to ensure provider credibility and solvency
Consider requiring a physical presence within the county at a credible base of operations (i.e., formal dedicated office) for the applicant
7. Key communication recommendations in the report should be adopted as follows: Consolidate all ambulance dispatching functions for all
9‐1‐1 requests within a consolidated and high‐performance communication center.
Mandate CAD‐to‐CAD interfaces between the communications center and 9‐1‐1 ambulance providers throughout the county
Fully deploy the provision of Emergency Medical Dispatch (EMD) services to all EMS requests:
Pre‐arrival instructions on 100 percent of all EMS requests Call priority response tiering CQI policies/practices completed on all requests
Encourage the participation of all EMS responders in the County’s Public Safety Emergency Communications System (PSECS)
Establish a communications policy requiring responding ambulances to contact first‐response agencies to receive on‐scene updates
Standardize data collection requirements and quality improvement standards and monitoring from dispatching operations
8. EMS governance structure: The EMS Agency staffing should be adjusted as
follows: Add “EMS specialist” staff positions (estimated to be at least one
up to three specialist positions) per recent statewide EMS agency survey
Eventually achieve a full‐time EMS medical director Study and implement specialized programs (i.e., mental health,
etc.)
Adjust and consolidate EMS advisory committee structure as appropriate: Re‐evaluate and “zero base” all current EMS advisory committees Determine if consolidation, re‐timing and/or elimination is a
possibility of each advisory committee
Take appropriate steps as called for by the consolidation study
9. Evaluate and develop strategies to improve on‐line medical direction: Implement optimal patient movement solutions Determine the ideal number of base hospitals to manage EMS
direction in the field while maintaining a sufficient span of control from the EMS Agency, while considering costs to agencies
Investigate ways to improve system coordination with a uniform medical control model (e.g., Medical Alert Center, Medical/Health Communications Center)
10. The County should address existing contract parameters with all of its 9‐1‐1 ambulance providers by: Targeting key operational and performance issues
required for a responsive and contemporary countywide ambulance delivery system
Creating or updating response times for each first responded entity, including participating first responder agencies that partner with private ambulance services
Establishing performance penalties with bench mark financial sanctions for under‐performance
Crafting a written agreement and a timetable for participation with countywide data and information technology initiatives
Obtaining a countywide agreement to participate in medical control and quality‐improvement initiatives
Adopting various equipment and vehicle standardizations
Developing reimbursement formulas for first responder costs and supplies used on EMS calls
Disclosing of key system status plan (SSP) provisions including advanced notification and approval by REMSA of planned adjustments to the SSP
Providing quarterly disclosure of financial statements at a unit (Riverside County) level, including continuance of the annual audited statement requirement
Seeking agreement to participate, negotiate in good faith and implement system enhancement features for future system innovations (assuming financial sustainability) of the EMS delivery system
Adopting a variety of contract clauses that permit the contract to be amended based on researched & verified efficacy and adopted ambulance delivery system benchmarks that demonstrate a high potential for system enhancements and alignment with the “triple aim” of Health Reform
11. The County should consider one of three models of ambulance exclusivity as documented in the report and, as appropriate, begin a request for proposal (RFP) process to establish appropriate providers throughout the county: In addition, the County should obtain commitments to achieve the
ambulance and contracting performance as listed in these recommendations and in the report.
The three broad options are listed in the report but the County should not be limited solely to these three options
ThankYou!
