Paramedics Plus ExECuTivE SuMMAry

Transcription

paramedics plus
executive summary
Paramedics Plus
Executive Summary
Paramedics Plus is pleased to present this proposal to serve as the exclusive EMS Ambulance
Transport Provider for Alameda County. As you will learn in this proposal, Paramedics Plus operates
nationally recognized EMS systems, meets stringent response time standards, excels in clinical quality,
benefits from solid financial backing, and produces superior customer service in a culture of fairness
and family for its employees. Our proposal meets and, in many ways, exceeds your performance expectations.
Paramedics Plus is not the largest provider in the EMS industry but it is agile, strong and capable.
Paramedics Plus won its first contract through a competitive bid in 1998 and has enjoyed calculated
growth since. The organization has never lost a contract for any reason. Why? The answer is simple.
We do an outstanding job at a reasonable cost and we keep our promises.
Pa r a m e d i c s P l u s 1
paramedics plus
executive summary
Our clinical efforts gained national attention when
two Paramedics Plus communities were named
among the top five in the country in a U.S.A. Today
study which compared cardiac arrest survival rates
among large urban EMS systems. Our efforts have
also led to a host of awards including the Florida
Sterling award in 2009, a quality award based on
Baldrige criteria, and as far as we can determine,
the highest award for quality won by an EMS organization anywhere in the United States.
Perhaps even more impressive and significant
than awards and public recognition are the relationships we develop with our clients. In Oklahoma,
Florida, Indiana and Texas, Paramedics Plus and
our parent organization, East Texas Medical Center
Regional Healthcare System, are known for integrity.
The integrity of our individual employees and
the integrity of the organization dictate that when
promises are made, promises are kept.
Sometimes keeping promises is costly. When
Paramedics Plus took over the contract for EMS
services in Pinellas County, Florida, attrition,
more stringent response times, and an unexpected
increase in call volume resulted in a shortage of 150
employees. It took time and money—more than $5.5
million in unbudgeted funds—to rectify the situation
and maintain stringent response times, but that’s what
we did. We paid bonuses. We recruited. And we kept
our promises. That’s why you can trust what you read
in this proposal. If we commit to it, we will do it, all
the while staying patient-centric.
To keep our promises, we employ and develop a
gifted management team and support it with solid
financial backing. Our parent organization has
working capital of $246,215,000, a current ratio of
3:24 to 1 and a quick ratio of 2:92 to 1. The start-up
costs for Alameda County, including the cost of a
new fleet of ambulances, will be financed by our
parent organization. When our commitments result in
short-term losses, we have the ability to absorb those
losses because we are not beholden to Wall Street
investors but rather to our principles.
Our President Anthony Myers, often says that it
is “immoral to make too much money on emergency
health care. Patients don’t have a choice and it is
unfair to take advantage of individuals who need
emergency care.” We also believe it is equally unfair
to take advantage of communities. While we expect
to make a reasonable profit in Alameda County, our
principles are based on those of our founding organization, a nonprofit healthcare system, which is why
we will cap our net profits in Alameda County at 7%
2 Pa r a m e d i c s P l u s
paramedics plus
executive summary
annually. Not only that, but our proposed rates do
not reflect the full 2009 and 2010 increases awarded
to the incumbent nor any anticipated 2011 increases
prior to the start of the new contract.
This scenario would sound too good to be true
if it weren’t backed by documented, patient-centric
clinical excellence and a proven track record for
success in meeting stringent response time standards
in service areas of more than a million people
(Please see our response times in this proposal in
Credentials and Qualifications.) Expert in the field
of efficient resource utilization, Paramedics Plus
will, from day one, provide better, faster and more
consistent service.
From the heavily urbanized areas in North County
to the suburban, diverse communities in South
County and over the foothills into the unique and
varied Tri-Valley area, Paramedics Plus is eager to
show its ability to care for people of every age and
every ethnicity. We are the communities we serve.
Old fashioned as it sounds, we encourage and reward
employees who treat others as they would want to
be treated—always with dignity, always with respect
and always with the best medicine possible.
And the best medicine is what you can expect
from Paramedics Plus. We have benefited from
strong, visionary medical oversight in our systems
and while we don’t take full credit for all the
great medicine we practice, we do take credit for
partnering with medical oversight, overcoming
obstacles, and creating a workforce and management
team that embrace change. Most ideas may come
from medical oversight but we enthusiastically and
paramedics plus
executive summary
energetically operationalize those ideas to provide
better pre-hospital care.
We encourage you to look more closely at some
We are data driven. From our patient and
employee satisfaction surveys to our sophisticated
monitoring of virtually all aspects of clinical care,
of the clinical innovations summarized on page
we gather and use data to drive decisions. Examples
173. You will see we are clinical leaders in the
abound. In one of our operations, we used data and
country and partners with community stakeholders.
creativity to shorten the time to definitive care for
Our clinical operations and quality improvement
STEMI patients to 30 minutes from the time the 911
programs are not only award winning, but also
call was received until Cath Lab treatment. While
visited and studied by EMS professionals from
most systems measure the time from the Emergency
Canada to Israel because we have found a way to get
Department to the Cath Lab, we measure the total
it right. That’s exactly what we will do for Alameda
time from the 911 call to Cath Lab treatment. We
County– get it right!
also use data to monitor system-wide protocol
How do we do it? Simple—we focus first on
patients and then on the medics who treat them. To
deliver the quality expected by the communities we
compliance and procedure proficiency and track data
on individual medic performance.
Paramedics Plus specializes in the management
are honored to serve, we place our second greatest
of high performance, response time accountable,
focus on creating a caring environment for our EMTs
all-ALS, emergency and non-emergency ambulance
and paramedics. We give these professionals superb
services. Paramedics Plus and ETMC-EMS operate
tools, training and support. Our coaching staff – the
293 paramedic-level ambulances and respond to
leadership talent we will assemble both from people
over half a million requests for ambulance service
inside the community and others networked from
annually. We serve a combined population of 3.6
outside the community – are highly experienced and
million people, in urban, suburban and rural areas
academically prepared. Their job is to help Alameda
including two service areas near or more than one
County medics reach their individual and collective
million. With nearly 1,200 EMTs and paramedics, we
potential. That requires a decision making process
produce more than 1.2 million ALS unit hours each
based in Alameda County, but founded on tested and
year.
proven processes and principles. We have mastery of
data management, a thirst for statistics, great teachers
and a philosophy that rewards performance and
innovation.
paramedics plus
executive summary
“
”
“Paramedics Plus has consistently exceeded even our highest
expectations for compliance and performance.”
—Richard C. Williams, Bureau Director, Department of Public
Safety Services, EMS Division, Pinellas County, FL
paramedics plus
executive summary
Paramedics Plus is one company, but one of many
Three Rivers Ambulance Authority. The newest
colors. You may have never seen a Paramedics Plus
member of the Paramedics Plus family is the Three
ambulance, but EMS professionals across the county
Rivers Ambulance Authority (TRAA) located in Fort
know the systems we run including:
Wayne, Indiana. This system serves a population of
EMSA. (www.emsaonline.com) For more than 10
just over 250,000 with 21,000 transports each year,
years we have served Emergency Medical Services
a paramedic and EMT staff of 102 and a fleet of 14
Authority (EMSA), the exclusive emergency
ambulances. This new Paramedics Plus operation has
medical services provider for more than 1.1 million
exceeded expectations through a smooth transition,
people in Central and Northeast Oklahoma. With a
quality clinical care, response time compliance and
fleet of 89 all ALS ambulances, we handle more than
earning re-accreditation from the Commission on
122,000 transports annually. Tulsa and Oklahoma
Accreditation of Ambulance Services within six
City were named by USA Today as two of the top
months of contract start.
five cities in which people survive out-of-hospital
cardiac arrests.
SunStar EMS. (www.sunstarems.com) In
ETMC-EMS. (www.etmc.org) ETMC-EMS is
one of the nation’s largest rural ambulance services,
as well as one of the most progressive and fastest
addition, we serve Pinellas County, Florida through
growing. Based in Tyler, Texas, with locations
Sunstar EMS. At Sunstar, more than 250 highly
throughout Texas, ETMC-EMS serves more than
skilled EMTs and Paramedics are employed fulltime
1.4 million people in 17 counties covering nearly
to provide care and transportation to the people
17,000 square miles and has for over 40 years. Its
of Pinellas County. Our compassionate caregivers
116 ambulances, three helicopters and 508 EMTs and
transport about 135,400 patients each year. SunStar
paramedics transport 103,000 patients a year.
EMS was awarded the Florida Governor’s Sterling
Award in 2009 for quality.
paramedics plus
executive summary
We are the communities we serve and we serve
County. Paramedics Plus leadership has met with
each in unique ways. There is no cookie cutter
key stakeholders in Alameda County, listened to their
approach. We know that each community is unique
concerns, and incorporated many of these stake-
and we tailor our approach to align locally. For
holder suggestions in this proposal. These ideas,
example, our Florida operation has taken the lead in
although expensive, significantly improve the quality
utilizing Baldrige quality criteria. We will use what
of pre-hospital care system-wide. Here are a few of
we have learned in this award-winning process as a
the highlights of our proposal for Alameda County.
basis for our initial, localized approach for Alameda
Paramedics Plus will –
Upgrade system equipment. Our patient-centric
approach will drive decisions such as our proposal
to provide Paramedics Plus EMTs and paramedics in
Alameda County with—
• LIFEPAK-15s capable of transmitting
12-Lead EKGs directly to hospitals.
• Autovent Ventilators to improve care for
intubated patients.
• ePCRs which are easy to use and integrated
with First Responder partners.
• LUCAS devices on all supervisor vehicles.
Improve equipment, support, and continuing
• LIFEPAK-15s on each unit and an annual
maintenance contract.
• LUCAS devices on each unit for consistent,
effective chest compression.
• Rugged mobile personal computers for the
ePCR system for each First Responder unit.
• IT support for First Responder EMS
equipment.
• An EMS supply system to check PAR levels,
order and deliver supplies. We will pay for all
disposable supplies.
• EMS CE for all Alameda County First
education for First Responders to address the
Response agencies, regardless of inclusion in
disparities and inconsistencies in First Response
the EOA. Recognizing the inherent difficulties
equipment across the County. Based on our
in sending First Response agency personnel
discussion with key stakeholders, we will provide
to our location, CE training will be made
clinical enhancements costing more than $5.7 million
available at First Response agencies through
for First Responders, which will not only elevate
our four clinical education coordinators. For
the clinical sophistication, but also assure that all
new Fire employees, collaboration with First
citizens of the County receive consistent high quality
Response will also include field internships,
pre-hospital care. We will provide, at no cost to First
riding on ambulances and working with our
Response agencies:
FTOs for initial system training.
paramedics plus
executive summary
Become a true partner with First Response.
to $67 million over five years comparing the rates
Discussions between Fire leadership and Paramedics
proposed by Paramedics Plus with the rate increases
Plus have been productive and fruitful. In addition
approved through the November 2010 contract
to the more than $5.7 million in clinical upgrades
period.
already mentioned, Paramedics Plus will bring a new
Honor the NEMSA collective bargaining
spirit of partnership to Alameda County. We will
agreement and work to build a collaborative
share information obtained through the ePCR, build
relationship with union leadership.
a collaborative quality improvement process and
Embrace and hire the incumbent workforce.
foster a relationship of transparency, trust and mutual
These individuals have proven themselves in
respective.
the current system and will be welcomed into
Cap annual net profits at 7%. Paramedics Plus,
the Paramedics Plus family at the same wages
and its non-profit parent East Texas Medical Center
and seniority in the same Alameda County
Regional Healthcare System, are in the health care
position. Historically, Paramedics Plus has offered
business. We are not in the business of maximizing
employment to about 99% of the workforce and,
profits to the detriment of the patients and commu-
almost without exception, employees accept and stay.
nities that need our services. One Paramedics Plus
Staff three Clinical Field Supervisors at all
community alone has received $5.8 million in
times, exceeding the requirements of the request
returned profits over the past three years.
for proposal. These experts in clinical education
Cap corporate overhead allocation at $500,000
annually. This limit will be adjusted annually based
on the Consumer Price Index.
Produce an initial 4,920 unit hours each week
and supervision will improve patient care while
mentoring field crews.
Purchase an all new fleet of ambulances and
support vehicles selected for reliability, safety,
and 255,840 unit hours annually. We are prepared
functionality, ease of use, ease of maintenance,
to increase resources if necessary but will not reduce
crew comfort, efficiency, performance and environ-
that staffing plan, if ever, until we have demonstrated
mental impact. New 2010 model year, low emission,
to ourselves and Alameda County EMS that we have
American Emergency Vehicle Type III ambulance
the capacity to ensure response time performance.
vehicles are diesel and support the EPA National
Propose rates that project millions of dollars in
savings to the citizens of Alameda County.
Paramedics Plus proposed rates, compared to
those effective in the system in November 2009,
project savings to County citizens of more than $21
million over five years. The projected savings climb
Clean Diesel Campaign for diesel emission reduction
strategies. We will also do our part to reduce green
house gas emissions by utilizing Tahoe hybrid SUVs
for supervisors.
paramedics plus
executive summary
“
Although relatively new to our
community, Paramedics Plus
is quickly proving that they
place patient care to be
of utmost importance.
They have continually demonstrated
their desire to be a true ‘partner’
in our system by doing whatever is necessary
to meet or exceed the needs of patients, our
local medial community, the Authority.
–Gary A. Booher, Executive Director
Three Rivers Ambulance Authority
Fort Wayne, Indiana
”
paramedics plus
executive summary
Purchase quality equipment and supplies.
Recognize and respect the unique role of the
The selection process for equipment and supplies
County EMS Medical Director and work coopera-
must consider the best interest of the patient, while
tively to educate, enforce policy, embrace clinical
keeping the team members who use the equipment in
innovations and create opportunities for system
mind. As an example, we will purchase:
improvements. Our budget includes $100,000 for
• Stryker Power Pro Stretchers which will raise
and lower patients at the push of a button
while reducing employee injuries
• The Road Safety SafeForce Driving System to
annual clinical upgrades.
Enlist the expertise of consultants in diversity
planning to create and monitor a best practice plan
which will increase the diversity in the workforce
improve safety while reducing wear and tear
while bolstering employees’ appreciation of cultural
on vehicles.
and ethnic differences. Paramedics Plus will partner
Employ Paramedics Plus unique Performance
with Biddle Consulting Group, Inc. of Northern
Utilization Late-call System Evaluation (PULSE)
California, an experienced and respected diversity
process combined with state-of-the-art technology
consultant, and its partners, Crawley Consulting and
and managerial experience to exceed Alameda
Firefighters ABCs.
County response time requirements. Paramedics
Recruit from underserved and under-represented
Plus will use the PULSE process to fine-tune and
communities for an in-house EMT program. This
improve situational awareness for all departments
work/study program will allow motivated students
and renew focus daily on the operational measures
to receive training, at no cost, while earning wages.
impacting system performance. Paramedics Plus will
Students who successfully complete training will be
also purchase the Mobile Area Routine and Vehicle
offered employment with Paramedics Plus where
Location Information System (MARVLIS) to provide
they will have the opportunity for paramedic training
the latest real-time information on call volume and
at no cost.
service area coverage based on the deployment plan.
Link education with CQI. Paramedics Plus
Identify and implement effective community
continuing education programs are directly linked
education programs through collaboration with
to its continuous quality improvement programs.
Alameda County EMS and other system stake-
Award-winning and proven improvement practices
holders. Our first community education program will
draw from the work of Deming, Covey, Devel-
focus on child passenger safety and will solicit funds
opment Dimensions International, Chopra and Six
for the purchase of car seats for children in need. We
Sigma and are based on Baldrige quality criteria.
will also donate ten Public Access Defibrillators each
Paramedics Plus will implement a local continuous
year to the Alameda County EMS Public Access
quality improvement plan that meets or exceeds the
Defibrillation Program.
standards of Alameda County.
1 0 Pa r a m e d i c s P l u s
paramedics plus
executive summary
successful application. Paramedics Plus operations
in Florida and Oklahoma have been recognized by
their respective state quality programs both based on
Baldrige criteria.
Organize a smooth transition using the expertise
of an experienced successful team. Our seamless
transitions in large high performance EMS systems
in Florida and Oklahoma prepare us for success in
Alameda County.
Advance the careers of the workforce by
providing opportunities for every employee to learn
and gain new skills in preparation for the next level.
Paramedics Plus will provide, at no cost:
• paramedic training to EMTs
• management training through our proprietary,
Ph.D. led program
• coaching and mentoring on every level
• individualized education plans.
Paramedics Plus will also host a regional EMS
mid-level managers’ educational conference. What
is more, Paramedics Plus will collaborate with local
fire departments to develop a career ladder to train
paramedics available for employment with those
agencies.
Earn recognition as a quality organization
through participation in the California Council
for Excellence program. Paramedics Plus will
apply for the California Award for Performance
Excellence in year five of this agreement. With
quality management resources available throughout
the Paramedics Plus organization, including the
leadership in Alameda County, we are confident of a
Add a full-time Medical Response Coordinator
to work with our staff, other public safety agencies,
and community stakeholders on disaster planning and
special events. Paramedics Plus will also assemble
a planning and development team from multiple
agencies and disciplines to execute an annual countywide disaster exercise. Whether the next Alameda
County disaster is an earthquake as in 1989 or a fire
as in Oakland during 1991, Paramedics Plus will be
ready to respond quickly with adequate resources,
advanced plans and solid working relationships
across Alameda County public safety agencies.
Surround the capable Alameda County field
crews with a talented management team. The top
three members of the management team are all
known to Alameda County; additional members of
the team will be recruited locally.
• Jeff Taylor, who will serve as Chief
Operations Officer, is an effective leader
as demonstrated in well-documented
successes including past service in Alameda
County. He is knowledgeable in Baldrige
quality processes, is results oriented and
has depth of knowledge and experience in
paramedics plus
executive summary
managing large high performance EMS
systems.
• Paramedics Plus has enlisted Senai Kidane,
M.D., as Medical Director. A residency
trained Emergency Physician, Dr. Kidane
completes a fellowship in EMS in July,
2010 and recently completed the EMS
Medical Director training through the
National Association of EMS Physicians.
Dr. Kidane has experience as a Medical
Director for an Alameda County area fire
department.
• Marlene Rivers, R.N., M.S.N. will serve
as the Director of Clinical and Education
Services. Ms. Rivers is an experienced
manager familiar with pre-hospital care and
grounded in quality management.
Take no exception to any requirement in the
request for proposals.
While you may not have been familiar with
Paramedics Plus before this proposal process, there’s
a lot to like about us and the things we accomplish.
We are clearly capable of doing the job outlined in
the Alameda County Emergency Medical Services
District Request for Proposals.
If the County is looking for an organization that
keeps its commitment, is agile, clinically excellent,
financially sound, willing to partner and with
a proven track record, then please consider our
proposal carefully. You can believe what you read
as we keep our promises. Please feel free to contact
our partner clients for confirmation. References are
provided in Exhibit D.
To see and hear what others say about Paramedics
Plus, go to www.sunstarems.com/videos
• Stephen Williamson, President and CEO
of the EMSA operation in Oklahoma,
comments on the partnership between the
authority and Paramedics Plus.
• Oklahoma City Councilman Pete
White comments about the positive
change Paramedics Plus brought to his
community.
• Jeff Dixon, M.D., chairman of the
Medical Control Board in Oklahoma,
talks about Paramedics Plus and its
productive relationship with medical
oversight.
• Gary Booher, Executive Director for
Three River Ambulance Authority,
speaks about Paramedics Plus and its
smooth contract transition.
• Ben Goldsberry, Paramedic Field
Supervisor with Three Rivers Ambulance
Authority, comments on the equipment
provided and maintained by Paramedics
Plus.
• Paramedics Plus Chief Operating Officer
Mark Postma speaks about the importance of an engaged, satisfied workforce.
• Consultant Jay Fitch speaks about Sunstar
EMS winning the Pinnacle Award and the
Florida Governor’s Sterling Award for
quality.
“
paramedics plus
executive summary
Paramedics Plus is a true partner with EMSA, working
cooperatively to solve day-to-day issues while playing a key
role in our maintaining an outstanding national reputation
for quality. I believe the organization has the resources, both
human and financial, the corporate culture, experience and
unique management talents to achieve the standards outlined in
the Alameda County EMS request for proposal.
”
H. Stephen Williamson, M.P.H.,
President and CEO of the Emergency Medical Services Authority
which serves more than one million Oklahomans
Pa r a m e d i c s P l u s 1 3
paramedics plus
executive summary
Exhibit P
Proposal Checklist/Mandatory Table of Contents
BINDER #1 - NARRATIVE
Page #
Executive Summary (optional)......................................................................................................................................................................... 1
Required Forms:



Face Sheet (Exhibit F)........................................................................................................................................... 15
Completed Proposal Checklist (Exhibit P)................................................................................................... 17
Proposal Form: Proposed Patient Charges (Exhibit G ).......................................................................... 23
 Evidence of Insurance (Exhibit C). .................................................................................................................. 26





Debarment and Suspension Certification (Exhibit K)............................................................................. 29
Exceptions, Clarifications, Amendments (Exhibit H). ............................................................................. 30
References (Exhibit D).......................................................................................................................................... 31
Additional Requirements (Exhibit J).............................................................................................................. 33
First Source Agreement (Exhibit L)................................................................................................................ 49
 Investigation Release Form - Individual (Exhibit M)............................................................................... 51
 Investigation Release Form - Entity (Exhibit N)........................................................................................ 79
 Budget Compliance Form (Exhibit O)............................................................................................................ 81
Credentials and Qualifications: (See General Information Section)

Experience (See 4.1) .................................................................................................................................................................................. 87
 Demonstrated ability to meet response time standards (See 4.2)........................................................................................90



Financial stability (See 4.3)...............................................................................................................................................95
Outstanding/Pending Litigation (See 4.4)...........................................................................................................................98
Current contracts in Good Standing (See 4.5)............................................................................................ 99
Clinical Quality Improvement:
See Exhibit A – Scope of Work for the required contents of each of the following:


Quality Management (See Section D[1])......................................................................................................................... 117
Quality Processes and Practices (See Section D[2]). ................................................................................................. 128








Leadership............................................................................................................................................................... 128
Strategic Planning................................................................................................................................................. 138
Customer Focus..................................................................................................................................................... 145
Customer Service Telephone Line................................................................................................................. 152
Measurement, Analysis, and Knowledge Management........................................................................ 154
Process Management.......................................................................................................................................... 165
Results....................................................................................................................................................................... 180
Commitment to Employees (See Section E).................................................................................................................................185














Continuing Education Program...................................................................................................................... 204
Clinical and Operational Benchmarking..................................................................................................... 206
Ambulance Staffing Requirements................................................................................................................ 211
Work Schedules and Human Resource issues.......................................................................................... 212
Personnel Licensure/Certification/Training Requirements.............................................................. 215
Personnel Training............................................................................................................................................... 216
Character Competence and Professionalism of Personnel................................................................. 225
Internal Health and Safety Programs........................................................................................................... 228
Evolving OSHA and Other Regulatory Requirements........................................................................... 231
Treatment of Incumbent Workforce (if applicable)............................................................................... 232
 Destinations............................................................................................................................................................ 235
 Prohibitions Against Influencing Destination Decisions..................................................................... 235
Operations Management Provisions (See Section H)............................................................................................... 237

Key Personnel......................................................................................................................................................... 202
Transport Requirement and Limitations (See Section G)....................................................................................... 235
Dedicated Personnel........................................................................................................................................... 199
Minimum Clinical Levels and Staffing Requirements (See Section F)..................................................................... 211


Workforce Engagement......................................................................................................................................185
 Services Description............................................................................................................................................ 237

Response Time Performance/Reliability/Measurement Methods................................................. 239
Commitment to EMS System and Community (See Section I). ............................................................................ 275



Coverage/Dedicated Ambulances/Use of Stations, Posts................................................................... 275
Collaboration with First Responder Agencies.......................................................................................... 277



 Customer Feedback Surveys............................................................................................................................296

Electronic Data Collection System................................................................................................................. 280
Health Status Improvement/Community Education............................................................................ 286
Support of Local EMS Training Activities................................................................................................... 291
Participation in EMS System Development...............................................................................................294
 Accreditation..........................................................................................................................................................297
Disaster Assistance and Response................................................................................................................298

 Environmentally Friendly Business Practices..........................................................................................311
Mutual Aid Requirements.................................................................................................................................302
 Deployment Planning.........................................................................................................................................305
Regulatory Compliance and Financial Provisions:..................................................................................................................315
See Exhibit B for the required contents of each of the following. If no specific requirement is stated,
provide a statement that the Proposer will comply with the requirement.

Federal Healthcare Program Compliance Provisions (See Section A). .............................................................315




Medicare Compliance Program Requirements........................................................................................315
HIPAA Compliance Program Requirements..............................................................................................315
State and Local Regulations Compliance Provisions (See Section B)................................................................317
Contractor Revenue (See Section C). ...............................................................................................................................317
 Patient Charges......................................................................................................................................................317
 Billing/Collection Services...............................................................................................................................318

 Fee Adjustments....................................................................................................................................................317
 Contractor Compensation to the County and the System...................................................................320
 Market Rights.........................................................................................................................................................320
 Air Ambulance Agreements.............................................................................................................................320
 Accounting Procedures......................................................................................................................................320
Administrative Provisions (See Section D)...................................................................................................................320








Material Breach and Provisions for Termination of the Agreement...............................................321
Definition of Breach.............................................................................................................................................321
Termination (See Section G)................................................................................................................................................321


Written Notice........................................................................................................................................................321
Failure to Perform................................................................................................................................................321
Emergency Takeover (See Section H). ............................................................................................................................321
Transition Planning (See Section I). ................................................................................................................................321

Continuous Service Delivery............................................................................................................................321
Provisions for Curing Material Breech/Emergency Takeover (See Section F) .............................................321

Annual Performance Evaluation....................................................................................................................320
County Remedies (See Section E).....................................................................................................................................321

Service Plan.............................................................................................................................................................320
 Competitive Proposal Required......................................................................................................................321

Current Service Provider's Employees....................................................................................................321
“Lame Duck” Provisions (See Section J)........................................................................................................................321
 General Provisions (See Section K).................................................................................................................................321
Assignment..............................................................................................................................................................321


 Retention of Records...........................................................................................................................................321

Permits and Licenses..........................................................................................................................................321

 Product Endorsement/Advertising..............................................................................................................321
Compliance with Laws and Regulations.....................................................................................................321
Private Work...........................................................................................................................................................321









Observation and Inspection.............................................................................................................................321
Omnibus Provisions.............................................................................................................................................321
Small Business Utilization.................................................................................................................................321
Relationship of the Parties................................................................................................................................319
Rights and Remedies Not Waived..................................................................................................................321
Consent to Jurisdiction.......................................................................................................................................321
End-Term Provisions...........................................................................................................................................321
Cost of Enforcement............................................................................................................................................321
General Agreement Provisions.......................................................................................................................321
BINDER 2
APPENDICES
Appendix 1 RHS ETMC Organizational Chart.............................................................................................. 5
Appendix 2 Financials.................................................................................................................................... 7
Appendix 3 Letter of Guarantee from Byron Hale.........................................................................................93
Appendix 4 Contract List 2009.......................................................................................................................95
Appendix 5 Standard of Care Suggestion Form.............................................................................................97
Appendix 6 Examples of Time Management..................................................................................................99
Appendix 7 Best Practices Article Materials Management Process ............................................................105
Appendix 8 Principles EMS Strategic Planning Blueprint...........................................................................107
Appendix 9 CQI and Other Reports..............................................................................................................109
Appendix 10 Sunstar Sterling Application 2009............................................................................................183
Appendix 11 Resumes...................................................................................................................................257
Appendix 12 Sample Scorecards...................................................................................................................275
Appendix 13 Diversionary Tactics Article.....................................................................................................295
Appenidx 14 Project Tracking Tool...............................................................................................................303
Appendix 15 EEO and Affirmative Action Policies......................................................................................305
Appendix 16 Alcohol and Drug Free Workplace...........................................................................................405
Appendix 17 Job Descriptions.......................................................................................................................409
Appendix 18 Credentials and CE Reports.....................................................................................................419
Appendix 19 March Academy 09..................................................................................................................425
Appendix 20 CISM........................................................................................................................................427
Appendix 21 Professional Conduct Policy 2006...........................................................................................431
Appendix 22 Personal Appearance Policy 2009............................................................................................445
Appendix 23 Requirements for Employment Policy 2009............................................................................447
Appendix 24 Vehicle Specifics......................................................................................................................449
Appendix 25 Drug Box..................................................................................................................................461
Appendix 26 Stryker......................................................................................................................................463
Appendix 27 LIFEPAK-15............................................................................................................................473
Appendix 28 LUCAS Brochure.....................................................................................................................507
Appendix 29 Autovent 3000..........................................................................................................................523
Appendix 30 Approval Process for New Equipment.....................................................................................525
Appendix 31 Extrafleet Software...................................................................................................................527
Appendix 32 Checklist...................................................................................................................................533
Appendix 33 Down Time Report Attachment...............................................................................................537
Appendix 34 Cost per Mile Report................................................................................................................539
Appendix 35 Radio Specifics.........................................................................................................................543
Appendix 36 OnBoard Mobile Gateway Datasheet.......................................................................................559
Appendix 37 MARVLIS Brochure................................................................................................................561
Appendix 38 Droid Cellphone Specifications................................................................................................565
Appendix 39 FirstWatch................................................................................................................................567
Appendix 40 Sansio Corp - Alameda County 091123 Response...................................................................571
Appendix 41 Sample Clinical Reports...........................................................................................................609
Appendix 42 Sample Operational Reports....................................................................................................615
Appendix 43 Sample Response Time Reports...............................................................................................659
Appendix 44 Sample Personnel Report.........................................................................................................665
Appendix 45 Sample Government Report.....................................................................................................667
Appendix 46 Shift Schedule Alameda RFP ALS Unit Hour Proposal v2.....................................................671
Appendix 47 Posting Locations Alameda County ALS.................................................................................675
Appendix 48 Samples of Printed PCR...........................................................................................................677
Appendix 49 Posting Maps............................................................................................................................697
Appendix 50 Zoll Resource Planner..............................................................................................................707
Appendix 51 PULSE Meeting Agenda..........................................................................................................709
Appendix 52 Joint Notice of Privacy Practice...............................................................................................711
Appendix 53 HIPAA Disclosure Matrix........................................................................................................715
Appendix 54 Charity Care and Uninsured Patient Policy.............................................................................725
Appendix 55 Evidence of Insurance..............................................................................................................741
Appendix 56 Employee Health Information Confidentiality Agreement......................................................745
EXHIBIT G
$ 1560. 17
EXHIBIT C
1. INSURANCE REQUIREMENTSEVIDENCE OF INSURANCE: Certificates of insurance are
required from a reputable insurer evidencing all coverages required for the term of any contract that
may be awarded pursuant to this RFP.
Paramedics Plus will meet or exceed the insurance coverage required by Alameda County. Current
Certificates of Insurance are shown in Appendix 55.
A. Commercial General Liability
The minimum limits required are $5,000,000 per occurrence. Paramedics Plus carries a primary commercial
general liability policy with a limit of $1,000,000 per occurrence; however, the company also carries
umbrella liability policies with a $6,000,000 limit per occurrence, providing total coverage of $7,000,000
per occurrence; exceeding the requirement.
B. Automobile Liability
The minimum limits required are $5,000,000 per occurrence. Paramedics Plus carries a primary automobile
liability policy with a limit of $2,000,000 per occurrence and umbrella liability policy with a $6,000,000
limit per occurrence. Combined, Paramedics Plus has a limit of $8,000,000 per occurrence exceeding the
requirement.
C. Workers Compensation and Employer Liability
Paramedics Plus workers compensation coverage complies with the statutory limits. Our coverage also
includes employer’s liability at $1,000,000 per accident. Additionally, umbrella liability coverages sit atop
the employer’s liability providing total coverage of $7,000,000 per accident which exceeds the $1,000,000
requirement.
D. Professional Liability
Paramedics Plus professional liability coverage limits are currently $1,000,000 per occurrence and
$3,000,000 aggregate. With the previously mentioned umbrella coverages, the combined limits are
$7,000,000 per occurrence and $13,000,000 aggregate which exceeds the requirements of $5,000,000 per
occurrence and $10,000,000 aggregate.
E. Endorsement and Conditions
Paramedics Plus agrees to the Endorsements and Conditions as stated in the request for proposals.
Upon successful award of the contract, the required coverages will be endorsed to show Alameda County,
the Board of Supervisors, the individual members thereof, and all County officers, agents, employees and
representatives as additionally insured.
EXHIBIT D
REFERENCES
Proposer name:
PARAMEDICS PLUS, LLC.
CURRENT REFERENCES
Company Name:
Emergency Medical Service Authority
Address:
1417 North Lansing
City, State, Zip Code:
Tulsa, OK
Contact Person:
H. Stephen Williamson
Telephone Number:
(918) 596-3150
Service Provided:
ALS 9-1-1 Emergency Medical Transport and NonEmergency Transport
Dates/Type of Service:
November 1, 1998 to Present
Company Name:
Oklahoma City Council
Address:
200 North Walker
Oklahoma City, OK 73102
Contact Person:
Pete White, City Councilman
Telephone Number:
(405) 297-2424
Service Provided:
November 1, 1998 to Present
Company Name:
Pinellas County Public Safety Services Division
Address:
12490 Ulmerton Road
Largo, Florida 33774
Contact Person:
Richard (Dick) Williams, Executive Director
Telephone Number:
(727) 582-2095
Service Provided:
October 1, 2009
WE HAVE NO FORMER REFERENCES AS WE HAVE NEVER LOST A
CONTRACT
EXHIBIT J
ADDITIONAL REQUIREMENTS
1. FINANCIAL REQUIREMENTS
1.1 Externally audited financial statements for the past three years. Proposers’ audited financial
statements must be satisfactory, as deemed solely by County to be considered for contract award.
Consolidated financial statements for East Texas Medical Center Regional Healthcare System (ETMC)
for the years ended October 31, 2006, 2007, and 2008 as well as unaudited, consolidated financial statements for the fiscal year ended October 31, 2009 are included in Appendix 2. These unaudited financial
statements have been certified by ETMC’s Chief Financial Officer Byron Hale. Unaudited financial statements of Paramedics Plus, LLC for the fiscal years ended October 31, 2006, 2007, 2008, and 2009 are also
included in Appendix 2.
1.2 Contractor shall provide annually an externally audited financial statement for the entire term of
the contract by the end of the 1st quarter (October 1st) following the end of the County fiscal year.
The fiscal year end of ETMC is October 31. Audited ETMC consolidated financial statements are
available by February 28 of the following year. Historically, Paramedics Plus has been included in the audit
of the overall ETMC consolidated financial statements. Upon successful contract award, we will begin
to obtain separate audited financial statements of Paramedics Plus which will be available on the same
timeline. All audited financials will be provided to the County.
As stated previously in this response, Paramedics Plus agrees to put a ceiling on the net profit margin
for the Alameda County operation. We propose capping the net profit margin at seven percent (7%). To
provide verification to the County, we are proposing additional steps be included in the annual audit
engagement to verify that the net profit is within the agreed upon limit.
Because a net profit cap can be subjected to fluctuating corporate charges to bring the profit into
compliance, we are proposing to limit the indirect overhead allocation to $500,000 for the first year of
operation. Thereafter, we propose that the indirect overhead limit be increased based on the same changes in
the Consumer Price Index as this contract and subject to the same limitations.
1.3 Estimated amount of start-up capital required to finance administration and ambulance operations
for the first 90 days of the contract. Contractor should be able to operate for six months after contract
start date without revenue.
The estimated amount of start-up capital required to finance administration and operations for the first
90 days of the contract is $12,500,000. The source of this capital will be existing reserves of ETMC /
Paramedics Plus. Attached in Appendix 3 is a letter from ETMC’s Chief Financial Officer Byron Hale
attesting to the availability of this funding.
2. KEY PERSONNEL—Qualifications and Experience
Key personnel fall into three categories: key on site personnel, the implementation team and the
transition team. Key on site personnel will be involved in all aspects of the Alameda County operation
from implementation to transition to operation. Those team members are: Jeff Taylor, Senai Kidane, M.D.,
and Marlene Rivers, R.N., M.S.N. Additional key personnel will be involved in the implementation or
transition processes and will be available on an ongoing basis as needed. Designated members of each
team are indicated in the biographical information provided below. Implementation team members will
be accessible immediately after award of the contract and will be onsite within seven days from contract
award. Individual transition team members will be on site in Alameda County as long as necessary to assure
a smooth transition. Each individual has specific expertise to enhance the implementation or transition
process.
Jeff Taylor
Jeff Taylor has been selected to serve as the Chief Operating Officer for
Paramedics Plus in Alameda County because of his EMS experience, his leadership
abilities and his history of working collegially and effectively with others both
inside and outside of the organization. He has been with Paramedics Plus for
the last two and half years as Director of Operations for the Pinellas County,
FL operation where he is responsible for managing this high performance EMS
operation with a $30 million operating budget. He serves as an Affiliate on the
County Fire Chiefs Association and was part of the Executive Team which spearheaded the quality application, based on Baldrige criteria, which earned the 2009 Florida Governor’s
Sterling Award.
Prior to joining Paramedics Plus, Mr. Taylor successfully served American Medical Response in a variety
of positions and operations.
He has served as the Director of Operations in several systems and held
other high level positions including the Regional Director of Communications, Performance, Deployment
and Contract Management for 53 counties. While the Director of Operations in Richmond, Virginia, he
improved the system performance from a UHU of 0.36 to 0.42 while maintaining response time performance. He has served as the Director of Communications in several systems and was the Director of
Contract Management for American Medical Response in its North Pacific region.
He has served as an international consultant for the Joint Commission Resources, a global knowledgebased organization which is part of the Joint Commission on Accreditation of Health Care Organization. Mr.
Taylor will soon complete a degree in Emergency Management and has attended a host of courses related to
EMS. A partial list, including Six Sigma Green Belt and Six SigmaYellow Belt, is contained in his C.V. is
available for reference in Appendix 11.
Mr. Taylor is a results-oriented, experienced leader who works well with employees on all levels. He is
a know entity to many in Alameda County having worked in Northern California previously. He will be an
active participant and leader in all aspects of the Alameda County contract from implementation to transition
and the permanent on-site Leadership Team. He will be accessible immediately after contract award and will
be on-site in Alameda County within seven days.
Address: 12490 Ulmerton Rd., Largo, FL 33774
Office: 727-582-2164
Fascimile: 727-582-2249
Email:
[email protected]
Senai A. Kidane, M.D.
Senai Kidane, M.D. is a residency trained Emergency Physician who will
complete a Fellowship in Emergency Medical Services/Disaster Preparedness with
the Alameda County Medical Center and Alameda County EMS in July 2010. Dr.
Kidane brings confidence in his abilities to oversee the clinical areas for Paramedics
Plus, work with the County EMS Medical Director and support other system components including First Response. Dr. Kidane completed the EMS Medical Director’s
course through National Association of EMS physicians. Dr. Kidane was awarded
a University of Michigan Medical School Merit Scholarship, a UCLA Graduate Education Fellowship, and
was given the UCLA Community Programs Office Leadership Award. For a complete list of honors and
awards, certifications and achievements, please see Dr. Kidane’s resume in Appendix 11. Dr. Kidane will
begin employment with Paramedics Plus with this contract. He will serve on the on-site management team,
the implementation team and the transition team.
Address: Office: Email: Pa r a m e d i c s P l u s 3 5
Marlene Rivers, R.N., M.S.N.
Marlene Rivers will serve as the Director of Clinical and Education Services for
Paramedics Plus in Alameda County and is highly qualified to manage the quality
program. She will be responsible for compliance with Alameda County EMS a policies
and procedures. She will assure compliance with employee certifications, liaison with
the County EMS Medical Director and assure compliance with protocols, equipment
and supplies. She will oversee the clinical education and quality management process
for Paramedics Plus.
Ms. Rivers holds a Master’s degree in Nursing, Critical Care/Trauma from the University of California, San
Francisco and a Bachelor degree in Nursing from California State University, Dominguez Hills. She is a Registered Nurse, a Clinical Nurse Specialist, a California Public Health Nurse and is a CPR instructor. She is also
an Advanced Cardiac Life Support Provider and Pediatric Advanced Life Support Provider. Ms. Rivers begins
employment with Paramedics Plus with this contract and will serve on the permanent on-site management team,
the implementation team and the transition team. Her resume is included in Appendix 11.
Address: Home: Email: Anthony J. Myers
Anthony J. Myers, President of Paramedics Plus, Vice President of East Texas
Medical Center Regional Healthcare System and Chief Operating Officer of
ETMC-EMS, oversees all aspects of Paramedics Plus from his base in Tyler, Texas.
Mr. Myers has more than 46 years of experience in emergency services having served
as Fire Chief, Emergency Services Director, Executive Director of two high performance public utility model EMS systems (including TRAA), and Vice President of the
second largest rural all ALS EMS system in America. He currently oversees services
that provide nearly 400,000 paramedic level transports each year. He joined ETMC-EMS in 1993 and has been
President of Paramedics Plus since its inception.
President of Paramedics Plus and COO of ETMC EMS, Mr. Myers will be part of the implementation team
involved in contract negotiations, as well as labor agreement discussions and will be available on an ongoing
basis as needed for the Alameda County operation.
Address: 352 S. Glenwood, Tyler, TX 75702
Office: 903-535-5802; Facsimile: 903-526-7380
Email: [email protected]
Tony Farmer, CPA
As the Chief Financial Officer for ETMC-EMS since 2000, Tony Farmer
is responsible for the financial activities of ETMC-EMS, including managing
the ETMC- EMS accounting functions and personnel, coordinating the annual
operating and capital budgeting process. He works closely with all EMS departments to ensure proper internal controls are implemented and maintained and
that all resources are efficiently and effectively utilized. He provides senior
management to the ETMC-EMS Business Office which is responsible for
ambulance billing and collection.
Mr. Farmer had 15 years of experience prior to joining ETMC-EMS as a project accountant for the
University of Texas M.D. Anderson Cancer Center and in the banking industry in credit administration,
commercial lending, and internal audit. He also has experience in public accounting.
Tony Farmer provides leadership, planning and direction to all financial aspects of Paramedics Plus and
has since the company’s inception. He is directly involved in ensuring that Paramedics Plus operations
comply with all contractual requirements.
A graduate of Baylor University, Mr. Farmer holds a bachelor of business administration degree and is a
Certified Public Accountant licensed by the Texas State Board of Public Accountancy. He will oversee all
financial aspects of the Alameda County operation, will be part of the transition team and will be available
on an ongoing basis.
Address: 352 Glenwood Drive, Tyler, TX 74702
Office: 903-535-5800
Facsimile: 903-535-5813
Frank Gresh
Frank Gresh is the Chief Information Officer for Paramedics Plus and has
provided support for information technology, system status planning and finetuning processes for all Paramedics Plus operations since the award of the
Oklahoma EMSA contract in November, 1998. Mr. Gresh has more than 25 years
experience in EMS including 15 years in management roles. He has served as
Director of Communications in several high performance public utility model
systems and has been employed by Paramedics Plus for the past 11 years. He holds
a Bachelor degree in Business Management and a Masters degree in Computer Information Systems and
led Paramedics Plus two Oklahoma operations in earning status as Accredited Centers of Excellence by
the National Academies of Emergency Dispatch. Mr. Gresh is frequently asked to present at professional
conferences across the country. Mr. Gresh will assist in implementation and transition of technology, System
Status Management, ePCR and other related technological and dispatch related processes. He will be
available “as needed” on an ongoing basis.
Address: 1111 Classen Drive, Oklahoma City, OK 73103
Office: 405-297-7053
Facsimile: 405-297-7060
Stephen Dean, Ph.D.
Stephen Dean, Ph.D., Director of Corporate Training ETMC-EMS and
Paramedics Plus, designs curriculum and provides instruction on emergency medical
services system design, high performance operations, leadership, management and
supervision. He has been involved in EMS for nearly 35 years serving in a variety
of senior leadership positions. Dr. Dean holds a masters degree in Health Services
Administration and Planning and a Ph.D. in Public Policy. Dr. Dean will conduct
courses onsite for the Alameda County operation. His resume is included in the Appendix 11.
Phone: 405 297-7066
Facsimile: 405 297-7060
Joanne McNeil
Joanne McNeil, Director of Administration, has more than 35 years experience
in office management, employee and professional insurance benefits administration,
human resources and payroll administration. She has worked in the Oklahoma
EMSA system for the various contractors since 1993, and has been with Paramedics
Plus since the contract award in November, 1998. Her involvement will extend
to establishing the administrative office and assist with labor relations, benefit coordination and payroll
services.
Office: 405-297-7178
Facsimile: 405-297-7060
Debbie Vass
Debbie Vass has served as the Director of Clinical Services for the Paramedics
Plus Sunstar operation in Pinellas County, Florida since October, 2004. Ms. Vass
has made EMS her career for more than 23 years. Ms. Vass holds an Associates of
Science Degree in Emergency Medical Technology and an Associates of Science
Degree in Nursing and is a certified paramedic and licensed nurse in the State
of Florida. She is the recipient of the 2008 State of Florida “EMS Nurse” award and serves as a Lead
Examiner for the Florida Sterling Council Baldrige-Based State Level Award Program. Ms. Vass played
an integral role in the Sunstar operation’s achievement of the Florida Governor’s Sterling Award and serves
as Sunstar’s Accreditation Coordinator for CAAS and CAMTs. She will be part of the transition team for
Alameda County and will assist on an ongoing basis as needed.
Office: 727-582-2283
Facsimile: 727-582-2249
Philip Young
Philip Young serves as the Director of Support Services for Paramedics Plus
Sunstar operation in Florida and has been in this position since October, 2009. Mr.
Young oversees a fleet of more than 70 vehicles as well as the EMS warehouse
logistics. Mr. Young earned a Bachelor degree from the University of Alabama in
Industrial Engineering and has more than 30 experience in project management and
operations experience. He will be part of the transition team overseeing the receipt
and outfitting of the ambulance fleet for the Alameda County contract. He will also provide ongoing support
to the Alameda County operation as needed.
Office: 727-582-2048
Facsimile: 727-582-2249
Mark Postma
Mr. Postma has served as the Chief Operating Officer for the Paramedics
Plus Sunstar operation in Pinellas County, FL since the award of the contract in
October, 2004. Mr. Postma has been involved in EMS for more than 25 years
and joined Paramedics Plus in 2004. Mr. Postma holds a Master’s of Science in
Health Services Administration, is an EMT-P and former NAEMD dispatcher.
He is the recipient of the Iowa Governors Safety Award, named one of the Top
Business Leaders in the Quad Cities, served on the Board of Directors of the Iowa EMS Association and
is the immediate past chairman of the Commission on Accreditation of Ambulance Services. The Sunstar
operation he directs was awarded the Florida Sterling Award for quality in 2009. Mr. Postma will be part of
the transition team for Alameda County and will assist on an ongoing basis as needed.
Office: 727-582-2283
Facsimile: 727-582-2249
Erik Switzer
Erik Switzer, Corporate Fleet and Support Services Director, has extensive EMS
experience having served as a field paramedic, flight paramedic, EMT-P Supervisor
and Field Training Officer. For the past 15 years, he has been responsible for daily
operation, maintenance and repair of the ETMC-EMS fleet which currently consists
of 116 ambulances plus support vehicles. Mr. Switzer is an EMT-P and is currently
working on a Masters in Divinity through Liberty University, Lynchburg, Virginia.
Mr. Switzer has been with ETMC-EMS for the past 28 years. He will assist with the transition team for
Alameda County and will be available to the operation on an ongoing basis as needed.
Address: 352 Glenwood Drive, Tyler, TX 75702
Office: 903-535-5830
Facsimile: 903-533-8372
Mike Miriovsky
Mike Miriovsky has served as the Chief Operating Officer for the TRAA system
in Fort Wayne, IN, since contract award in July, 2009. He has more than 23 years
of EMS experience including service as the Executive Director for the Lincoln,
Nebraska EMS System and more than 10 years in a clinical leadership role. He
has served as a fire fighter paramedic, an EMS Quality Improvement Coordinator,
an EMS Authority Director, an EMS Clinical Director before becoming the Chief
Operating Officer for the newest Paramedics Plus location in Fort Wayne, Indiana. He has with Paramedics
Plus parent company, ETMC, since 2003.. Mr. Miriovsky holds a Bachelor’s degree in Human Relations
and is nearing completion of a Master’s degree in Management. He frequently participates in State and
Federal committees related to EMS. Mr. Miriovsky will be a value member of the transition team for
Alameda County where he will share his recent experience which produced a near flawless transition in
Indiana. He will also be available on an ongoing basis “as needed” in Alameda County.
Address:
Office: 525 Hayden St., Fort Wayne, IN 46802
260-423-1436
Facsimile: 260-424-1747
Elmer G. Ellis
Elmer G. Ellis has served as the President and Chief Executive Officer of the
East Texas Medical Center Regional Healthcare System since 1985. Under Mr.
Ellis' supervision, the system has grown into an organization with $3.3 billion in
gross annual revenues serving more than 890,000 patient visits each year. Mr. Ellis
is a Fellow of the American College of Healthcare Executives and holds an M.B.A.
from East Texas State University. Mr. Ellis will be available to support the Alameda
County operation on an as needed, ongoing basis.
Address: 1000 S. Beckham Ave., Tyler, TX 757-1
Office: 903 531-8001
Facsimile: 903 535-6334
Byron Hale
Byron Hale is the Senior Vice President and Chief Financial Officer of the
East Texas Medical Center Regional Healthcare System. He is a Certified Public
Accountant, a Fellow in the American College of Healthcare Executives, and holds
a M.B.A. from Texas Tech University. Mr. Hale will support the Alameda County
operation on an ongoing basis.
Address: 1000 S. Beckham Ave., Tyler, TX 75701
Office: 903 531-8010
Facsimile: 903 535-6334
Mike Gray
Mike Gray has served as Vice President and Director of Human Resources
for East Texas Medical Center Regional Healthcare System since 1991. He is
responsible for the administration of human resources activities for 14 hospitals
and the EMS system. He also serves as the corporate compliance officer, the
employee injury plan administrator, the employee recognition administrator, and
the corporate policy and procedure administrator.
Address: 1000 S. Beckham Ave., Tyler, TX 75701
Office: 903 531-8018
Facsimile: 903 535-6334
Bill Moore, M.D.
Bill Moore, M.D. is the EMS Medical Director for ETMC-EMS. As a
physician, Dr. Moore has practiced emergency medicine since 1977 and has been
involved with EMS for nearly 25 years. A graduate of the University of Texas
Medical School at Houston, he is a Diplomat of the American Board of Family
Medicine and a Fellow of the American Board of Emergency Medicine.
Address: 352 South Glenwood, Tyler, TX 75702
Office: 903 535-5837
Facsimile: 903 535-5813
3. IMPLEMENTATION PLAN AND SCHEDULE
The proposal shall include an implementation plan and schedule, including a description of strategic
deployment methodology.
Paramedics Plus will begin the implementation process immediately upon announcement of the intent to
award the contract to Paramedics Plus. Our commitment is to work with the Alameda County Emergency
Medical Services Agency, the incumbent provider, the County EMS Medical Director, and the employees
to ensure that clinical care and customer service remain at the highest possible level throughout the implementation and transition process. Recognizing the stress involved in transitions, we will work through the
process in such a way so as to minimize the duress for individuals and the system as a whole. Our experienced team has provided a smooth transition in each service area since the inception of Paramedics Plus.
Our Initial Management Team and the Transition Team are described earlier in this exhibit.
Implementation Timeline
May 2010
u Alameda
u Develop
County Board of Supervisors announces award
a schedule of monthly meeting(s) with Alameda County EMS and Paramedics Plus leadership
to discuss transition process and progress to date. Adjust plan/schedule and add resources as needed.
June 2010
u Conduct
meetings with incumbent leadership addressing work force concerns, Paramedics Plus
philosophy and culture, and set one-on-one meeting dates to discuss individual transitions to Paramedics
Plus.
u Schedule
meetings with incumbent employees. These informal meetings are designed to provide
employees with useful and factual information about Paramedics Plus, the transition process and ensure a
smooth changeover.
July – September 2010
u Agreement
u Meet
with the Alameda County EMS to discuss transition and negotiate the final contract.
u Relocation
u Place
Negotiations
of Chief Operating Officer beginning September 1, 2010
orders with vendors for capital equipment including ambulances and other support vehicles.
October – November 2010
u Alameda
u Identify
County will process Agreement
Paramedics Plus Operations Facility in Alameda County and begin negotiating lease
January 2011
u Alameda
County Board of Supervisors approves Ambulance Agreement
u Establish
an e-mail based method of communication with the incumbent workforce and other system
stakeholders. Communications will provide interested parties with information about the new system and
the transition.
u Schedule
u Finalize
u Set
an EMS Supply Process meeting with each of the Fire Departments within the EOA.
and execute Paramedics Plus Operations Facility lease and begin lease-hold improvements.
dates, times and locations for initial meetings with incumbent leadership.
u Form
employee work groups for--
u Equipment
layout in ambulances
u Operations
Facility process management
u EMS
u Satellite
Warehouse layout and process management
station locations, layout and process management
March 2011
u Ongoing
meetings with the Alameda County EMS, Paramedics Plus senior leadership including human
resources and union representatives to adjust and finalize the activities and timeline for start up of operations.
u Schedule
meeting with the incumbent provider’s management team to finalize the transition plan.
u Schedule
a meeting with the County EMS Medical Director and Paramedics Plus senior management
team to ensure that the transition plan covers all clinical issues and concerns.
April 2011
u Initial
delivery of capital equipment and ambulances.
u Begin
testing, installation and check-off of all equipment.
May 2011
u Begin
establishing methods and processes for day-to-day business and operation in the following
categories-
u Obtain
the following insurances:
u Professional
Liability and Commercial General Liability
u Commercial
Umbrella Liability
u Automobile
Liability
u List
u Original
u List
of vehicles by VIN, model and year
cost of vehicle
of all drivers
u Workers’ Compensation
u Number
of employees by job classification
u Address
of each location and number of employees at each location by job classification
u Total
wages by classification
u Employee
Insurance
u Clarify
coverage details for medical, dental, visions, Short and Long Term Disability,
AD&D, Life and EAP
u Number
wages
u Total
of employees by gender
u Establish
employee retirement program
u Establish
payroll system
u Establish
accounts payable system by vendor
u Complete
u General
u Focus
credit application process
Ledger accounts for financials
on employee needs. Schedule employee meetings over three consecutive days to allow all
employees the opportunity to attend. During this meeting-
u All
employees complete Paramedics Plus employment applications.
u All
employees complete drug screen applications.
u All
employees complete drug screens on-site by utilizing a mobile drug screening unit or
other approved mobile collection personnel or agency.
u Obtain
copies of all employee certifications.
u Obtain
copies of all drivers’ licenses and social security cards.
u Complete
I-9 and EEO documentation.
u Complete
W-4 forms.
u Complete
insurance coverage forms.
u Distribute
policy and procedure manuals with signed acknowledgment of receipt.
September 2011
u Employee
orientations begin
October 2011
u Final
check-off of Implementation Plan
November 2011 Start up
u Paramedics
Plus begins operations
4. STATEMENT OF COMPLIANCE
The proposal must include a statement that the Proposer is willing and able to comply with the
terms and conditions described in Exhibit B, “Regulatory Compliance and Financial Provisions.” Any
exceptions or limitations must be listed in Exhibit H and also referenced in the response to this section.
Paramedics Plus is both willing and able to comply with the terms and conditions described in Exhibit B.
No exceptions or limitations are requested or referenced.
5. INDEMNIFICATION
5.1 Paramedics Plus, LLC (Indemnitor) agrees to indemnify save and hold Alameda County
(Indemnitee), its officers and employees, agents, successors and assigns harmless from and against and
in respect of any act, judgment, claim, domain, suit, proceeding, expenses, orders, action, loss, damage,
cost, charge, interest, fine, penalty, liability, reasonable attorney and expert fees, and related obligations
(collectively, the "claims") arising from or related to acts and omissions of Paramedics Plus, LLC in
its performance under the Agreement, whether direct or indirect including but not limited to, liabilities,
obligations, responsibilities, remedial actions, losses, damages, punitive damages, consequential damages
to third parties, treble damages, costs and expenses, fines, penalties, sanctions, interest levied and other
charges levied by other federal, state and local government agencies on Alameda County by reasons of
Paramedics Plus, LLC direct or indirect actions. This indemnity will survive and remain in force after
the expiration or termination of the Agreement and is unlimited; provided, however that the indemnity is
not intended to cover claims against Alameda County arising solely of Alameda County’s own negligence
or intentional misconduct. For purposes of this section, the term County shall include the County,
officers, its employees and consultants.
5.2 Alameda County as (Indemnitor) will indemnify, save and hold Paramedics Plus, LLC,
(Indemnitee) its officers and employees, agents, successors and assigns harmless from and against and
in respect of any act, judgment, claim, domain, suit, proceeding, expenses, orders, action, loss, damage,
cost, charge, interest, fine, penalty, liability, reasonable attorney and expert fees, and related obligations
(collectively, the "claims") arising from or related to acts and omissions of Paramedics Plus, LLC in
its performance under the Agreement, whether direct or indirect including but not limited to, liabilities,
obligations, responsibilities, remedial actions, losses, damages, punitive damages, consequential damages
to third parties, treble damages, costs and expenses, fines, penalties, sanctions, interest levied and
other charges levied by other federal, state and local government agencies on Paramedics Plus, LLC
by reasons of Alameda County’s direct or indirect actions. This indemnity will survive and remain in
force after the expiration or termination of the Agreement and is unlimited; provided, however that the
indemnity is not intended to cover claims against Paramedics Plus, LLC arising solely of Paramedics
Plus, LLC own negligence or intentional misconduct. For purposes of this section, the term Contractor
shall include Contractor, officers, its employees and consultants.
5.3 The following provisions shall control the indemnity provided hereunder:
5.3.1 Indemnity defense. Indemnitor, at its cost and expense, shall fully and diligently defend
indemnitee against any claims brought; investigations undertaken or actions filed which concern claims
for which Indemnitee is indemnified.
Indemnitor may employ qualified attorneys of its own selection to appear and defend the claim or
action on behalf of Indemnitee upon Indemnitee approval. Indemnitor, acting in good faith and in the
best interest of Indemnitee, shall have the sole authority for the direction of the defense, and shall be
the sole judge of the acceptability of any compromise or settlement of any claims or actions against
Indemnitee so long as such compromise or settlement does not impose a liability on Indemnitee not fully
covered and satisfied by the indemnity provided by this section or, in Indemnitee‘s judgment, subject
to any material adverse order, judgment, or decree which impairs its image or ability to operate its
business as previously conducted. Otherwise, Indemnitee reserves the exclusive right to reject any such
compromise or settlement and prosecute the claim, compromise or settlement. Indemnitor shall inform
Indemnitee, on a quarterly or more frequent basis, on the progress and proposed resolution of any claim
and shall cooperate in responding to inquiries of Indemnitee and its legal counsel.
Paramedics Plus agrees to this provision.
5.3.2 Reimbursement for expenses. Indemnitor shall reimburse Indemnitee for any and all necessary
expenses, attorney's fees, interest, penalties, expert fees, or costs incurred in the enforcement of any part
of the Agreement thirty (30) days after receiving notice that Indemnitee has incurred them.
5.3.3 Cooperation of parties and notice of claim. Contractor and County shall provide the other prompt
written notice of any such audit or review of any actual or threatened claim, or any statement of fact
coming to that party’s attention which is likely to lead to a claim covered by the indemnity. Each party
agrees to cooperate in good faith with the other and respond to any such audit or review and defending
any such claim.
EXHIBIT O
BUDGET COMPLIANCE FORM
***THIS FORM MUST BE COMPLETED FOR THE FIRST THREE YEARS OF OPERATION AND BE
INCLUDED IN THE PROPOSAL***
PROPOSED ANNUAL OPERATING BUDGET
Year: First Year
ANNUAL REVENUES
Patient Charges
Private payments
$
45,526,789
Medi-Cal
$
20,234,128
Medicare
$
57,330,030
Other third party payments
$
45,526,789
Subtotal
$
168,617,736
Other, Specify:
$
Treat, No Transport
$
2,103,369
$
Total Revenue
NET INCOME
$
170,721,105
$
2,945,639
BASIS FOR PATIENT REVENUE PROJECTIONS:
Source of Payment
Annual number
of transports
Average payment /
transport
%
Annual Revenue
Private
23,997
26%
85.37
$
2,048,705
Medi-Cal Only
10,665
11%
129.35
$
1,379,581
$
-
Medicare / Medi-Cal
*
Medicare Only
30,219
32%
434.47
$
13,129,019
Other: Third party
23,997
26%
1,742.07
$
41,804,821
4,678
5%
100.55
$
470,370
0 $
-
$
58,832,496
Treat, no transport
No payment
TOTAL
*
93,556
100%
628.85
The basis of our net revenue projections are the four (4) primary payors of Medicare, Medi-Cal, Third
party, and Private pay. As such, there are no estimates available for patients specifically with Medicare &
Medi-Cal.
ANNUAL EXPENSES
Personnel
Paramedics
Wages
Benefits
EMT'S
Wages
Benefits
Other Personnel
Wages
Benefits
Subtotal
$ 11,538,588
3,550,065
6,064,522
1,865,865
8,957,869
2,756,058
$ 34,732,966
Vehicles
Gasoline, oil, tires
Repair and maintenance
Depreciation
Subtotal
Medical Equipment/Supplies
Supplies
Equipment lease/depreciation
Maintenance & Repair
Subtotal
Other
Rents and Leases
Insurance
Utilities and telephone
Office Supplies and postage
Professional Services
Taxes
1st Responder support
Dispatch fee
Intercompany financing costs
Other expenses
Other Equipment lease/depreciation
Proposed system enhancements
Community Healthcare Outreach
Start-up expenses
Management fee
Subtotal
TOTAL EXPENSES
$
499,421
382,602
1,611,232
$ 2,493,255
$ 2,612,193
1,427,431
136,534
$ 4,176,159
$
500,400
425,334
372,896
54,882
818,066
2,207,683
4,600,000
1,500,000
1,912,961
466,612
235,299
128,992
100,000
661,353
500,000
$ 14,484,478
$ 55,886,857
EXHIBIT O
Year: Second Year
ANNUAL REVENUES
Patient Charges
Private payments
$
47,361,518
Medi-Cal
$
21,049,564
Medicare
$
59,640,430
$
47,361,518
Subtotal
$
175,413,030
Other, Specify:
$
Treat, No Transport
$
2,188,250
$
Total Revenue
NET INCOME
$
177,601,280
$
3,831,198
Source of Payment
Annual number
of transports
Average payment /
transport
%
Annual Revenue
Private
24,237
26%
87.93
$
2,131,268
Medi-Cal Only
10,772
11%
129.35
$
1,393,377
$
-
Medicare / Medi-Cal
*
Medicare Only
30,521
32%
443.16
$
13,525,515
Other: Third party
24,237
26%
1,794.33
$
43,489,555
4,725
5%
103.19
$
487,531
0 $
-
$
61,027,246
Treat, no transport
No payment
TOTAL
*
94,492
100%
645.85
Medi-Cal.
ANNUAL EXPENSES
Personnel
Paramedics
Wages
Benefits
EMT'S
Wages
Benefits
Other Personnel
Wages
Benefits
Subtotal
$ 12,392,137
3,812,675
6,581,059
2,024,787
9,020,311
2,770,494
$ 36,601,464
Vehicles
Depreciation
Subtotal
Supplies
Subtotal
Other
Rents and Leases
Insurance
Taxes
Dispatch fee
Other expenses
Start-up expenses
Management fee
Subtotal
TOTAL EXPENSES
$
518,954
394,080
1,602,124
$ 2,515,159
$ 2,717,465
1,398,510
353,464
$ 4,469,439
$
502,380
434,698
384,083
56,528
721,354
2,871,389
4,738,000
1,545,000
938,921
417,803
200,912
132,919
103,000
48,000
515,000
$ 13,609,987
$ 57,196,048
EXHIBIT O
Year: Third Year
ANNUAL REVENUES
Patient Charges
Private payments
$
49,270,187
Medi-Cal
$
21,897,861
Medicare
$
62,043,940
$
49,270,187
Subtotal
$
182,482,175
Other, Specify:
$
Treat, No Transport
$
2,276,293
$
Total Revenue
NET INCOME
$
184,758,468
$
3,647,882
Source of Payment
Annual number
of transports
Average payment /
transport
%
Annual Revenue
Private
24,480
26%
90.57
$
2,217,158
Medi-Cal Only
10,880
11%
129.35
$
1,407,311
$
-
Medicare / Medi-Cal
*
Medicare Only
30,826
32%
452.02
$
13,933,986
Other: Third party
24,480
26%
1,848.16
$
45,242,185
4,772
5%
105.91
$
505,366
0 $
-
$
63,306,006
Treat, no transport
No payment
TOTAL
*
95,437
100%
663.33
Medi-Cal.
ANNUAL EXPENSES
Personnel
Paramedics
Wages
Benefits
EMT'S
Wages
Benefits
Other Personnel
Wages
Benefits
Subtotal
$ 13,310,972
4,095,372
7,142,023
2,197,378
9,373,961
2,871,643
$ 38,991,350
Vehicles
Depreciation
Subtotal
Supplies
Subtotal
Other
Rents and Leases
Insurance
Taxes
Dispatch fee
Other expenses
Start-up expenses
Management fee
Subtotal
TOTAL EXPENSES
$
539,257
405,902
1,605,473
$ 2,550,632
$ 2,826,979
1,409,142
359,972
$ 4,596,092
$
517,397
445,579
395,606
58,224
746,794
2,733,997
4,880,140
1,591,350
693,463
423,158
213,333
136,469
106,090
48,000
530,450
$ 13,520,050
$ 59,658,124
paramedics plus
credentials and qualifications
4. PROPOSER MINIMUM QUALIFICATIONS/SPECIFIC REQUIREMENTS
Proposers shall demonstrate the following minimum qualifications and/or requirements:
4.1 Experience
Experience as a sole provider of Advanced Life Support (paramedic) emergency ambulance services for
a specified area comparable in size and population to the EOA defined in this RFP. A population in a service
area greater than 500,000 is required as a comparable service area.
Service Area
Population
Square Miles
Population
Density
Annual
Transport
ALS Units
Pinellas County, FL
945,000
280
3375/sq mi
135,372
74
Oklahoma (Oklahoma City and
Tulsa areas)
1,058,000
1030
1027/sq mi
122,466
89
Alameda County
1,457,426
738
1985/sq mi
87,389
aramedics Plus has successfully managed emergency
P
and training. Paramedics Plus consistently meets response
911 ALS ambulance service in areas with populations
time standards in these comparison locations with popula-
of more than 500,000 since its inception in 1998 when
tions of more than 500,000.
it was awarded the contract for EMS for 1.1 million
The Florida operation was awarded the 2009 Florida
people in the Tulsa and Oklahoma City areas. In addition,
Governor’s Sterling Award, the state’s highest quality
Paramedics Plus has served, since 2004, as the exclusive
honor in a program utilizing the Malcolm Baldrige
provider of paramedic level 911 ambulance service for
criteria and the only ambulance service ever honored
Pinellas County, Florida which has a population of more
with this award. The Florida system is one of only two
than 945,000 and four million visitors annually.
systems in the nation to hold accreditation from all of
The comparison service areas in Florida and Oklahoma
the top accrediting agencies in EMS: the Commission
are high performance systems with stringent clinical
on the Accreditation of Ambulance Services (CAAS),
oversight and response time standards. Paramedics Plus
the Commission on Accreditation of Medical Transport
is responsible for the daily operation of emergency and
Systems (CAMTS) and Accredited Center of Excel-
non-emergency paramedic 911 ambulance service in
lence (ACE) by the National/International Academies
these communities, including patient care, personnel
of Emergency Dispatch. The two communities in the
management, communication center oversight, fleet and
Oklahoma operation earned recognition as two of the top
equipment maintenance, as well as clinical monitoring
five cities for cardiac arrest survival rates in a national
paramedics plus
Paramedics Plus
keeps its promises
When the Paramedics Plus contract
started in Pinellas County, attrition, a new
and more stringent response time standard and an
unexpected call volume increase resulted in a workforce that
was 150 short. Paramedics Plus paid significant bonuses
to the remaining staff until an aggressive recruitment plan
yielded a full staff. Over the first 25 months, Paramedics
Plus spent an unbudgeted $5.5 million to rectify the
situation. Paramedics Plus could have exited the
market to lessen the financial impact but instead
stayed the course, met response time
compliance and engaged the work force
in a culture where quality, service
and commitment are priorities.
paramedics plus
study conducted by USA Today. The Oklahoma system
ETMC operates ETMC-EMS which is the largest
was also recognized by the Oklahoma Quality Foundation
ambulance provider in the State of Texas.
for its “Commitment to Quality.”
East Texas Medical Center-EMS (ETMC-EMS) part
ETMC is a Texas non-member, non-stock,
non-profit corporation organized under the Texas
of ETMC RHS serves 17 counties and a population of
Non-profit Corporation Act and as a 501(c)(3)
1.4 million. ETMC responds to 136,500 requests for
organization is exempt from federal income taxation.
service annually and transports 103,000 patients. With 116
In addition to ETMC-EMS and Paramedics Plus,
ambulances covering 17,000 square miles, ETMC-EMS
East Texas Medical Center Regional Healthcare
is the largest provider in Texas. ETMC-EMS has won
System owns or operates fourteen non-profit,
numerous awards including recognition by the Texas
tax-exempt hospitals in the East Texas area and
Department of State Health Services as “Provider of the
provides other health care related activities through
Year.” An ETMC-EMS EMT earned the distinction of
an array of free-standing clinics, as well as treatment
Texas EMS Person of Year in 2009 for actions which
and rehabilitation centers.
saved the life of a child in respiratory arrest.
All Paramedics Plus operations have been won
A three person Board of Managers guides the
business affairs of Paramedics Plus. The Board of
through a competitive bid process and in July, 2009,
Managers consists of Elmer G. Ellis, Chairman
the Paramedics Plus family grew to include Ft. Wayne,
of Paramedics Plus and also President and Chief
Indiana. Paramedics Plus was selected as the contractor
Executive Officer of ETMC System; Anthony J.
for the Three Rivers Ambulance Authority in a compet-
Myers, President of Paramedics Plus and Vice
itive bid process because of its demonstrated commitment
President and Chief Operating Officer of East Texas
to clinical sophistication and quality management. This
Medical Center Emergency Medical Service; and
system responds to about 32,000 calls each year. Together
Byron Hale, Chief Financial Officer of Paramedics
ETMC-EMS and Paramedics Plus employ 1705 people
Plus and Senior Vice President and Chief Financial
to staff 293 ambulances. These units respond to more
Officer of the ETMC System. A detailed organiza-
than 521,300 responses annually, transporting more than
tional chart is provided in Appendix 1.
384,300.
Paramedics Plus is a Texas limited liability
company operating more than a decade as an indirect
subsidiary of East Texas Medical Center Regional
Healthcare System (ETMC) based in Tyler, Texas
and a for-profit, wholly-owned subsidiary of East
Texas Medical Center Regional Health Services, Inc.
paramedics plus
East Texas
Medical Center
East Texas
Medical Center
East Texas
Medical Center
East Texas
Medical Center
East Texas
Medical Center
East Texas
Medical Center
4.2 Demonstrated ability to meet response time requirements
4.2.1 Provide a letter from at least one jurisdiction with population of 500,000 or more verifying that
Proposer is meeting or exceeding contracted response time criteria.
paramedics plus
paramedics plus
4.2.2. Provide a statement that the Proposer
has not lost a contract due in part to response time
compliance.
Not only has Paramedics Plus never abandoned
a contract, it has never lost a contract either due
to response time compliance or any other reason.
Systems served by Paramedics Plus are wellsatisfied not only with the consistency with which
response time standards are achieved, but also for a
wide range of other factors from clinical quality to
commitment to the communities. The chart below
shows the consistency by which contractual response
time compliance is achieved in the large, high performance Pinellas County and Oklahoma systems. The
response time requirements in these systems are
among the most stringent in the country.
The Florida contract required an ALS ambulance
on the scene of each life threatening emergency,
as presumptively determined in accordance with
MPDS, within 10 minutes on not less than 92% of
all life threatening emergency transports. In October,
2009, the Pinellas County, FL contract requirement
was changed to require ALS ambulance on the scene
of each life threatening emergency, as presumptively
determined in accordance with MPDS, within 10
minutes on not less than 90% of all life threatening
emergency transports.
The Oklahoma contract requires an ALS
ambulance on the scene of each life threatening
emergency, as presumptively determined in accordance with MPDS, within 8:59 seconds on not less
than 90% of all life threatening emergency transports. In November, 2008 the Oklahoma system
paramedics plus
experienced two changes which negatively impacted
response time calculations, requiring adjustments to
the System Status Plan and additional resources.
The first involved an updated version of Clawson
Codes which upgraded some Priority 2 calls to
Priority 1. In addition, a new more stringent standard
was applied to “system overload.” Adjustments were
made to the System Status Plan, resources added
and compliance has been consistently achieved since
January, 2009.
Nov, 2007
Dec, 2007
Jan, 2008
Feb, 2008
Mar, 2008
Apr, 2008
May, 2008
June, 2008
July, 2008
Aug, 2008
Sept, 2008
Oct, 2008
Nov, 2008
Dec, 2008
Jan, 2009
Feb, 2009
Mar, 2009
Apr, 2009
May, 2009
June, 2009
July, 2009
Aug, 2009
Sept, 2009
Oct, 2009
Florida* Oklahoma**
94.37
93.56
94.46
93.47
93.98
93.80
93.45
93.71
94.02
93.33
92.67
94.16
94.19
94.04
93.79
92.53
93.57
94.92
94.09
93.09
93.89
93.76
93.65
92.92
90.86
92.85
90.05
91.99
92.54
93.15
92.72
91.68
90.96
92.03
92.43
91.78
88.16***
89.10***
92.77
91.66
92.26
90.87
94.02
92.72
93.25
92.48
92.73
92.58
*Response required within 10 minutes on not less than 92%
of all life threatening emergency transports. In October, 2009,
the contract requirement was changed to require response
within 10 minutes on not less than 90% of all life threatening
emergency transports.
**The Oklahoma contract requires response within 8:59
seconds on not less than 90% of all life threatening emergency
transports.
***Updated Clawson Codes upgraded some Priority 2 calls
to Priority 1 and a new more stringent standard was applied to
“system overload.”
paramedics plus
4.3 Financial Stability
is a fully diversified healthcare system. Due to this
4.3.1 Financial Statements
diversity we can more capably withstand challenges
Paramedics Plus, LLC as an operating entity of
in particular markets or industry segments, unlike
East Texas Medical Center Regional Healthcare
companies solely providing ambulance services or
System (ETMC) is reported as part of the consoli-
not as diversified.
dated financial statements of ETMC. Consolidated
The financial strength of ETMC/Paramedics Plus
audited financial statements are attached for the
is shown in our most recent consolidated financial
fiscal years ended October 31, 2006, 2007, and 2008
statements. ETMC has sufficient capital to provide
as well as unaudited consolidated financial state-
for implementation and start-up of this contract. At
ments for the fiscal year ended October 31, 2009.
October 31, 2009 and 2008 respectively, ETMC
These unaudited financial
statements have been
certified by ETMC’s Chief
Financial Officer, Byron
Hale. Financial statements
are included in Appendix 2.
Mr. Hale has also provided
a letter of assurance that
ETMC will guarantee the
financial and operational
performance of Paramedics
Plus under the terms of the
Paramedics Plus:
offering great service
at a reasonable cost.
We focus on delivering world class
healthcare at a reasonable cost.
We are part of a not-for-profit
healthcare delivery system with
sound finances, and that helps
us see the world from a different
perspective than some.
had $246,215,000 and
$208,863,000 in working
capital (current assets
minus current liabilities).
The current ratio (current
assets divided by current
liabilities) for these periods
was 3.24 to 1 and 3.11 to 1,
respectively. Additionally,
the quick ratio (cash &
equivalents divided by
current liabilities) further
contract with Alameda County. Bryon Hale’s letter of
indicates strengthening liquidity at 2.92 to 1 and 2.79
assurance is in Appendix 3.
to 1, respectively.
Unaudited financial statements for Paramedics
ETMC/Paramedics Plus has significant financial
Plus, LLC for the fiscal years ended October 31,
reserves that will enable it to sustain the Alameda
2006, 2007, 2008, and 2009 are also included for
County operation. At October 31, 2009 and October
reference.
31, 2008 respectively, ETMC had $332,018,000 and
ETMC/Paramedics Plus has a long financial
$293,570,000 in total net assets (equity). Of these
history demonstrating a strong pattern of managed
total net assets, $326,893,000 and $284,437,000 were
growth combined with a low debt to equity ratio and
unrestricted as to use.
ample liquidity. A unique characteristic of ETMC /
Paramedics Plus is the fact that ETMC as a whole
ETMC/Paramedics Plus has a very low leverage
ratio. At October 31, 2009 the ratio was slightly
paramedics plus
reduced to 1.14 to 1 from 1.16 to 1 at October 31,
2008. Long-term debt is incurred largely through
issuing bonds for the purpose of capital improvements such as additions to and replacements of
hospital facilities. Hospital systems such as ETMC
should be expected to have higher leverage in
comparison to other segments of the healthcare
industry. Debt instruments are integral in financing
capital intensive projects such as hospitals and
u Liquidity
ratios are indications of a company’s
cash management practices.
u Leverage
ratios are indications of a company’s
debt management.
u Coverage
ratios are indications of how well a
company can pay its debt.
u Profitability
ratios are indications of how well
a company invests its assets.
ETMC is exceptionally stable in all four areas.
clinics. ETMC has managed this extremely well,
The following table compares common financial
maintaining leverage near 1 to 1 and maintaining
ratios from our most recent fiscal year to the
excellent interest coverage.
publicly traded national ambulance companies.
The financial stability of ETMC Paramedics Plus
is shown through our financial statements. A few key
points include:
u
Indicator
Revenue has been stable and operating expenses
have been controlled resulting in improved net
income.
u Cash
flow from operations has been positive
every period. Operating cash flows provide the funds
to invest and finance the growth of the company.
u The
company has maintained and increased
liquidity through the years. The current ratio at
October 31, 2006 was 2.38 to 1. At October 31,
2009 it stood at 3.24 to 1. The average increase each
period was 11 points.
u Equity
has shown significant growth averaging
12% each period, while total assets have average
growth of 10% each period.
Ratio Comparisons to Direct Competitors:
There are four areas of financial measurement
with which to analyze or compare companies-9 6 Pa r a m e d i c s P l u s
ETMC/
Paramedics
Plus
AMR
Rural
Metro
Liquidity
Current Ratio
3.24
2.71
1.64
Quick ratio
2.92
2.65
1.55
1.14
0.70
n/a *
5.79
4.96
1.29
4.11%
4.08%
1.51%
Leverage
Debt to equity ratio
Coverage
Interest coverage
Profitability
Net profit
Rural Metro has negative retained earnings due to prior period
losses.
Source: www.reuters.com/stocks/ratios, accessed 11/13/09
Emergency Medical Services Corporation
(Parent Corporation of AMR)
http://www.reuters.com/stocks/ratios?symbol=EMS.N
Rural Metro Corporation
http://www.reuters.com/stocks/ratios?symbol=RURL.P
paramedics plus
4.3.2 Working Capital—Proposers shall
document the estimated amount of working capital
that will be committed to the startup, the method
which is evidenced by a letter of assurance from
the ETMC’s Chief Financial Officer.
4.3.3 In-Kind Support—Proposer shall disclose
of financing of all startup and operational costs
any and all financial and in-kind support or
including the amount of funding dedicated to
funding from existing sources that will support
“Reserve for Contingencies.”
the provision of ambulance services within
With $246,215,000 in working capital as shown
Alameda County. This includes, but is not limited
in our October 31, 2009, ETMC has ample financial
to disclosing the full cost allocation for services
resources to support the addition of Alameda
including, but not limited to, risk management,
County into the family of Paramedics Plus opera-
insurance, purchasing, maintenance, legal and
tions. We estimate operations will require approxi-
human resource, or other functions if those
mately $12,500,000 in working capital to fund the
functions are not solely dedicated to ambulance
initial startup until cash flow from billing activities
services in Alameda County and fully funded within
begins. This working capital will be funded from
the price proposed.
the cash reserves and existing cash flow of ETMC /
The Alameda County operation will be largely
Paramedics Plus operations. The Alameda County
self-supporting like other Paramedics Plus opera-
operation will be charged a market rate of interest
tions. Each of these operations is supported by
until its own cash flows are sufficient to fully
certain functions better managed in a centralized
reimburse ETMC.
manner.
The initial ambulance fleet and equipment
u Risk
management / Insurance – Risk manage-
required to begin operations will be funded from
ment and insurance issues are managed corporately.
existing cash reserves. The Alameda County
There is a cost allocation for risk management
operation will be charged a market rate of interest to
based on an estimate of the time associated with
repay ETMC over a five year term.
the operation. Alameda County operations will be
Any new operation will likely incur unforeseen
expenditures. Through our budgeting process,
charged the full cost of its insurance premiums.
u Legal
– Legal affairs are managed by our
we believe we have minimized these occurrences;
corporate attorney. The Alameda County operation
however, we are prepared to set aside and additional
will be charged the cost of any legal issues directly
$12,500,000 as a reserve for contingencies. With
related to it.
that said, ETMC will guarantee the financial and
u Purchasing
– The Alameda County operation
operational performance of Paramedics Plus under
will be responsible for its materials acquisition upon
the terms of the contract with Alameda County
proper approval of ETMC / Paramedics Plus senior
management.
paramedics plus
u Accounting
– Overall accounting functions
are centralized and costs will be allocated based
4.4 Outstanding/Pending Litigation
Describe the legal actions pending of the
on an estimate of the time associated with the
Proposer’s parent company and all of its
operation. Sufficient accounting resources will be
ambulance services or operations. Contractor shall
added to support Alameda County operations. These
notify County within 24 hours of any litigation
additional costs will be borne by Alameda County
or significant potential for litigation of which
operations.
Contractor is aware.
u Senior
Management – We allocate the costs of
A list of open litigation is provided below.
senior management based on an estimate of the time
Contractor agrees to the notification requirements as
associated with each operating area.
stated.
We estimate that the total cost allocation of
centralized functions to the Alameda County
operation to be approximately $500,000.
Open Claims ETMC-EMS
Event Date
Claim Date Description
Expected Claim Total
Event Date
Claim Date Description
Expected Claim Total
12/12/04
10/13/06Failure to diagnose and transport
07/27/07
04/23/09Failure to treat/transport from jail
10/02/07
05/21/09Alleged negligence on part of EMS dispatch
10/06/07
01/23/08Alleged EMS dropped patient; fx elbow and hit head
Open Claims Paramedics Plus
03/17/05
04/17/07
07/20/07
06/26/08
06/15/09
06/02/08
08/24/09
09/01/05Wrongful death/medical negligence
08/05/08
Picture released to unknown parties
06/25/08
Picture released to unknown parties
07/07/08
Sexual battery
06/15/09
Laceration to leg while moving patient
11/06/09
Alleged assault
Fx shoulder while moving patient to cot
08/28/09
$ 200,000.00
$ 25,000.00
$ 100,000.00
$ 75,000.00
$ 505,328.24
$ 54,850.00
$ 40,000.00
$ 35,000.00
$ 5,001.00
$ 8,500.00
$ 35,001.00
paramedics plus
4.5 Current Contracts in Good Standing
Provide a statement that all existing contracts with any governmental jurisdiction are in good standing
with no delinquent obligations, financial or otherwise.
Neither Paramedics Plus nor its parent organization East Texas Medical Center Regional Healthcare System
has any delinquent obligations, financial or otherwise. We accept that failure to provide accurate information
may lead to disqualification. Please see Appendix 4 for a list of contracts.
paramedics plus
1 0 0 Pa r a m e d i c s P l u s
paramedics plus
contractor’s responsibilities
A. Contractor shall provide emergency
State of California regulations. Care and services will
ground ambulance services, as requested by the
be performed without consideration of the patient’s
County’s Dispatch Center(s), to all areas within
race, color, national origin, religion, sexual orien-
the “Exclusive Operating Area” (EOA) with the
tation, age, sex, or ability to pay.
exception of the cities of Alameda, Berkeley, and
1.2 Contractor shall ensure that relevant and
Piedmont and the Lawrence Livermore National
frequent educational courses are offered to assist
Laboratory.
field personnel in maintaining certification/
Such service shall be provided in accordance
licensure as defined in Title 22, Chapters 2, 4 and
with the stated requirements. Contractor shall work
11 and, to the extent possible, shall be built upon
cooperatively with the EMS Director and the EMS
observation and findings derived from the quality
Medical Director.
system.
Basic Services: Contractor shall provide
Paramedics Plus will meet or exceed this expec-
emergency ground ambulance services, without
tation. Paramedics Plus will apply for and maintain
interruption, 24 hours per day, 7 days per week, 52
approval as a continuing education (CE) provider
weeks per year, for the full term of the Agreement.
in Alameda County. All in-service programs for CE
Paramedics Plus will provide emergency ground
credit will comply with state of California regulations.
ambulance service without interruption for the term
Continuing education and other training topics will
of the agreement. Paramedics Plus is committed
be consistent and compliant with Alameda County
to providing the resources necessary to meet the
initiatives and policies, and purposely designed to
demands of the Alameda County system while
support local system needs. The curriculum will also
making every effort to maintain 100% response time
be consistent with NHTSA national Standard Training
compliance as defined in Section H-2. Paramedics
Curriculums for EMS Personnel.
Plus has a solid history of response time compliance.
Paramedics Plus develops education content
Please see documentation in 4.2 Demonstrated Ability
specific to each location’s system needs as identi-
to Meet Response Time Requirements on page 94.
fied by Medical Direction, Continuous Quality
1.1 Contractor shall provide emergency ground
Improvement, and overall local and state EMS and
ambulance service without regard to the patient’s
public health concerns and initiatives. Our educa-
race, color, national origin, religion, sexual
tional model provides for monthly training for each
orientation, age, sex, or ability to pay.
provider and creates a framework for timely, factual,
Paramedics Plus will provide care and transpor-
and responsive education assuring sufficient CE
tation to any patient requesting medical treatment
to support licensure and certification renewal at all
and transportation. Transportation will be provided in
levels. accordance with Alameda County EMS protocol and
Pa r a m e d i c s P l u s 1 0 1
paramedics plus
1.3 Contractor shall develop and maintain a
1.4 Contractor shall participate in pilot or
comprehensive and relevant quality improvement
research programs as requested by the EMS
plan and system that compliments and interfaces
Medical Director and authorized by the EMS
with the County’s quality management system.
Director.
Paramedics Plus will meet or exceed this expec-
Paramedics Plus will meet or exceed this
tation. Paramedics Plus will work closely with
expectation. As described in Section E 5.4 of this
Alameda County EMS and other appropriate stake-
document, as part of Paramedics Plus commitment to
holders to ensure that the quality improvement
clinical sophistication, we will participate in out-of-
plan and quality management system described in
hospital research in Alameda County. Research
section D 1-1.2 is in accord with the County’s quality
projects will be determined through collaboration
management system and expectations.
with key stakeholders and with the approval of the
Paramedics Plus is sought after by agencies
EMS Medical Director. Paramedics Plus will partic-
nationally and internationally for its expertise in
ipate in approved research projects at no additional
Continuous Quality Improvement, System Status
cost to the County. Once a research project has been
Management, System Scalability, ePCR, education,
approved and reached the beta testing or pilot phase,
and many other functional areas of EMS. Paramedics
Paramedics Plus will provide the necessary services
Plus has hosted visitors from Canada to Israel to the
as required for the project in addition to the other
United Kingdom in addition to state and regional
services described in the final EMS Ambulance
professionals seeking best practices.
Transport Provider Agreement.
Key elements of our Quality Improvement plan
1.5 The proposal submitted in response to this
have also been showcased in EMS conferences such
Request for Proposal will be retained and will be
as the EMS Symposium in Sand Key, Florida in
incorporated and referenced, and made a part of
2005, and the Pinnacle Conference in St. Petersburg
the final Agreement, except that in case of any
Beach, FL in 2009. The adoption of the Malcolm
conflicting provisions, the provisions contained in
Baldrige Criteria as the framework for our overall
the Ambulance Services Agreement shall prevail.
Quality Management System resulted in recognition
Paramedics Plus accepts that this proposal will
of Paramedics Plus as the first EMS service to
be incorporated, referenced, and made part of the
receive the Florida Governor’s Sterling Award, the
final Agreement and that the Ambulance Services
highest quality award given in the state.
Agreement will prevail in cases of conflicting provisions.
“
paramedics plus
“I also made a scene at the 4th and Utica for report of a man down in
a wheelchair. We had called onhim previously so I personally went
to the scene and found the patient was without medical complaint,
but having trouble navigating the ice and snow to get to the Salvation
Army shelter. I had the crew STARCARE* him over to the Salvation
Army. He was quite grateful, but it was more than an appropriate
thing with the extreme temperature and wind chills today.
”
– from James Postoak’s
Supervisor Report on January 3, 2010
*STARCARE reference is to the value– A as in attentiveness to human needs
paramedics plus
paramedics plus
Section B: clinical overview
The County’s goal is to provide a clinically
currently serving on the U.S. Secretary of Transpor-
sophisticated system of EMS that achieves
tation’s National EMS Advisory Council to refine the
contemporary benchmarks of clinical excellence
vision of the future. In fact, the Strategic Blueprint
and can continue to do so in a sustainable fashion
for EMS created in Oklahoma is the foundation for
consistent with the direction provided in the
the National EMS Advisory Council’s 14 Guiding
NHTSA document, The EMS Agenda for the
Principles which are not yet published.
Future, and the core recommendations of the more
recent IOM report on EMS, Emergency Medical
Services: At the Crossroads.
Paramedics Plus wholeheartedly embraces the
clinical goals of Alameda County described as:
1. Discomfort is minimized
Paramedics Plus and all who lead progressive
2. Disability is reduced
EMS systems owe a debt of gratitude to the ground-
3. Death is minimized
breaking 1996 strategic plan and needs assessment,
4. Disfigurement is reduced
EMS Agenda for the Future, as well as the subse-
5. Disease is identified and reduced
quent Institute of Medicine reports published in
Designing, re-designing, or refining clinical
2001 and 2006. While the original vision and those
systems that achieve these goals should also satisfy
that followed may not have been fully realized,
elements identified by the Institute of Medicine
the modern systems operated by Paramedics Plus
report on EMS: Crossing the Quality Chasm: A New
reflect many of the goals set in these documents.
Health System for the 21st Century which empha-
Paramedics Plus incorporates these well-established
sizes a shift from an acute and episodic approach to a
standards in existing operations and will build on this
broader holistic view of pre-hospital medicine.
progress in Alameda County.
The report specifies six aims for systems:
The EMS Agenda for the Future described a set of
1. Safe
initiatives to strengthen EMS including expand the
2. Effective
role of EMS in public health and prevention; involve
3. Patient-Centered
EMS in community health monitoring; integrate
4. Timely
EMS with other health care providers and provider
5. Efficient
networks and be cognizant of the special needs
6. Equitable
of the entire population. This document discusses
Paramedics Plus has a well-documented
14 attributes that lead to realization of this vision.
record of integrating these initiatives in its opera-
Paramedics Plus integrates elements of these 14
tions in Florida, Oklahoma, Indiana, and in its
attributes in its operations. While Paramedics Plus
parent organization ETMC RHS. For example, in
has utilized these documents and worked toward the
Pinellas, using the Baldrige Criteria as the Quality
visions established, its strong medical direction is
Management System, four Critical Success Factors
paramedics plus
SEction B: clinical overview
were developed that align to these six initiatives.
A recent example of an approach to safety which
The four Critical Success Factors or Strategic Objec-
benefits both our clinical workforce and patients
tives are People- a safe, skilled, compassionate
involves an equipment upgrade to power stretchers
and engaged workforce; Quality-provide quality
after Paramedics Plus identified stretcher or cot drops
patient care; Responsible Financially-to optimize
as a preventable mechanism of patient injury. The
financial resources; and Service- exceed the expec-
root cause analysis indicated a large majority of cot
tations of our customers. All strategic initiatives,
drops resulted from an unexpected change in the
measures, goals, and action plans are built around
center of gravity of the stretcher due to a variety of
these important factors. A brief summary is provided
uncontrollable circumstances such as uneven terrain,
below and more details are available throughout this
unexpected patient movement, employee muscle
proposal.
fatigue, etc.
Safe
Paramedics Plus implemented power stretchers in
Safety is reflected in Paramedics Plus Star Care
its operations in Texas, Florida, and Indiana and the
values. A focus is created through our policies and
Oklahoma operation will soon follow. As a result of
procedures, quarterly safety campaigns, ongoing
this change, cot drops have virtually been eliminated.
training, safety measures to monitor compliance
Power cots are proposed for Alameda County.
with safety goals (i.e. collisions, employee injuries,
general and professional liability, etc.).
Another recent example of safe practices resulted
in virtually eliminating the possibility of undetected
esophageal intubation. The Paramedics Plus
paramedics plus
Oklahoma operation was the first large urban EMS
system in the country to measure the time between
insertion of the endotracheal tube to placement
of ET-CO2. Paramedics Plus, in cooperation with
the Office of the Medical Director, implemented a
protocol with some key features similar to Alameda
County EMS policies and includes:
Application of capnography on all intubated
patients within 60 seconds of confirmed tube
placement.
Continuous presence of waveform analysis
Loss of waveform results in immediate trouble
shooting of equipment.
Failure in troubleshooting results in immediate
extubation and use of less invasive airway control.
All intubation cases are reviewed on a daily basis
to ensure compliance with the initiative.
If compliance is in question, the case is reviewed
with medical direction.
Effective
Evidence-based medicine is central to the
standard of care change of care process utilized in the
Oklahoma operation is in Appendix 5.
A recent illustration of our firm commitment to
evidence-based medicine comes from our Oklahoma
Paramedics Plus process. Paramedics Plus partici-
operation where a true anti-emetic medication is
pates in clinical studies such as the “Tale of Seven
unavailable in the pre-hospital setting. A Standard
EMS Systems” (a study involving an Impedance
of Care change was entered and is currently under
Threshold device and Improved CPR Techniques
review by a multifunctional team including system
for cardiac arrest patients), cardiac arrest survival
Physicians, EMS and Fire Department Leadership,
studies among others to help determine which new
and others. There are a number of features to this
therapies or devices provide the best risk vs. benefit
document including, suggested change, potential
outcome to the patient. In addition to participating in
advantages, type of change, cost analysis, etc.
our own clinical trials, we apply the results of other
A very important feature is the submission
trials, medical literature and evidence through our
and review of clinical literature and evidence that
standard of care change process. A copy of the 9-step
confirms or refutes the suggested change. This
paramedics plus
provision greatly enhances the evidence-based
ambulance response and in emergency room transfer
decision making.
so patients do not wait for crucial emergency care.
Patient-Centered
Patients are not diseases. They are people first
In addition, we recognize the importance of time
in the field where we measure any number of time
and foremost. All people deserve a care setting
variables including trauma scene time, mission time,
respectful of individual needs, preferences and
hospital drop times and a multitude of others. See
values. Paramedics Plus has long since moved from
Appendix 6 for Control Charts which support time
a disease-centered model to one that recognizes
measurements.
that behind the disease, illness or injury is a living
breathing person with hopes, fears, dreams and
concerns. The system must recognize and create
mechanisms for patients to become active participants
in their care and receive services designed for their
individual needs and preferences.
Paramedics Plus is sensitive to patient values in
guiding care decisions. We realize that this means
that outcomes for patient care are not only based
on optimal injury and illness management but also
consider a much broader range of outcomes including
Efficient
patient safety, patient choice and preventative care to
IOM defines efficiency as: “avoiding waste,
name but a few. While national research continues on
including waste of equipment, supplies, ideas and
this important subject, Paramedics Plus believes that
energy.” Effective and optimal use of resources is
patient questionnaires, which gather information from
actually a core competency of Paramedics Plus. We
the patient’s perspective, present a good beginning
are proud of the efficiencies created in our systems
strategy for understanding broader patient-centered
through effective labor utilization, efficient resource
needs within our systems.
management, and productivity measurements. A
Timely
review system in place in Paramedics Plus opera-
Paramedics Plus uses time-management processes
tions that contributes greatly to our efficiency is the
that enable the Leadership Team to identify delays
PULSE process. PULSE stands for Performance
in response and delays in hospital turn-around
Utilization Late call System Evaluation. PULSE
on a real-time basis. Our dynamic system status
meetings occur daily with key personnel to review
management plan allows managers to make necessary
performance and production needs ensuring that
adjustments immediately to reduce delays both in
adequate resources are available while making near
paramedics plus
real-time improvements for optimal performance on
unit hours. An effective unit hour is an ambulance
a daily basis.
that is fully staffed, fully stocked, properly placed
Part of Paramedics Plus PULSE process is the
and available for service for one hour. Factors
review of responses where we exceed the response
affecting the availability of a crew or an ambulance
time requirement (“Late Call” review). The goal
(loss of unit hours) for even as little as one minute
in this review is to determine cause of late calls
can contribute to inefficiencies. Paramedics Plus
and assure employees are as efficient as possible in
measures out-of-service time and the causes to
responses. We review the route employees take to
identify areas for improvement. For example, in
calls and then provide feedback and coaching. In
our Pinellas location, by identifying equipment as
some cases, map reading remediation is required.
a cause for out of service time and then identifying
Below is a snapshot of a review that is performed on
the top types of equipment needs, the system was
a daily basis in our PULSE meetings.
able to reduce out-of-service time for equipment by
Efficiency in EMS is often measured by effective
400%. One Paramedics Plus backbone process to
optimize resources is our state-of-the-art materials
management process which ebbs and flows with
ambulance launch and recovery. Our Service Point
System is a very efficient and reliable stocking
process that utilizes bins and batching to ensure
correctly stocked ambulances. This system also
normalizes the workload allowing ambulances to
be quickly stocked during peak launch times. During
non-peak launch times bins are restocked, promoting
an efficient use of labor. Another engineered expecPa r a m e d i c s P l u s 1 0 9
paramedics plus
Paramedics Plus—
caring about
the people we serve
When the Paramedics Plus crew
responded to an auto/pedestrian incident
they found a 40-year-old mentally
handicapped man who had been hit
while riding his bicycle. While the man
wasn’t badly hurt, his bicycle
was a complete loss.
Since his bicycle was his only means
of transportation, the loss was
significant. Paramedics Plus medics
pooled their money and bought
the man a new bike.
paramedics plus
tation of this system is the correct rotation of shelf life
of our core values and guides employees in daily
consumables and recovery and disposal of expired
decisions and interactions with others. STARCARE
items. See Appendix 7 for details on the Service
means:
Point System use through Paramedics Plus.
The Paramedics Plus employee suggestion program
We are Safe
and utilization of employees on committees and teams
We are Team based
allow us to gain perspective from our employees
We are Attentive to human needs
and use their knowledge to make improvements in a
We are Respectful
variety of areas including efficiency, safety, produc-
We are Customer accountable
tivity, and clinical care.
We are Appropriate
All employees are encouraged to participate in
future development. Employee’s thoughts, ideas, and
We are Reasonable
We are Ethical
opinions are actively sought when looking at new
equipment, processes, and standards of care or treat-
Paramedics Plus believes the STARCARE
ments. Employee opinion groups and surveys are
philosophy is a commitment and we encourage each
created and utilized for specific projects. Recently
employee to meet that commitment through our
employees were asked to share preferences regarding
STARCARE Challenge program. This program not
team meeting times and days. The following illus-
only promotes these beliefs but also recognizes and
trates the results.
rewards employees who demonstrate excellence in
Equitable
In the IOM report “Crossing the Quality Chasm”
STARCARE in their daily practice.
Another way in which we promote equity is
Equitable care is described as a setting where quality
through our efforts in understanding and applying the
does not vary because of personal characteristics such
concepts of cultural competency and cultural humility.
as gender, ethnicity, geographic location or socioeco-
Paramedics Plus has solicited the assistance of experts
nomic status.
on this matter from the Biddle Consulting Group to
Paramedics Plus provides all of the communities
assist in designing a world class diversity program
it serves with excellent, high quality care while
for all Paramedics Plus operations. Paramedics Plus
attending to the basic human needs of our patients,
believes that this program will encourage openness,
regardless of their age, race, ethnicity, gender,
appreciation, acceptance, and flexibility of cultural
geographical location or socioeconomic status.
values. While Paramedics Plus is proud to provide
Paramedics Plus achieves this equity in care in many
consistent quality care, we recognize the existence of
ways. STARCARE philosophy is the foundation
cultural influences that pose barriers. This diversity
paramedics plus
program will prepare employees to respectfully cross
program is a work/study arrangement that provides
and meet people at those barriers to provide quality,
participants with opportunities for education, and
compassionate care to all people.
income while in school. Upon graduation, these
In another more recent report, Life and Death
from Unnatural Causes: Health and Social Inequity
individuals will be employed in Alameda County by
Paramedics Plus.
in Alameda County an executive summary from
Summary
2008, states “certain groups of people in Alameda
Clinical excellence does not occur by accident.
County are getting sick and dying prematurely from
Paramedics Plus recognizes that excellence is a
“unnatural causes.” The report goes on to describe
product of vigorous development, clearly stated
that health, disease, and death are not randomly
and realistically applied methods, identification of
distributed but rather that illness concentrates around
critical success factors that create a balance of the
low income people and people of color residing in
needs of all key stakeholders, development of initia-
certain geographical places within Alameda County.
tives surrounding those success factors (strategic
Paramedics Plus believes that as the ambulance
objectives), creation of measurements and goals to
provider, we have a great responsibility to participate
track the progress in achieving objectives, devel-
in programs and initiatives within the community to
opment of action plans to deploy initiatives and help
provide for and promote health equity. Paramedics
meet goals, and a performance review system to
Plus agrees that “inequalities in health are related to
systematically and frequently review the progress of
much more than access to health care.” Within the
achieving goals and creating or altering action plans
Alameda Report there are a set of policy initiatives
accordingly. Paramedics Plus has been successful in
to “Correct the Course in Alameda County.” The first
providing clinical excellence through the adoption
of which describes policies that will impact income,
of the Baldrige criteria as its Quality Management
wealth, education, and work.
System. We believe that through the use of this
Paramedics Plus will implement an EMT and
model in Alameda County, we will not only live up
Paramedic Scholarship program that will serve all
to the Institute of Medicine specifications identified
of Alameda County while focusing on under served
but also exceed them.
populations and geographical areas. This EMT
paramedics plus
Section c: medical oversight
C. Medical Oversight
The County recognizes the unique role of the
While medical oversight in our systems most
often initiates policy or protocol change, it is
EMS Medical Director in delegating, to Contractor’s
Paramedics Plus that embraces the change, commu-
personnel, the authority to perform certain medical
nicates the need for the change and makes the
interventions in accordance with the standards
operational adjustments necessary to realize the
outlined by California law.
improvement. We welcome the opportunity for
Paramedics Plus embraces strong medical
oversight and has flourished under progressive
engagement with the County EMS Medical Director
and all members of the medical oversight team.
medical leadership in the systems it operates.
1. Medical Protocols
Paramedics Plus looks forward to working under
To ensure appropriate levels of quality care,
the medical direction of the County EMS Medical
Contractor shall comply with medical protocols
Director and online medical control. As an organi-
and other requirements as established by the EMS
zation, we recognize and support the unique role of
Medical Director.
the EMS Medical Director in delegating authority
Paramedics Plus physician advisors are pleased to
to perform medical interventions, according to
have reviewed the high quality, sophisticated protocols
California law.
of Alameda County. These evidence-based protocols
Under the leadership of the Medical Director in
use an easy to follow format and meet the current
one Paramedics Plus operation, Paramedics Plus
prevailing standard of care for EMS. Paramedics Plus
has been engaged in a fruitful high level strategic
will comply with the medical protocols of Alameda
planning process. Leaders from medical oversight,
County and other requirements established by the
the emergency medical services agency, Paramedics
County EMS Medical Director.
Plus and the Fire Departments worked collabora-
Furthermore, the Paramedics Plus Medical Director
tively to create a visionary document based on 14
will work collaboratively to support the County EMS
Guiding Principles. These principles have since been
Medical Director to ensure medical protocols remain
used by the U.S. Department of Transportation’s
consistent with evidence-based principles as well
National EMS Advisory Council in drafting national
as established standards of care while monitoring
guidelines. For a copy of the 14 Guiding Principles
protocol compliance through the system CQI process.
of the Strategic EMS Blueprint, see Appendix
Paramedics Plus proposes stringent monitoring
8. This strategic planning process is an example
of protocol compliance in Alameda County. In our
of Paramedics Plus wholehearted collaboration
other systems, the ePCR gives us the capability to
with medical oversight as well as our colleagues
review 100% of cases for protocol compliance as well
throughout the system including First Response and
as procedural proficiency. Reporting is provided in
administrative oversight.
aggregate and by individual medic.
paramedics plus
SEction C: MEDICAL OVERSIght
1.2 Contractor shall document compliance with
are also monitored in Paramedics Plus systems.
system medical protocols using descriptive statistics.
Medics who are noncompliant with protocols or do
Communications, First Response and Transport
not meet system proficiency success rates for proce-
components/resources are integrally linked and
dures receive remediation and education. Process
dependent upon the effectiveness and efficiency of
control charts showing a range of variables routinely
each other. Component-distinct medical assessments
tracked and monitored are included in Appendix 9.
and treatment combine to form the essential medical
While not in the command structure with First
care delivered to a “single patient.”
Proper management and treatment begins when the
Response or with the dispatch function in Alameda
County, Paramedics Plus has a strong history of
911 call is received. Efficient call taking and appro-
working cooperatively and productively with
priate pre-arrival instructions lay the groundwork
these components in other systems. A common or
for the system. First Response has a unique and
compatible ePCR for First Response will allow
essential role to play in the stabilization and treatment
for integrated compliance reporting for the First
of patients. Each component, including transport,
Response and transport functions. Paramedics
is a critical component in providing coordinated,
Plus provides, in each of its operations, unfettered
integrated and seamless care to individual patients.
access to any and all data required to verify medical
Paramedics Plus encourages a common ePCR
for both First Response and Transport. Software
compliance.
In all systems, Paramedics Plus works to build
for a common ePCR will be made available and the
long-term trusting relationships with its partners.
data set for First Responders should be the initial
In our experience trust is built on open, honest
subset of clinical protocols. Compatible equipment,
communication and the transparency of our opera-
common protocols, and a coordinated CQI process
tions. Medical oversight for Alameda County
should not only consider national standards of care
should see, understand and trust every aspect of
but also the needs and outcomes of the local system.
Paramedics Plus’ operation. A component of that
An appropriate continuing education program with
trust and confidence comes from the way we protect,
the flexibility to address improvements recom-
maintain, share, and ultimately use the volumes of
mended through the CQI process should be available
data created by a modern EMS system. We firmly
to all components and is offered in this proposal. The
believe we have an obligation to share valid, secure
shared field training experience, also recommended
data whether the data is generated through the ePCR,
in this proposal, will enhance the cooperation and
financial systems, or fleet operations.
bond between First Response and Transport.
In addition to protocol compliance, medication
compliance, procedure compliance and success rates
Paramedics Plus believes that EMS exists to
care for people in their time of crisis; therefore,
patient care is the central focus. The “single patient”
paramedics plus
Section c: medical oversight
dominates the EMS system’s design of response,
2. Medical Review/Audits
medical treatment, continuing medical education
The EMS Medical Director may require that any
and quality improvement. To that end, we will work
Contractor employee attend a medical review/audit
with medical oversight and our partner system
when necessary.
components to document and demonstrate medical
Paramedics Plus will require that employees
attend medical reviews or audits when requested by
compliance.
the EMS Medical Director.
“
Paramedics Plus exercises a distinguished level of evidence-based clinical operations
through its robust CQI initiatives. While many services are coming into
an age of control chart analysis, Paramedics Plus set this standard years ago.
”
– Jeffrey Goodloe, M.D.
Medical Director for the Medical Control Board in Oklahoma
paramedics plus
SEction C: MEDICAL OVERSIght
paramedics plus
Section D: CLINICAL quality IMPROVEment
D. Clinical Quality Improvement
Paramedics Plus has structured a world-class,
The County requires that the Contractor
industry-standard clinical management philosophy
develops and implements a comprehensive quality
that embraces the core concepts and recommenda-
management program, and recommends that it be
tions from these reports as well as concepts and
modeled after the Baldrige criteria using statistical
processes developed from actually running some
process control.
of the most highly acclaimed EMS systems in the
The Paramedics Plus approach to clinical
country.
quality improvement (CQI) begins with a vision of
Our approach to quality management and quality
balanced results, a corporate culture for locally lead
improvement in Alameda County will be to adopt the
improvement, an academically prepared Leadership
best practices from Paramedics Plus operations. Our
Team and a set of benchmarks, tools and processes
overall Quality Management System will be based
crafted while serving communities with some of the
on the Baldrige criteria as well as the Paramedics
most stringent quality standards in the world. We will
Plus experience in producing award winning and
bring our proven processes based on Baldrige criteria
widely recognized EMS CQI programs.
using statistical process control from Paramedics
Paramedics Plus accepts that clinical indicators
Plus operations as a foundation, and collaborate with
measured by all system participants will be
Alameda County EMS, First Responder agencies,
developed through collaborative efforts of the First
County EMS Medical Director, and medical commu-
Responder agencies, the Contractor, and the County
nication center operations to design a program to
and based on current EMS research and local consid-
maximize local talents and individuality. The effec-
erations. We accept that the County must approve the
tiveness of the unique Paramedics Plus approach
quality monitoring and improvement plan to be used.
is proven by world-class cardiac arrest survival
The purpose of any EMS system is to reduce pain
measures, superb response time performance, and
and suffering and positively affect the community’s
an unprecedented commitment to fulfilling promises
morbidity and mortality from out-of-hospital medical
made in proposals and below average cost to
emergencies. Since resources are finite, a great EMS
consumers.
system that uses resources more efficiently to achieve
Paramedics Plus fully concurs with the Alameda
County’s respect for and direction provided in the
results is a better system.
Paramedics Plus management philosophy is
National Highway Traffic Safety’s ground-breaking
to strive for both maximum results and minimal
work, EMS Agenda for the Future, and the Institute
cost. To achieve this balance, we have developed
of Medicine reports: Crossing the Quality Chasm:
a Leaderhip Team with advanced academic and
A New Health System for the 21st Century and
business preparation as well as practical experience
Emergency Medical Services: At the Crossroads.
managing high performance EMS systems. We
paramedics plus
SEction D: CLINICAL quality IMPROVEment
have adopted and adapted principles of operations
Identify a problem or opportunity for
management from industry as well as scientific
improvement, both systemically and individually
evidence from clinical studies to identify practices
for our team members. We want a balance of stable
with the best chance of superior clinical results
processes in statistical control, and change. We study
and cost effectiveness. Innovation is enhanced by
causal relationship between process structure and
focusing our investment into technology, procedures
performance. That is, we look beyond the data into
and education that have a demonstrable value.
the interrelationships of activities and the underlying
We employ a logical, rigorous approach in four
interrelated steps with six sub-elements:
factors effecting performance. Some of our proprietary systems include the ability to review ambulance
route to any “late calls” to diagnose the reason and
focus corrective actions.
Analyze for Root Cause by measuring, modeling,
understanding and monitoring process cost, process
flow time, process variation and stakeholder satisfaction. Morbidity and mortality are theoretically
the best measure of EMS system quality. Patient
opinions about customer service related to the care
process are logically also important metrics, because
Plan-Do-Check-Act, also known as the Deming
Cycle, establishes the four fundamental steps in the
Paramedics Plus Performance Improvement System.
We recognize an opportunity and plan a change
in step one. In step two, we test the change, often
through a small-scale study or through a trial of short
duration. In step three, we review the test, analyze
the results and identify what we have learned. In step
four, we take action on what we learned in the study
step. Through this simple but logical process we
identify a problem or opportunity, analyze for root
cause, generate potential solutions, select a plan or
solution, implement the solution and then evaluate
the results.
suffering is not only physical but also mental,
emotional and economic. However, measuring EMS
quality is not quite so simple, because final outcomes
from medical emergencies can both be difficult to
measure due to patient confidentiality; limits of
data from downstream health care providers; and
because of factors outside the control of any EMS
provider which can skew clinical outcome statistics.
So, Paramedics Plus management philosophy is to
measure both inputs and outputs of the systems we
manage. Therefore, we utilize an extensive set of key
performance indicators and use statistical process
control charts and other tools that help isolate special
causes for variation in measurements. Each month
we review over 200 pages of performance control
paramedics plus
charts, well more than we could provide as a sample
the most important part of the entire process. Change
given the page limits in this procurement. We, of
is only effective when people accept that change and
course, would be pleased to provide an overview
willfully incorporate it into their routines. Empow-
if there is an opportunity to answer questions or
erment, employee participation and communication
provide a presentation to the selection committee.
are combined with customer satisfaction measures to
Generate Potential Solutions while looking for
local standardization of key processes. Standard-
give us the best chance to truly impact patient care.
Paramedics Plus is recognized nationally for its
ization is the solution for unwanted variation. We
innovative and much admired EMS CQI programs.
combine the data with the experiences of our team
Few systems enjoy similar quality as evidenced by
and identify inputs and outputs that are unstable.
industry leading pre-hospital cardiac resuscitation
However, we do not try to standardize processes
scores and below average cost to consumers. The
across our multiple sites, because that ignores the
CQI Program we will implement in Alameda County
individuality of the communities we serve and the
is based on successful programs in our system
teams we employ.
which have long incorporated the National Highway
Select Plan or Solution by supporting and
Safety Traffic Administration’s Leadership Guide
encouraging organized innovation through
to Quality Improvement for Emergency Medical
empowered integrated teams and planning groups to
Services Systems. These programs continue to evolve
redesign processes and test alternatives.
embracing techniques used in industrial quality
Implement and drive all training programs from
the CQI process, ensuring that investments in staff
development are focused on improvement oppor-
improvement, including extensive use of statistical
process control.
The CQI Process we propose in Alameda County
tunities. We link our CQI and training efforts so
combines the CQI process which leads Paramedics
our coaching time with our busy ambulance crews
Plus staffed EMS systems to be among the first in
is focused on either systematic topics, or areas of
the country to adopt new modalities of treatment.
individual performance.
For example, a Paramedics Plus system was among
Evaluate and recognize this process is an iterative
the first to use CPAP for the treatment of pulmonary
cycle which should reflect increasing knowledge
edema. The CQI process lead this system to be
focusing on the ultimate goal or ideal state. We
among the first to use capnography for all intubated
recognize through this simplistic approach that while
patients as well as a diagnostic tool for the differ-
our knowledge and skills may be limited, they are
ential diagnosis of respiratory distress.
always improving.
Data and analysis are essential in CQI, but the last
step noted in our CQI project steps is undoubtedly
The CQI process takes a patient-centered
approach and looks for innovative ways to improve
care. A recent example involves an innovative time
paramedics plus
measurement related to end-tidal carbon dioxide
nation of commitment, attitude, information tools and
monitoring. While most EMS systems measure the
management talent will be assembled in Alameda
percentage of CO2 used in endotracheal intubation,
County to produce outstanding results.
the CQI committee determined it is also significant to
1. Quality Management- Alameda County is
measure how long it takes for field personnel to place
committed to a comprehensive model of quality
capnography.
management that, while patient centered,
Initial analysis showed a wide range of times
encompasses all vital functions with the system.
for placement of equipment for end-tidal carbon
The County seeks a Contractor who shares this
dioxide monitoring. A goal was set for placement
perspective.
within 60 seconds of intubation since capnography
Paramedics Plus embraces a comprehensive
will allow the medic to know if the endotracheal
model of quality management that is patient-centric
tube was correctly placed. An educational process
and encompasses all system functions. Through
followed so that medics understood the impact of
the Baldrige process, Paramedics Plus operations
timely placement. Further analysis revealed the need
have identified that the alignment and integration
to change the location of capnography equipment in
of all departments, resources and personnel are key
the medics’ packs for quick access. The time to ET
to achieving performance excellence. Quality is
CO2 monitoring has dramatically improved and is
not a one person or one department job. Alignment
having a significant impact on reducing the number
and integration of data and information, resources,
of esophageal intubations. Should a tube be miss-
and strategic efforts are achieved through a perfor-
placed, the medic knows within 60 seconds and can
mance management system (Figure D1-1) that
correct placement. Continuous CO2 monitoring
begins with strategic planning and incorporates
assures good tube placement. The process involved
four Critical Success Factors (People, Quality,
careful analysis of the data by the CQI committee,
Responsible Financially, and Service), organization,
management’s support of the field team and a
department, and employee scorecards, a performance
willingness on the part of the Materials team and
review system (Figure D1-2), and performance
field crews to make changes to benefit the patient.
improvement system. The development of critical
The right CQI tools and technology combine to
success factors allows Paramedics Plus to balance the
provide the Leadership Team solid information for
needs of all key stakeholders to achieve our ultimate
decisions. Then talented managers in the system,
mission of superior care for our patients. Scorecards
trained in Six Sigma and statistical control charts,
ensure alignment while indentifying and communi-
collaborate with community partners and support
cating departmental and employee contribution to the
paramedics in the field to create great quality with
accomplishment of the mission, quality objectives
the patient as the single focus. This unique combi-
and initiatives.
paramedics plus
Figure D1-1 Performance Management
System
1.1 Proposers are required to document their
commitment to have the senior members of their
Alameda County operations actively participate in
Director of IT, and Director of Communications.
(see Figure D1-2 Portion of Performance Review
System involving partners, collaborators, and
customers, next page)
As part of the review system, a key meeting is
the leadership and oversight of the County quality
held monthly to address clinical performance. The
management system.
Quality Steering Committee is made up of senior
1.1.1 Active participation of Proposer’s senior
leaders from Paramedics Plus, the Authority or
leadership in EMS groups or committees dealing
County EMS, and medical oversight or the Office
with quality management
of the Medical Director and, depending on the
The Baldrige based performance management
scope of the committee, may include representa-
system utilized by Paramedics Plus includes a perfor-
tives from First Responder Agencies, the Medical
mance review system. While embracing local needs,
Control Board, local College of Medicine, and local
this plan will provide the basis for the Alameda
hospitals. This group meets monthly to review the
operation. The performance review system consists
system’s performance, improvement projects, and
of regular meetings with partners, collaborators,
results. A similar committee is proposed for the
and customers used to listen and learn, confirm key
Alameda County operation with input from County
requirements, review key performance measures, and
EMS and the County EMS Medical Director for
improve processes. Figure D 1-2 represents meetings
suggested representation and organization.
the Leadership Team attends with key external stakeholders. The Leadership Team includes the Chief
Operating Officer, Director of Operations, Director
of Clinical Services, Director of Support Services,
paramedics plus
Freq.
Meeting
Attendees
Purpose
Monthly
Quality Council
COO, LT, Office of
MD, Authority
Review of Org. Scorecard measures
Monthly
PALS committee
(EMS
Coordinators)
COO, DOCS, DOSS,
Fire Dept., Office of
MD, Auth
Listening and Learning; obtain info for
Environmental Scan; ID key partner req.
Monthly
Operations and Fire DOO, FD
Chiefs meetings
Monthly
Metro. Medical
Response System
DOO, DOSS,
Partners
Monthly
Equipment
Committee
DOCS, Ed. & Train
Mgr., DOSS, EE,
Authority, Fire Dept.
Environmental Scan; ID key partner and
customer req.; discuss improvements
Bimonthly
Medical Control
Board
COO, DOCS,
Partners
Quarterly
Safety Committee
DOHS, DOSS, EE,
Review of safety measures; Listening and
Learning; obtain info for Environmental Scan;
ID key partner requirements
Quarterly
ER Nurse
Managers
COO, DOCS,
Partners
Quarterly
Med Dispatch
Review
DOC, Office of MD,
Auth
Listening and Learning; Input for
Environmental Scan; ID key partner req.;
Review/improve processes; review EMD
measures
Quarterly
Public Safety
Answering Point
DOC, Auth, Supplier
Listening and Learning; Input for Env. Scan;
ID key partner req.;Review/improve processes
Monthly
or PRN
Emergency
Mgt. Steering
Committee
COO, LT,
Supervisors, key
personnel
To ensure preparedness, mgt. continuity of
operations, and recovery of disasters; AAR
BiWeekly
Corporate Zoll
Conference Call
DOC, DOIT, Corp,
Supplier
Discuss key req.; process improvements;
share Mission, Vision, Values
As
Needed
Materials Vendor
DOSS, Suppliers
Discuss key req.; process improvements;
share Mission, Vision, Values
BiAnnual
Employee
Performance
Review
Sup, EE
Employee scorecard measures; discuss
key requirements; reinforce Mission,
Vision, Values
Quarterly
CME Steering
Committee
SPC, Auth, OMD,
Ed & Training, FD
Quarterly
Joint Labor Mgt.
Union Rep, EE, Sup,
Director
Listening and Learning; discuss key
requirements; review Mission, Vision, Values
Figure D1-2 Portion of Performance Review System involving partners, collaborators, and customers
paramedics plus
1.1.2 Designation of a Quality Manager to
oversee quality program
In Alameda County, the Paramedics Plus Director
mance daily and hourly. The performance measures
tracked are documented in the tables in Sections
E5.1 and E5.3. Fine tuning adjustments are made
of Clinical and Education Services will lead the
as needed in real-time, ensuring a watchful eye on
quality program, oversee analysis of data and work
those factors most important to the provision of
closely with the County EMS Medical Director
clinical care and customer service to patients in the
to support the Quality Steering Committee while
community.
interfacing daily with the Paramedics Plus Medical
Work of the Committee
Director, the Director of Operations and others on
Each month the committee examines information
sentinel events or other time-sensitive developments
from the preceding month. Special emphasis is
observed in the data. In addition to serving as the
placed on time-sensitive emergencies to include
manager, he or she will assist the on-site training
Acute Cardiac Syndrome, stroke, cardiac arrest,
staff to develop and present educational material
trauma and advanced airway techniques. The
needed based on areas identified in the CQI process.
committee will standardize practices for handling
Each Paramedics Plus system has a manager
these types of patients and looks for ways to improve
assigned to oversee the quality program and
patient outcomes. From these meetings, training
analyze data. The Leadership Team member is in
material will be created or obtained to address
daily contact with the Medical Director’s staff and
identified needs. The progress of each agency, both
Paramedics Plus educators. The CQI program is the
First Response and transport, is tracked with the use
cornerstone for improvements in process and for the
of control charts and flow sheets to meet or exceed
design of educational offerings.
goals or standards established by the County EMS
1.1.3 Submission of comprehensive key
performance indicator reports to the county
The Quality Steering Committee as a group deter-
Medical Director, the County EMS, or the committee
itself. In addition to tracking each agency, each
provider within the system can be tracked to ensure
mines the key indicators of customer service, opera-
that each meets or exceeds standards. Additional
tional performance, patient care and patient outcomes
measures to be monitored are included in Section E5
to be measured. These measures are reported in
Clinical and Operational Benchmarking.
a monthly document provided to members of the
Paramedics Plus commits to design and
committee and others as appropriate. In addition to
implement a set of monitoring practices that will
the KPIs reported at the monthly Steering Committee
detect system or individual performance deficits
meeting, other members of the Paramedics Plus
early and correct them quickly. As with the rest of
management team monitor performance in key
our leadership practices, these activities will be trans-
processes such as response time and fleet perfor-
parent to the County EMS and its Medical Director
paramedics plus
with frank open and frequent discussion about
giving aspirin to patients suspected of having a
performance issues, improvements, and results from
myocardial infarction. They believed that it was to
improvement efforts. Meeting agendas will be fluid
treat pain and felt pain was sufficiently addressed
and the committee’s work agile to allow the system
with morphine. The team also discovered that when
to adjust to the changing EMS environment.
the Materials personnel added aspirin, it was placed
1.1.4 Active Participation in projects designed
in the medication cabinet in the ambulance rather
to improve the quality of EMS in Alameda County
than in the paramedic response bag. To improve
Our improvement practices draw from the
performance, an educational audiotape was created
work of Deming, Covey, Development Dimen-
for all paramedics which discussed the research
sions International, and Six Sigma. As an example,
and rationale for administering aspirin early in the
in one Paramedics Plus operations the KPI
management of a patient with suspected cardiac
monitoring process noticed a significant drop in
chest pain. The information described the system’s
our compliance to Chest Pain Protocol. Our perfor-
actual performance and compliance problems with
mance improvement team discovered that the drop
this issue. The improvement team also had the
occurred immediately after the protocol was changed
Materials’ personnel rubber band a bottle of aspirin
to include administration of aspirin early in the
to the nitroglycerin bottle in each of the paramedic
management of patients who have chest pain likely
jump kits. After these interventions, the statistical
to be cardiac in origin. A Pareto analysis of the data
process control chart for compliance with the chest
showed that the major contributor to non-compliance
pain protocol climbed back from around 70 percent
was failure to administer aspirin. Using Plan-Do-
to over 97 percent.
Check-Act, additional investigation revealed that
many paramedics misunderstood the rationale for
The CQI process takes a patient-centered
approach and looks for innovative ways to improve
Acute Cardiac Syndrome Patients Not Receiving Aspirin
paramedics plus
care. A recent example involves STEMI patients. The
medical standard for STEMI is 60 minutes from the
Emergency Department “door to balloon”. Through
1.1.5 Description of the Proposer’s overall
approach to comprehensive quality management
Paramedics Plus adopted the Baldrige National
the CQI process, Paramedics Plus employees, Office
Quality criteria as its Quality Management System
of Medical Director and partners began to study
in 2006. The Baldrige categories are linked to create
the total time from “911 call to balloon” since total
an integrated management system that enables the
time is more significant than measuring any single
organization to focus systematically on perfor-
component for this time-sensitive condition.
mance excellence and continuous improvement.
Paramedics Plus involved its technical experts to
identify ways to speed delivery of 12-Lead readings
The framework used to define a total quality system
consists of seven categories:
to key individuals at its receiving hospitals. New
1) leadership
technology now allows Paramedics Plus medics to
2) strategic planning
transmit 12-Lead readings from the field to up to five
3) customer and market focus
departments or individuals identified by the hospital.
4) measurement, analysis, and
Those receiving 12-Lead readings typically include
knowledge management
the Emergency Department, the cath lab, on-call
5) workforce focus
cath lab team and the on-call cardiologist. A recent
6) process management
response in a Paramedics Plus operation occurred on
7) results.
Nov 18th, 2009 when crews responded to a cardiac
Many of the quality management techniques
complaint. The patient was rapidly assessed and
developed by quality experts, most notably W.
identified as a STEMI patient. The 12-Lead reading
Edwards Deming (Statistical Method from the
was transmitted from the scene alerting the cardiol-
Viewpoint of Quality Control), Joseph M. Juran
ogist and cath lab personnel. The patient was treated
(expanded the Pareto principle applying it to quality
and transported with a total time from 911 call to the
issues -for example, 80% of a problem is caused
cath lab of 33 minutes. Patients routinely bypass the
by 20% of the causes), and Philip B. Crosby who
Emergency Department going directly to the cath lab
developed the principle of doing it right the first time
with excellent results. This is an example of the way
(DIRFT) are reflected in the Baldrige criteria. These
in which Paramedics Plus works with all members of
criteria form the most widely accepted definition of
the medical community to focus on patient care.
a total quality management system and are designed
to help organizations use an integrated approach to
organizational performance management that results
in-- delivery of ever-improving value to customers
and stakeholders, contributing to organizational
paramedics plus
sustainability, improvement of overall organizational
Adopting the Baldrige criteria as our Quality/
effectiveness and capabilities, and organizational and
Performance Management System has allowed a
personal learning.
Paramedics Plus operation to achieve the outstanding
In addition to adopting the criteria, we adopted
results listed below. Paramedics Plus will use this
the Core Values and Concepts as well (Figure D1-3).
approach in Alameda County as its overall approach
The values and concepts are embedded beliefs
to quality management.
and behaviors found in high-performing organiza-
Examples of improvement experience in the
tions. They are the foundation for integrating key
Baldrige based quality management system used in
performance and operational requirements within a
a Paramedics Plus system and proposed for Alameda
results-oriented framework that creates a basis for
County--
action and feedback. These core values and concepts
u
97% Overall Customer Satisfaction Rate
include: visionary leadership, customer-driven excel-
u
98% Dispatch Courteous and Helpful Rate
lence, organizational and personal learning, valuing
u
Exceeding Emergency and Non-Emergency
workforce members and partners, agility, focus on
Response Time Compliance Requirements
the future, managing for innovation, management
u
Improved Employee Engagement by 27%
by fact, societal responsibility, focus on results and
u
Full-Time Clinical Employee Attrition
creating value, and systems perspective.
Figure D1-3 Core Values and Concepts
reduced by 14%
paramedics plus
u
u
u
u
u
u
u
u
u
98% Employee Satisfaction with in-house
1.2 Proposers are encouraged to incorporate the
training
most current Baldrige national Quality Program:
100% Stroke Alerts called appropriately by
Health Care Criteria for Performance Excellence
paramedics in the field
and the self analysis worksheet in their response.
42% Return of Spontaneous Circulation
A Paramedics Plus operation was awarded the
post cardiac arrest
2009 Florida Governor’s Sterling Award. This state
Community Outreach /Education Hours
quality award is based on the Baldrige National
increased from 163 in FY 2005 to 523 in
Quality criteria. It is our understanding that this
FY 2008
Paramedics Plus operation is the only EMS or
Cost per transport increase of only .30 cents
ambulance service in the nation to have earned an
from FY 2006 to FY 2008 in spite of increases
award of this level utilizing the Baldrige criteria. As
in expenses (insurance, fuel, etc.)
detailed in the sections above, Paramedics Plus will
.55 Vehicle Crashes per 100,000 miles driven
incorporate in Alameda County many of the Baldrige
(Industry Mean is approximately 1.25)
criteria based approaches which led to the Sterling
.94 Employee Injuries per 10,000 Hours
Award as well as outstanding results for patients,
Worked Rate ( “Healthy People Vision 2010
employees and community. The Paramedics Plus
Injury and Safety Rate” is 3.4)
Sterling application is provided in Appendix 10.
Number of Employee Suggestions (F.I.S.H.
As a quality driven leader in the industry,
Fresh Ideas Start Here forms) tripled
Paramedics Plus will submit an application for
Winner of the 2009 Florida Governor Sterling
the California Award for Performance Excellence
Award (using the Baldrige criteria)
(CAPE) which is sponsored by the California
(Figure D1-3 Core Values and Concepts)
Council of Excellence.
paramedics plus
2. Quality Processes and Practices
operation and, while the vision and mission state-
2.1 Leadership
ments vary slightly, the STAR CARE philosophy is
2.1.1 Describe the Proposer’s leadership
consistent across all Paramedics Plus operations.
structure. Include purpose, vision, mission, and
STAR CARE VALUES
values.
Safe: Are my actions safe – for me, for my
The Alameda County EMS Leadership Team will
lead a process, based on Malcolm Baldrige criteria
colleagues, for other professionals and for the public?
Team-based: Are my actions taken with due
and involving the local workforce, to create a written
regard for the opinions and feelings of co-workers,
purpose, vision, and mission statement based on the
including those from other agencies?
Star Care values of Paramedics Plus.
The streamlined leadership structure of
Attentive to human needs: Do I treat my patient,
customer or colleague as a person? Do I tell each
Paramedics Plus allows for agility and respon-
what to expect in advance? Do I treat families and/or
siveness in meeting the needs of employees, patients
relatives with similar respect?
and communities. Paramedics Plus is owned by the
Respectful: Do I act towards my patients,
not-for-profit hospital system, East Texas Medical
colleagues, my customers, and the public with the
Center Regional Healthcare System (ETMCRHS),
kind of respect that I want to receive myself?
located in Tyler, Texas. A three person managing
Customer accountable: Can I look my patients
board oversees Paramedics Plus. A Chief Operating
and customers in the eye and say “I did my very best
Officer in each system is responsible for managing
for you”?
the local system and reports directly to the President
Appropriate: Is my care or work appropriate –
of Paramedics Plus, Mr. Anthony J. Myers. Owner-
medically, professionally, legally, and practically,
ship by a not-for-profit corporation ensures that the
considering the circumstances I face?
“service to others” culture of the founding entity
Reasonable: Do my actions make sense? Would a
influences the leadership of Paramedics Plus and
colleague with similar experience make a comparable
guides each decision made. Patient care rather than
decision?
profit is the primary focus of Paramedics Plus.
Recognizing the unique character and needs of
each of the communities it services, Leadership
Ethical: Are my actions fair and honest in every
way?
The following Vision and Mission statements were
Teams are formed in each location. These teams,
created by the Leadership Team of an award winning
including the Chief Operating Officer, Directors
Paramedics Plus EMS system.
and Managers, create vision and mission statements
VISION
reflective of the community. This process has been
To be an organization that sets the standard for
successfully implemented in each Paramedics Plus
EMS by providing extraordinary care and service
paramedics plus
to our customers and community, continuously
program. Mr. Taylor’s resume and those of the
improving through innovation and technology, and
key members of the management team are shown
being a great place to work.
in Appendix 11. As Director of Operations for
MISSION
Paramedics Plus, Mr. Taylor is part of the Leadership
To provide compassionate quality care and
Team that implemented the quality management
service to our community at a reasonable cost.
program which was a critical component of the
2.1.2 Describe the quality management
award winning Sterling Award application. The
competencies that members of the leadership team
possess.
Florida Governor’s Sterling Award program is
described in more detail below.
Jeff Taylor, proposed Alameda
Senai Kidane, M.D., will
County EMS COO, will lead
serve as the Paramedics Plus
a management team through
Medical Director. Dr. Kidane will
the strategic planning process
complete an EMS Fellowship
described in Sections D2.1 –
with Alameda County Medical
2.5 of this proposal to analyze
Center and Alameda County
performance data and conduct
EMS in July 2010. He has completed the National
improvement projects. Mr. Taylor’s participation
Association EMS Physicians Medical Director
and leadership on the team led to a 2009 Florida
course and has experience in EMS medical oversight.
Governor’s Sterling Award and has prepared him
Dr. Kidane will support the quality effort in Alameda
to implement an outstanding quality management
County. Dr. Kidane’s CV is included in Appendix 11.
program in Alameda County.
Marlene Rivers, R.N, M.SN.,
With more than 18 years of EMS experience,
will serve as the Director
Mr. Taylor uses his extensive experience to analyze
of Clinical and Education
performance data and conduct improvement projects
Services for Paramedics Plus
beyond the academic setting to generate results in
in Alameda County. Both
the EMS industry. As the Director of Operations for
through formal training and
several large high performance EMS systems, Mr.
experience, Ms. Rivers is
Taylor has analyzed hundreds of reports each month
highly qualified to manage the quality program.
to make full use of resources, improve quality of care
Her extensive background includes development
and enhance patient satisfaction.
of an initial quality assurance program for an area
Mr. Taylor expanded his quality management
fire department, development of education course
knowledge through Yellow Belt Six Sigma and
content, coordination of multiple special projects,
Baldrige criteria training with the Florida Sterling
and experience with Alameda county EMS. Her
paramedics plus
perspective gained through experience with First
Response, hospital nursing, and EMS oversight will
position her for maximum effectiveness. In addition,
excellent working relationships are already established in the County. Ms. Rivers’ CV is included in
Appendix 11.
Specific examples from the Paramedics Plus
Sterling Award application are cited in this and
other sections to describe the processes suggested
for Alameda County. Through the talents of the
individual leaders selected to be a part of the
Alameda County operation coupled with Paramedics
Plus commitment to its values and successful application of its core competencies, we are confident that
we will create the culture for success sought by the
Alameda County EMS District.
Annually, through a systematic Strategic Planning
Process described in Section D 2.2 Strategic
Planning, vision, mission, values, critical success
factors, measures, goals, and key action plans are
reviewed and modified as necessary. The mission
and vision are accomplished through the four
critical success factors listed below, capitalizing
on core competencies (agility, data analysis, and
optimize use of resources), and frequently monitoring
the key performance measures within the organization (see Section D 2.2 Strategic Planning).
paramedics plus
Critical Success
Factors (CSF)
CSF Description
Key Performance Measures
People
Highly Engaged,
Satisfied, Caring,
Skilled and Safe
Workforce
% Overall employee engagement
% Customers rate workforce compassionate and
caring
% Employee overall job satisfaction
Overall employee workforce safety index
% Clinical employees meeting CME Attendance
Requirements
Quality
Quality Care to Our
Patients
% Overall EMD compliance
% Arrive emergencies within 10 minutes
% Arrive scheduled non-emergencies within 15
minutes
% Arrive unscheduled non-emergencies within 60
minutes
% Cardiac arrest survival
% STEMI patients going to correct facility
% Stroke alerts called appropriately
% Trauma alert patients arrive hospital within golden
hour
Responsible
Financially
Optimize Financial
Performance
Cost per unit hour
Cost per capita
Cost per transport
% Change in annual cost per unit hour
Response time compliance fines
Service
Exceed the
Expectations of
Our Customers
% 911 customer satisfaction
% Non-emergency customer satisfaction
% EMS Authority key contract requirements met
Figure 2.2-1
paramedics plus
2.1.3 Describe the methods used to commu-
monitor in the Materials Management area. Other
nicate openly with the workforce and the methods
performance results are communicated in monthly
used to assess the effectiveness of this communi-
newsletters and during continuing education classes.
cation.
u
Paramedics Plus will deploy the methods
described below to communicate openly with
the workforce.
u
Paramedics Plus will use the Gallup survey
Methods used to communicate openly with the
workforce are shown in the table (next page).
2.1.4 Describe how the organization’s
leadership team promotes legal and ethical
behavior for themselves and the entire
model questions to measure the effectiveness
organization. Describe the organization’s process
not only of communication but also of efforts
for handling breaches of ethical behavior.
to engage the workforce.
u
Paramedics Plus will use the methods below
u
Paramedics Plus leaders will create an
environment that results in legal and ethical behavior
to communicate performance data to the members
not only by modeling the behavior personally but
of the workforce.
also by implementing policies that support and
A method used by Paramedics Plus in one of its
require such behavior organizationally.
operations communicates performance data through
organizational, department, and employee scorecards. An organizational scorecard was developed
u
Paramedics Plus will implement a hotline for
reporting violations of legal and ethical standards.
The need to proactively address ethical
aligning mission, vision, values, critical service
behavior is an integral part of performance/quality
factors, measures, goals, and action plans into an
management. Consequently, ethical behavior is
easy to read one-page document. The process
one of the STAR CARE philosophies supported
was further deployed and integrated throughout
and deployed by the Leadership Team.
the organization with the development of four
department scorecards.
Employee scorecards are reviewed with
Senior leaders personally promote an organizational environment that fosters, requires, and results
in legal and ethical behavior by personally estab-
employees every six months. During these sessions,
lishing policies, procedures, and frequent monitoring
the employee’s individual performance is reviewed
of organizational performance at all levels. An ethics
compared to set goals and standards. Performance
hotline has been established at all Paramedics Plus
in employee, operational, and clinical outcome
locations to accommodate anonymous reporting of
measures is a key determinant of the effectiveness
violations of legal and ethical behavior.
of employee communication methods. In addition
Ethics training for employees begins in
to the scorecards, employees receive response time
orientation and is reinforced annually through
compliance performance results monthly via a TV
mandatory in-house training. All employees are
paramedics plus
Specific Examples of Methods Used to Communicate with Workforce
Method
Frequency
One Way Two Way
PULSE meetings
Daily
Director meetings
Weekly
Admin/Support meetings
2 x month
Employee BBQ
Monthly
Department staff meetings / station meetings
Monthly or Quarterly
Discipline specific meetings
Monthly or Quarterly
√
Safety Committee meetings
Quarterly
√
Employee orientation
Monthly
Supervisor encounters (talking point cards)
On-going
√
Walk-a-rounds
On-going
Ride-a-longs
On-going
Newsletter and scoop
Monthly
TV screen in materials
On-going
Email
On-going
Employee evaluations
2 x year
Education classes
On-going
Bulletin board postings
On-going
√
Memos
On-going
√
Paging
On-going
√
Employee mailboxes
On-going
In vehicle computer messages
On-going
√
FISH forms (Fresh Ideas Start Here )
On-going
Ninthbrain website
On-going
ePCR laptops
On-going
Performance Scorecards
Monthly & Biannually
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
paramedics plus
required to sign a document annually signifying
first STAR CARE value is Safe: Are my actions safe
their commitment to the Paramedics Plus codes of
– for me, for my colleagues, for other professionals
conduct. Members of the Leadership Team and
and for the public? A safe workforce is also one of
supervisors review the leadership code of conduct
the strategic objectives under critical success factor
and take an annual oath to reaffirm understanding
“People.”
and commitment to the STAR CARE philosophies
and ethical business practices.
Paramedics Plus does not tolerate violations of
The Leadership Team creates and promotes
a culture of patient safety through policies and
procedures that address and emphasize the safety
the code of ethics. If there is a report of a breach
of patients and employees, safety training, and the
of ethical behavior, the employee is placed on
Safety Committee. The manager with responsibility
administrative suspension during an investigation.
for health and safety takes ownership in ensuring that
The matter is investigated quickly, thoroughly, and
safety is integrated into processes and the core of the
confidentially. If there is sufficient evidence that a
operation to create a successful and safe environment
breach of ethics occurred, the employee enters the
for patients, employees and the community. Perfor-
disciplinary process which may include termination.
mance related to safety is measured on a regular
As an example, a serious allegation was made in one
and continuous basis and reflected on department
Paramedics Plus location in regard to the conduct of
scorecards.
an employee. Ultimately, the Leadership Team filed a
Patient Safety
report with local law enforcement.
Paramedics Plus is a clinical organization and
2.1.5 Describe how the organization’s
is organized to produce clinical quality. Several
leadership promotes a culture focused on patient
operational policies are used to deploy standards for
and employee safety.
patient safety including Movement of Patient/Safety
Paramedics Plus will promote a culture focused on
Restraints, Child Safety Restraints, Stretcher Safety,
patient and employee safety in Alameda County by
General Safety Program, and Infection Control Plan.
fully integrating safety into the organization through
In addition to clinical programs, others such as
the mission and vision statements, values, key
Road Safety provide our EMTs the tools needed to
processes, and key performance measures described
monitor their driving performance in real time and
here.
also provide measures to guide the Leadership Team
The leadership of Paramedics Plus promotes a
in decision making.
culture based on patient and employee safety through
Employee Safety
the vision and mission statements, values, and critical
Employee safety is addressed through safety and
success factors described previously. Safety is a core
risk policies, an infection control plan, the hazard
value reflected in the STAR CARE philosophy. The
communications program, the emergency action
paramedics plus
plan, safety initiatives, and the safety committee.
cameras and, in some instances, security guards. In
Safety Committees are cross-functional teams
addition, formal written policies are continuously
which meet quarterly to identify and address
updated, adopted and communicated on a wide
workplace health, safety and security concerns.
range of safety related topics including Workplace
One role of the Safety Committee is to perform
Violence, Emergency Action Plan for workplace
safety inspections of work areas.
emergencies, Safe Lifting, TB Exposure Control,
Paramedics Plus improves workplace health,
Exposure Control and Bloodborne Pathogens,
through a free Employee Assistance Program for
Hazardous Chemicals, Respiratory Protection, High
support with life, work, family, money, and health
Visibility Safety and a Driving Standards Policy.
issues plus an employee inoculation program which
All health and safety information is gathered at the
covers Hepatitis B, flu vaccinations and annual TB
corporate office and benchmarked against all other
testing. Each Paramedics Plus location offers security
Paramedics Plus operations to identify trends and
to employees through restricted access, security
replicate best practices. Key methods and measures
paramedics plus
for ensuring employee health, safety, and security
ensure compliance to contractual obligations,
are listed here.
industry standards and regulations; performing
Safety Key Performance Measures
annual drivers’ license and background checks
u
Number of validated OSHA violations
of all employees; and a formal hiring process.
u
Number of substantiated EEOC complaints
Methods used to anticipate public concerns with
u
Number of substantiated ethics complaints
current services include an annual Strategic
u
Percent of Workers Comp cases reported in
Planning Process that consists of an environ-
less than 24 hours
mental scan, maintenance of several accreditations,
Percent of OSHA 300 log entries reported
certification of clinical staff, continuing education,
within 7 days
quality
Percent of employee injuries per 10,000
assurance reviews, daily performance monitoring,
hours worked
and review of customer satisfaction surveys.
u
u
u
Percent of significant exposures per 1,000
patient contacts
2.1.6 Describe how the organization handles
For example, an adverse effect of driving
emergency in heavy traffic was addressed through
the risk reduction processes implemented under Jeff
situations that have or may have had an adverse
Taylor’s leadership. The risk reduction processes
impact on patients or the public.
include a mandated Emergency Vehicle Operators
u
Paramedics Plus will use a formal complaint
Course which provides classroom education
management process based on the processes summa-
and driving range management. The Road Safety
rized here and detailed in D 2.3.5 and D 2.4.4 to
System installed in all Paramedics Plus ambulances
handle situations that may have an adverse impact on
monitors and records unsafe vehicle operating
patients or the public.
parameters such as speeding, high vehicle g-forces
u
Under the direction of the County EMS Medical
caused by rapid accelerations, hard decelerations
Director and County EMS Authority, Paramedics
and high speed turns. Annual drivers’ license
Plus will develop and implement a process for inves-
reviews are performed on individuals who drive
tigating and resolving both clinical and non-clinical
company vehicles.
complaints modeled on the processes described here.
Another avenue for preparing for public
The processes will be transparent and based on the
concerns is through Paramedics Plus integral role
STAR CARE philosophy.
in medical and public health preparedness efforts.
Paramedics Plus addresses any adverse impacts
Since 1999, Oklahoma Paramedics Plus personnel
on the public of key services through frequent
have been involved in planning, preparing for,
monitoring and measuring of key processes to
and responding to numerous disasters and public
paramedics plus
health emergencies. These individuals manage
between $2 million and $3 million dollars each
Clinical and Non-Clinical Complaint Process
Another approach to tracking and handling
year in funding from the MMRS Program, UASI
potential adverse impact on patients or the public
program, and ASPR funding through the State
is an effective complaint management process.
Department of Health.
Paramedics Plus systems have formal complaint
Paramedics Plus employees are trained in the
management processes to ensure complaints are
National Incident Management Training (NIMS)
resolved effectively and promptly. All complaints
training program which provides the framework
are assigned to a lead person who is responsible
for organizations to work together to prepare for,
for investigating, documenting, and contacting the
protect against, respond to, and recover from the
complainant to provide the outcome of the investi-
entire spectrum of all-hazard events.
gation. More details are outlined in Section D 2.3.3
and D 2.4.4.
paramedics plus
2.2 Strategic Planning
and improved through several cycles. Key process
2.2.1 Describe how the organization assesses its
steps in completing the SPP are described below
strategic challenges and opportunities.
Paramedics Plus will implement the six-step
and in the figure at left. The six stages of the process
are: Input, Analysis, Direction Setting, Strategy
Strategic Planning Process described below in
Development, Deployment, and Evaluation. The
Sections 2.2.1-4. This Strategic Planning Process
first stage of the process, Input, described in detail
(SSP) is based on
below, allows the organization to assess its strategic
Malcolm Baldrige
challenges and opportunities.
quality criteria
Performance Improvement Model
and has been
Step 1- Input: The goal of this step is to answer
validated through
the question, “What information do we need to better
other Paramedics
understand and identify trends/obstacles necessary to
Plus operations.
achieve our mission, vision, and meet our short and
Recommended
longer-term critical success factor goals?”
key participants
This phase begins with an Environmental Scan,
include the Paramedics Plus Leadership Team,
SWOT (Strengths, Weaknesses, Opportunities
County EMS Medical Director and Alameda County
and Threats) Analysis, and Voice of the Customer
EMS staff.
analysis to determine strategic challenges and advan
Paramedics Plus has used a systematic six-step
tages (see chart below).
SPP, deployed throughout one operation organization
Challenges
Advantages
Business
&
Operations
1. Meeting contractual obligation
with increased population growth
and call volume.
2. Hospital bed delays.
1. Our core competencies (agility, data
analysis, optimize use of resources).
2. Deployment of System Status
Management.
Human
Resource
3. National and regional paramedic
shortage.
4. Communicating with clinical
mobile workforce.
3. Ability to match call volume demand
with flexible workforce scheduling.
Organizational
Sustainability
5. Contract expires in October 2009.
6. County committee evaluating
transport alternatives by the fire
department
4. Services provided at no cost to taxpayers. Totally funded by user fees.
5. Positive relationships with key stakeholders.
paramedics plus
2.2.1 Describe how the organization creates
overcome our challenges?” The Leadership Team
strategic objectives and goals in response to the
meets over several days to review the objectives. In
challenges and opportunities it faces.
this phase, the team defines and reviews measures
Jeff Taylor and the Pinellas Team use the six-step
for each strategic critical success factor/strategic
model SPP described above to create strategic
objective, determines targets/goals, and develops
objectives and goals in response to the challenges
action plans for each success factor. The organi-
and opportunities the organization faces. Steps 2-6
zation, department, and employee scorecards are
of that plan are described below. We use the term
developed and reviewed in this step.
“critical success factor” instead of the term “strategic
Step 5- Deployment: The goal of this step is to an
objective.”
swer the question, “How are we going to make
Step 2- Analyze: The goal of this step is to answer
it happen?” In this phase, the department heads
the question “what things identified in the Environ
(directors and managers) are assigned responsibility
mental Assessment/SWOT Summary have (or could
for implementing the action plans through the per
have) the greatest significance?” The Leadership
formance scorecard system (figure below) and
Team meets to analyze the inputs to prioritize
reporting results at the monthly quality council and
items that have the greatest impact on the division’s
scorecard meetings.
sustainability and ability to execute the strategic plan.
Current benchmarks are also confirmed in this
phase of the process.
Step 3- Setting Direction: The goal of this
step is to answer the question, “What do we want to
achieve and what is critical to our success?” This
phase begins with a review of the mission, vision and
values, and critical success factors, which establishes
the principles on which strategies will be based.
In this phase, we define or confirm the long-term
direction of the organization. Information from steps
1 and 2 helps us to determine if the mission and
Performance Scorecard System
vision are still valid.
Implementation of the strategic plan includes
Step 4- Strategic Development: The goal of this
firming up time frames, the development of related
step is to answer the question, “What must we do
action plans, and allocation of resources needed
to achieve our mission and vision, meet our critical
for successful completion of action plans. The final
success factor objectives (strategic objectives), and
plan is represented in the organizational scorecard.
paramedics plus
The plan is communicated to the Supervisors in
monthly meetings so they are aware of their roles in
achieving the plan. Supervisors are then responsible
for communicating with the employees. Employees
see their roles in achieving our mission, vision, and
critical success factor/strategic objective through
their biannual employee scorecard. An organizational
scorecard has been created to help track progress.
Step 6- Evaluate: Paramedics Plus currently
manages and reviews progress in achieving the
objectives and action plans via the Performance
Management System (see figure below). Continued
improvements to the Strategic Planning Process
include monthly scorecard meetings with the
plans are established based upon meeting current
Leadership Team in addition to the monthly quality
year contractual and budget requirements, while a
council meetings where measures from the score-
three-year longer-term plan is primarily based upon
cards are reviewed. Each department head reports
contract renewal options that allow extensions of the
results and discusses progress on the action plans.
contract. The strategic planning process addresses
Changes or improvements identified are fed back into
these time horizons through the development of
the process as inputs in Step 1.
four department one-year score‑ cards, and a single,
The Division’s short term (one year) and longer-
organizational wide strategic plan that includes
term (three years) planning time horizon is set during
performance goal projections for each critical success
the annual strategic planning process. Short-term
factor/strategic objective measure.
paramedics plus
Methods used to collect and analyze relevant data and information are described in the figure below.
Key Factors
Data and Information Sources
Strengths, Weakness,Opportunities and
Threats (Includes key business, operations,
and human resource challenges)
• SWOT analysis (Leadership Team, Department, EMS Authority,
OMD in planning sessions)
• Organizational and Department Scorecards
• Baldrige self assessment
• Ambulance Service Agreement requirements
• Meetings with partners
• Employee satisfaction survey
• Ambulance response data
• Headcount analysis
• Consumer Price Index (CPI)
• Unit Hour Utilization (UHU)
• Cost per Unit Hour
Major Shifts in Technology
• Environmental assessment worksheet by all Departments
Customer Preferences
•Customer communications method
Regulatory Environment or Competition
• Patient satisfaction results
• Supplier communications
• Ambulance Service Agreement.
• Meetings with partners
• Conferences and seminars
• Industry publications
Long-term Organizational Sustainability
• Capital and operational budget process
• Organizational scorecard
Ability to Execute the Strategic Plan
• Capital and operational budget process
• Organizational and department Scorecards
• Headcount
Our four critical success factors or strategic objectives are shown in Figure 2.2-1 organizational scorecard.
Key measures within each represent the most important goals. The timetable for accomplishing each includes
one, two, and three year projection targets and stretch goals.
In step 2 of the SPP, short and long-term challenges, opportunities, and advantages are identified in the
environmental scan and SWOT analysis. These are categorized by the strategic objectives and are addressed in
step 4 of the SPP during the development of the strategies, measures, and targets within each critical success
factor. The creation of the four critical success factors or strategic objectives establishes balance for all key
stakeholders by providing an equal focus on employees (People), customers (Service), citizens (Responsible
Financially) and the users of our services (Quality).
paramedics plus
2.2.2 Provide an example of the organization’s
organizational level at the monthly quality council
ability to execute its strategic plan and accomplish
meetings and recently our scorecard meetings.
objectives.
Example--
Included as Appendix 10 is the 2009 Florida
Long-term planning and review of current
Governor’s Sterling Award Application in its entirety
performance and projections allowed one Paramedics
which provides a detailed description of how one
Plus operation to identify the need for 10 more
Paramedics Plus operation executed its strategic plan
ambulances in 2006. The planning process allowed
and accomplished the objectives in that plan.
the need to be identified in time to have the trucks
2.2.3 Describe the process for creating action
plans from the strategic objectives. Provide a
available by the beginning of 2007.
Key short and longer-term action plans are
sample of an action plan that’s aligned with one
documented in the strategic plan. The figure (next
of the organization’s strategic objectives.
page) demonstrates the alignment of action plans
Below is a description of the process used for
aligned to critical success factors. Examples of
creating action plans that align with the organiza-
Action Plans aligned with Strategic Objective/
tion’s strategic objectives. The term “critical success
Critical Success Factor are provided in the chart that
factor” is synonymous with the term “strategic
follows.
objective.”
The department heads, including Directors and
Managers, participate in the Strategic Planning
Process. Once the strategic plan is finalized, the
Directors and Managers communicate the organization’s critical success factors and action plans to their
department staff. A sample action plan for employee
recruitment is provided here.
Each key department has a scorecard with
additional measures that align to the critical success
factors. Each department monitors its specific performance in achieving organizational action plans
aligned to each critical success factor. Department
heads are responsible for developing action plans
and measures to assure that positive outcomes are
achieved and sustained. These measures are reviewed
within the department at staff meetings and at an
paramedics plus
Recruiting Action Plan
Improvement Strategies: Enhance website with new look and add recruiting video
Tasks/Action Steps
What Will Be Done?
Responsibilities Resources and Stakeholders
By When?
Who Will Do It? (Funding/Time/People/Materials) (Day/Month)
Update look of website
Director of IT
Outside vendor for other options
June 2009
Meet with SPC to discuss
helping with development
of recruiting video
Recruiter
St. Pete College Coordinator
July 2009
Schedule appointments
with central FL schools
Recruiter
August 2009
Update JEMS ads (quarter- Recruiter
ly with different focus and
possibly seasonal theme)
IT Tech
May 2009
Develop and direct mail to
Duval County (Jacksonville) and Panhandle area
IT Tech; Receptionist; postage
(June 2009)
Determined to
be unnecessary
Corporate HR
December
2009
Recruiter
Research pre-hire screenRecruiter
ing questionnaires (on-line)
Evidence Of Success
(How will you know that you are making progress? What are your benchmarks?)
Increase in monthly applicants by 10 %
Evaluation Process
(How will you determine that your goal has been reached? What are your measures?)
Actual Headcount will be within 95% of goal.
paramedics plus
paramedics plus
2.3 Customer Focus
cooperate on an intermittent basis when short-term
2.3.1 Describe how the organization determines
goals are shared or aligned. The term “partners”
the desires, needs and expectations of patients and
refers to those key organizations or individuals who
other customers. Include a list of key customer
are working in concert with the organization to
groups in addition to patients.
achieve a common goal or to improve performance.
Performance and quality are judged by an organi-
The term “stakeholders” refers to all groups affected
zation’s customers. Under the Baldrige criteria,
by an organization’s actions and success. Initially,
customers are defined as actual or potential users
the Paramedics Plus Leadership Team makes the
of the organization’s programs or services. The
following categorization of entities. This list is
term “collaborators” refers to those organizations
reviewed annually during the Strategic Planning
or individuals who cooperate with the organization
Process to determine the validity of the classifica-
to support a particular activity or event or who
tions or the need for modification.
Key Customers
Key Partners
& Collaborators
Key Stakeholders
Emergency Patients
Local Fire Departments
All Patients
Non-emergency Patients
Medical Director’s Office EMS Authority
EMS Authority
Local Hospitals
Workforce
Hospitals/ Facilities
Requesting Service
Key Suppliers
Local Fire Departments
Medical Director’s Office
Local Hospitals
Surrounding
Communities/Citizens
Government Officials
paramedics plus
Paramedics Plus determines the desires, needs, and expectations of patients through customer focus group
interviews and our Customer Relationship Model shown below.
Determining emergency patient key customer requirements is accomplished through an annual telephone
focus group survey of patients who recently used EMS services. Patients are contacted and asked to
share their overall experience, as well as to identify the top three or four key requirements or expectations most important to them when they requested services. The results are compiled for each group using
a Pareto analysis to identify key requirements and their relative importance (below). Survey questions
are based on these responses to determine if the organization is meeting key customer requirements and
exceeding expectations.
paramedics plus
Other methods used to determine key customer
Changes to our ambulance service agreement
requirements include feedback from community
are other key forms of information and feedback.
meetings, customer complaint data, current customer
For example in 2005, the Pinellas County EMS
satisfaction results, input from partners, and monthly
Authority added a new key requirement—respond
meetings with the EMS Authority or County EMS
to all 911 emergency calls 92% of the time within
Agency.
10 minutes instead of 90%. Feedback from our
Listening methods for each customer group are
customer resulted in the formation of the “92.5
segmented by key customer type. For example,
Response Team” which produced work system
primary listening methods for the EMS Authority
and several process improvements. This project was
or County EMS include contract requirements
awarded in 2007 by the Sterling Region 4 showcase.
and monthly Quality Council meetings. Listening
Additional methods to facilitate quality
methods for patients include customer satisfaction
management process improvements include
tools which survey our performance in achieving
daily interaction with the EMS Agency to receive
their specific and unique requirements. Other
feedback, immediate responses to customer concerns,
listening methods include focus groups, community
quarterly analysis of customer satisfaction results
meetings, website, and complaint data.
by the Leadership Team, aggregation and review
2.3.2 Describe the mechanisms used to
of complaint data, and monthly Quality Council
incorporate the “voice of the customer” in the
meetings to review organizational performance
strategic planning and quality management
within each of the four Critical Success Factors.
processes.
Paramedics Plus method to incorporate the voice
This information is used as inputs not only for the
strategic planning process but also for education and
of the customer into the strategic planning process
training programs, “talking points” for supervisors’
and quality management processes is displayed in the
discussions with employees, and setting objectives
Customer Relationship Management Model. Infor-
and goals for employee scorecards. For example,
mation and feedback from customers is reviewed
when the management team in one Paramedics Plus
through numerous formal and informal methods to
system received a couple of complaints from the
make work system and quality management process
public regarding discussions our crews had in public
improvements. For example, annually during the
places, a training video was created to incorporate
Strategic Planning Process, customer satisfaction
into our annual mandatory organizational training
and dissatisfaction results are reviewed to identify
class (strategic initiative under “People”) to illustrate
trends and identify opportunities for improvement
the perceptions of the public and reinforce HIPAA
to specific processes.
regulations to the workforce.
paramedics plus
2.3.3 Describe the system for assuring and
of mental health vehicles for the transportation of
monitoring equitable EMS care to traditionally
psychiatric patients. The environmental scan and
underserved patients such as the elderly, substance
strategic planning process also guides education and
abusers, and psychiatrics as well as to all patients
training we provide to our workforce. As an example,
based on neighborhood, age, gender, and ethnicity.
we presented “Geriatric Education for Emergency
Annually during our Strategic Planning Process,
Medical Services” to help employees better under-
the needs of our stakeholders, foremost of which
are our patients, are reviewed through an environ-
stand the specific needs of the aging population.
Paramedics Plus will also insure equitable care for
mental scan. Changes in population demographics
a diverse community by building a workforce which
are reviewed to determine significant changes in
reflects the diversity of Alameda County. More infor-
the community served. Using this process and our
mation about the Paramedics Plus diversity plan is
STAR CARE Values as our guide, goals and initia-
included in Section E 1 Workforce Engagement.
tives are developed to assure the needs of the diverse
Mandatory and enforced policies will also
community are met. In some of our other opera-
assure that all patients, regardless of their economic
tions, this process led to the introduction of bariatric
status, age, gender, ethnicity, disability, or medical
ambulances to provide the most comfortable and
condition, receive the same level of courtesy, respect,
dignified transport of obese patients and the initiation
and care.
paramedics plus
2.3.4 Describe and provide detailed examples
of the methods used to assess and monitor the
effectiveness at meeting the needs and desires of
patients and other customers.
processes, and monitor to identify opportunities for
improvement and innovation.
For example, in one Paramedics Plus operation,
patients, as a customer group, were segmented into
This process begins during the annual Strategic
non-emergency patients and emergency patients
Planning Process where key customer requirements
based on focus group telephone interviews of both
are systematically reviewed, identified and incorpo
types of patients. These interviews indicated that
rated into the workforce management system.
although there are some similarities, non-emergency
The Leadership Team meets frequently and
(interfacility) patients have different requirements
through numerous methods (daily PULSE meetings,
than emergency (911) patients. One of the biggest
weekly Directors’ meetings, bi-monthly supervisor
differences is the need for non-emergency patients
meetings, monthly department meetings, monthly
to be handled carefully and gently. As a result of
Quality Council meetings, quarterly leadership
identifying this customer segment’s needs, a separate
meetings, and quarterly and annual strategic planning
satisfaction survey letter was created for specific
meetings) to review customer feedback, identify and
feedback. In a mandatory continuing education class
incorporate improvement plans based upon results,
that followed, we communicated patients’ require-
ensure customer requirements are deployed into key
ments and expectations to the workforce along with
Non-Emergency Patient Satisfaction Survey Results
Jan-Mar
Q2 2008
Apr-Jun
Q3 2008
Jul-Sep
Q4 2008
Oct-Dec
Q1 2009
Jan-Mar
Q2 2009
Apr-Jun
Q3 2009
% Overall
non-emergency
customer satisfaction
96.16%
98.46%
98.34%
94.49%
96.66%
99.00%
Knowledgeable
95.74%
97.53%
98.50%
97.00%
98.90%
100.00%
Courteous, nice, kind
95.74%
97.50%
98.50%
97.00%
98.90%
100.00%
Careful lifting/
gentle with me
97.83%
100%
98.50%
97.00%
97.70%
100.00%
Listen to needs
& talks with/to me
95.65%
98.72%
98.50%
94.00%
96.60%
100.00%
Professional
95.74%
100%
98.50%
97.00%
97.80%
100.00%
Helpful and caring
95.74%
98.73%
98.50%
91.00%
95.60%
98.00%
Make me comfortable
93.33%
97.47%
98.50%
94.00%
95.60%
100.00%
paramedics plus
initial satisfaction results. In a subsequent class
OMD. More serious complaints (yellow or red) are
held last July, patient requirements and results were
also investigated by the OMD through its Quality
reviewed. The table on the previous page shows the
Assurance Review (QAR) process. The goal of these
improvement in all areas from the process which
processes is to ensure that appropriate patient care is
recognized patient wants or requirements, measured
being provided. All clinical complaints are tracked
progress on meeting those requirements, commu-
by the Quality Manager’s personnel and results are
nicated information with the workforce, and shared
used to steer changes in protocols and determining
information about improving customer service.
Continuing Medical Education topics.
2.3.5 Describe the organization’s mechanism
As with clinical complaints, non-clinical
for managing complaints including receiving,
complaints are entered into a tracking database and
investigating, resolving, tracking, and analyzing
routed to the appropriate department for investigation
complaint patterns along with examples of
and follow-up with the complainant. For example,
improvement activities resulting from analysis.
complaints regarding lost items or crew conduct are
Paramedics Plus has a formal complaint
routed to the operations supervisors. The on-duty
management process to ensure complaints are
supervisor conducts an investigation and identifies a
resolved effectively and promptly. All complaints are
resolution. The supervisor is responsible for assuring
assigned a lead person who is responsible for investi-
the resolution is deployed and all information is
gating, documenting, and contacting the complainant
documented into the tracking system.
to provide the outcome of the investigation.
Complaints are segmented into two groups –
Complaints that cannot be resolved in the same
day remain in an “Open” status. Personnel logging
clinical and non-clinical. Non-clinical complaints,
into the database see all open issues assigned to
such as lost items, questions about policies, or
them. The system is also designed to send emails
conduct of the crew are investigated internally by
as reminders regarding open issues approaching
Paramedics Plus staff. Information is entered into a
expiration dates. The database allows Paramedics
tracking database and classified by complaint type.
Plus to aggregate and analyze data to identify
Clinical complaints received directly by
patterns and trends, determine root causes, and
Paramedics Plus become Quality Assurance Reviews
implement preventive actions. Both clinical and
and are co-investigated by Paramedics Plus staff
non-clinical complaints are formally reviewed at
and the Office of the Medical Director (OMD).
weekly Directors’ Meetings and monthly Quality
Less serious clinical complaints (coded as green)
Council meetings which include Paramedics Plus
are handled by Paramedics Plus Education and
Leadership Team, and EMS Authority/County EMS
Training Department and updates are provided to the
and Office of the Medical Director representatives.
paramedics plus
Complaint data is also used as an input into the
and other communicable pathogens. The health
strategic planning process for improvement opportu-
and welfare of each employee is a joint concern of
nities under our Critical Success Factor “Service.”
the employee, our partners, the operational chain
2.3.6 Describe the mechanism for providing
infection control for employees, system partners in
healthcare, and patients.
In congruency with meeting the needs and
of command, and the organization at large. Key
elements of these plans include:
u
Provide all employees and First Responder
partners with the necessary training and personal
requirements of patients, Paramedics Plus focuses
protective equipment needed for protection from
on building an effective and supportive environment
communicable disease (such as exam gloves in
for our workforce, as well as for our partners. In each
appropriate sizes, eye protection in carry-in bags and
location, Paramedics Plus has several programs that
in the unit, standard surgical masks, approved respi-
address infection control for employees, our system
rators, combination visor-masks, impervious gowns
partners, and patients. Employee policies regarding
and shoe covers, Level C protective suits, and full
the donning of personal protective equipment
face respiratory masks);
and workplace guidelines, creates awareness and
u Staff
a 24/7 designated infectious control officer
education for infection control, which, in-turn,
to handle, confidentially, suspected or confirmed
provides protection for our patients.
employee exposure or diagnosis of communicable
Some of these plans and programs include
an Infection Control Plan, Designated Officer
Program, Blood-borne Exposure Plan, Airborne
Exposure Control Policy, Health Maintenance
disease;
u Provide
employees with the necessary immuni-
zations to prevent communicable diseases;
u Seek
to eliminate “sharps” exposures to
Program, In-House Vaccination Program, and
employees and partners; offer post exposure prophy-
Safety Committees. Crew monitoring is also
laxis treatment to employees;
performed to assist employees in proper infection
u Create
a hazard communications (HazCom)
control procedures. The manager with responsibility
program to inform and train employees and partners
for Health and Safety will oversee these programs,
about the potential hazards of materials they may
assure compliance, and collect incident data for
be exposed to while performing their duties. As an
tracking and trending.
organization, provide information about chemical
Paramedics Plus infection control plans fully
hazards and their control through our labeling,
comply with Federal OSHA standards 29 CFR
chemical inventory, Material Safety Data Sheets
1910.1030 and other applicable standards in the areas
(MSDS) and training programs as detailed in the
of occupational exposure to bloodborne, airborne,
formal HazCom program.
paramedics plus
u Organize
a Safety Committee comprised of
are aware of this access mechanism, we will publish
a cross-functional team that meets quarterly to
the number on our website and in the local telephone
identify and address workplace health, safety and
directory. Additionally, this phone number will be
security concerns. This group reviews information
advertised at local healthcare facilities, fire stations,
gathered from various sources incorporating
public safety agencies, and on the management
staff input, including annual safety inspections,
team’s business cards.
incident reports or FISH (Fresh Ideas Start Here)
2.4.3 If the number is answered by an
forms that identify patient or employee health or
automatic greeting or menu selection, the initial
safety concerns.
message must immediately convey that this is a
2.4 Customer Service Telephone Line
customer service line, if caller has an emergency,
2.4.1 Contractor shall establish and publish
hang up and call 911. Call must be returned in 30
a Customer Service Telephone Hotline giving
internal and external customers and system
minutes, 90% of the time.
If the manager/designated liaison is not able
participants the ability to contact a designated
to answer the call and the caller is routed to an
liaison of the leadership team to discuss
automatic greeting, the caller will be advised that
commendations or suggestions for service
the number dialed is a customer service line and
improvements.
if he/she is experiencing an emergency to hang
As one of our methods to listen and learn from
up and dial 911 but that non-emergency service
our customers and partners, Paramedics Plus will
messages may be left and will be promptly returned.
establish and publish a Customer Service Telephone
This customer service line will be designed so that
Line phone number for all internal and external
appropriate members of our Leadership Team will
customers and partners. This telephone line will be
be notified of incoming calls. Callers that were
accessible 24/7 without charge to all callers within
routed to voicemail will receive a callback from a
the continental United States.
member of the Leadership Team within 30 minutes,
2.4.2 The number may be answered by a
90% of the time. This performance standard will be
designated manager or provide an opportunity for
tracked in our complaint/feedback software database
the caller to leave a voicemail message.
system. Paramedics Plus understands that prompt
The Customer Service Telephone Line number
and effective resolution of complaints or issues
will be answered by a manager who is a desig-
helps build customer and partner confidence. Conse-
nated liaison. If for some reason that manager
quently, the Paramedics Plus complaint management
cannot answer the call, the caller will be routed to
process has a standard to either resolve the issue or
an automatic greeting where the caller can leave a
re-contact the caller with a status update by the end
message. To assure that our customers and partners
of the next business day from receipt of the call.
paramedics plus
2.4.4 Handling Service Inquiries and
Complaints
Paramedics Plus strongly believes that for
of the average time to resolution, we will ensure
responsiveness to our customers.
Complaints or issues are categorized by
continuous improvement of the organization
“complaint type”. Paramedics Plus aggregates and
issues must not merely be “resolved” as they arise.
analyzes this data monthly to look for trends and
Complaint aggregation, analysis, and root cause
identify improvement opportunities. In a recent
determination lead to effective elimination of the
example in one Paramedics Plus operation, location
causes of complaints and help set priorities for
of lost belongings was identified as a top customer
process and service improvements. As a result,
complaint through analysis of the type of complaints
Paramedics Plus will log all service complaints
received. This information was used to launch an
and inquiries made in the complaint management
education campaign to employees on management
database. Date, time, caller, and parties involved
of patient belongings with an emphasis on documen-
will be documented along with the time inquiries or
tation of chain of custody. Additionally, the process
complaints are resolved (or closed). Every effort will
for lost managing items was improved to assure
be made to respond immediately to service inquiries
patients were quickly reunited with their belongings.
and complaints. By including complaint resolution
These actions have nearly eliminated the need for a
times in our Key Results Areas and monthly tracking
“lost and found” box.
paramedics plus
2.5 Measurement, Analysis, and Knowledge
Management
2.5.1 A comprehensive quality management
Paramedics Plus will work with the EMS Director
and the County EMS Medical Director and any
relevant quality committees to define Key Perfor-
system addresses all of the key areas in an
mance indicators. Our six-step Strategic Planning
organization that are essential for accomplishing
Process described in section D 2.2 is an inclusive
the organization’s purpose, vision, values, and
process based on core values of Teamwork and being
strategic objectives. The Proposer selected to
Customer Accountable.
provide emergency ambulance service to Alameda
2.5.1 Proposers should list their Key Result
County will work with the EMS Director and the
Areas along with a description of how that
EMS Medical Director, and any relevant quality
area contributes to the accomplishment of the
committees to define Key Performance Indicators
organization’s purpose, vision, values, and
(KPIs) that help define and measure progress
strategic objectives. At minimum, Proposers
toward accomplishing each KRA.
should describe KRAs documented in the RFP.
Paramedics Plus will enter into the required
The Vision, Mission, and Critical Success Factors
privacy agreements to guarantee the confidentiality
developed in one Paramedics Plus operation were
requirements of clinical compliance processes.
described previously in section D 2.1. The organi-
paramedics plus
zation in Alameda County will develop similar Vision, Mission, and Critical Success Factors (or Strategic
Objectives) based on the core STAR CARE philosophy. For each Key Result Area below Mission and Vision
statements are used as examples. Please see sample reports from Paramedics Plus operations in Appendix 9.
Response time performance by zone, sub area, priority, and the EOA.
Definition
Performance Indicator
Response time performance by zone, sub area, priority, and the EOA
% of calls within response time standard by zone, sub area and priority
ContributionMeets Mission and Vision of providing extraordinary service.
Data SourceDispatch System
Scene time and total prehospital time for time dependent clinical conditions like cardiac chest pain,
stroke, and major trauma.
Definition
Specific conditions such as cardiac chest pain, stroke and major trauma
identified using our Strategic Planning Process including system
stakeholders.
Percent of calls meeting standards for total scene time and total prehospital time as defined in Strategic Planning Process.
Percent of trauma alerts within time standard.
ContributionMeets Mission and Vision of providing compassionate quality care and the
Critical Success Factor of Quality Care for Patients
Data Source
Prehospital Care Form and Dispatch data
Compliance with policies, procedures, timelines, and destinations for:
ST-elevation myocardial infarction (STEMI)
Definition
Compliance with policies, procedures, time lines, and destinations for
ST-elevation myocardial infarction (STEMI)
Percent of STEMI patients whose care complied with protocols
Percent of STEMI Patients transported to correct facility
Data Source
paramedics plus
Pulmonary edema and congestive heart failure
Definition
pulmonary edema and congestive heart failure
Percent of cases that comply with protocols for pulmonary edema and
congestive heart failure.
Data Source
Asthma or seizures
Definition
Compliance with policies, procedures, time lines, and destinations for asthma and seizures
Percent of cases that comply with asthma and seizure protocols
Data Source
Cardiac arrest
Definition
Percent of cases that comply with cardiac arrest protocols
Percent of cases in which there is ROSC at scene measured by
Utstein critiera
Data Source
Trauma
Definition
Compliance with policies, procedures, time lines, and destinations
for trauma
Percent of cases that complied with trauma protocols
Data Source
paramedics plus
Presumed stroke symptoms
Definition
presumed stroke symptoms
Percent of cases managed in compliance with protocols for stroke symptoms.
Data Source
Assessment of pain relief
Definition
assessment of pain relief
Percent of cases that complied with pain relief protocols.
Data Source
Compliance with protocols, procedures, adjuncts, timelines for all patients who received,
or should have received, an endotracheal tube, King tube, Combitube, or any other “advanced airway”
Definition
Compliance with protocols, procedures, adjuncts, timelines for all patients who received, or should have received an advanced airway
Percent of cases that complied with protocols for advanced airway management
Data Source
Customer satisfaction
Complaint management
Definition
Respond rapidly and effectively to complaints
Performance IndicatorAverage amount of time to provide response to complainant
ContributionMeets Mission and Vision of providing extraordinary care and service to
customers and community and Critical Success Factor of Service—exceed
the expectations of customers
Data SourceComplaint tracking software system
paramedics plus
Employee satisfaction
Definition
Improve employee engagement
Percent of responses that agree or agree strongly with employee engagement survey questions
Contribution
Meets Mission of being a great place to work and Critical Success Factor of People—overall employee engagement
Data SourceEmployee Satisfaction Survey results
Paramedic skill retention
Definition
Ensure Paramedics remain competent to perform critical skills
Percent of success intubations
Percent of successful IV attempts
Meets Mission and Vision of providing compassionate quality care and the Contribution
Data Source
Use of mutual aid
Definition
Minimize the use of mutual aid
Number of mutual aid runs given minus number received
Contribution
Meets Mission and Vision of providing compassionate quality care
Data Source
Dispatch data
Safety
Definition
Ensure patients and employee safety
Process claims in a timely manner
Number of valid OSHA violations
Percent of workers comp cases reported in less than 24 hours
Number of employee injuries per 10,000 hours worked
Number of significant exposures per 1,000 patient contacts
Contribution
Supports Mission and Vision of providing compassionate quality care
Meets value of “Safe”
Supports Critical Success Factors of People, Quality, Responsible
Financially and Service
Data Source
OSHA Log
paramedics plus
2.5.2 Proposers should provide a list of
including the County EMS staff, County EMS
suggested KPIs and goals for each of the KRAs
Medical Director, Paramedics Plus Medical Director
listed in the RFP.
and other service providers to establish realistic goals
The key performance indicators for each of the
and prioritize key response areas in accordance with
KRAs are listed (previous page) as is a specific data
the values and mission of the Alameda County EMS
definition and data source for each key performance
system.
indicator.
Key performance indicators established for one
Our goals for each of the key performance
Paramedics Plus operation are provided below as
indicators listed (previous page) is to implement and
examples. These measures and associated goals
measure performance for each during the first six
are displayed on the Organization and Department
months of the contract and to conduct a performance
Scorecards. Please see Appendix 12 for Scorecards.
review after six months with system stakeholders,
Key Work Key Key Performance Measures Requirements
Processes
• Courteous and helpful % Case entry protocol compliance % Key question protocol compliance 96%
96%
• Arrive quickly
% Pre-arrival instruction protocol compliance % Post dispatch instructions protocol compliance 96%
96%
Dispatch
Services
2009
Goals
• Manage resources % overall EMD compliance efficiently
% correct unit assignment Average out of chute times Average turnaround times % customer rate dispatch courteous and helpful
• Maintain accreditation Maintain ACE accreditation • Contractual % Dispatchers meeting CDE requirements requirements
EMS
Operations
• Key customer
requirements
• Quality care to
our patients
• Safe Workforce
• Maintain accreditation
• Contractual requirements
% arrival emergencies within 10 minutes % arrive scheduled non-emergencies within 15 minutes % arrive unscheduled non-emergencies within 60 minutes Vehicle crashes per 100,000 miles # of miles driven between road safety counts % cardiac arrest survival % ROSC % of STEMI pts. transported to appropriate PCI facility % stroke alerts called appropriately center in golden hour % PCR with complete clinical documentation % PCR with proper billing information % Overall emergency customer satisfaction % Overall Non-emergency customer satisfaction 96%
98%
<: 30 secs
<: 20 min
97%
100%
100%
93%
98%
95%
.80
8 (level 5)
21%
28%
98%
91%
94%
98%
95%
95%
paramedics plus
Support
Processes
Key Key Performance Measures Requirements
% unit hours available System UHU
% field schedule successfully filled daily % part time employees fulfilling mandatory hours 99%
Reduce mechanical failure
% calls without a mechanical failure 99%
Maintain accreditation
Maintain CAAS accreditation Maintain CAMTS accreditation Maintain AHA accreditation Ensure clinical staff
have proper education and
certifications
% clinical employees meeting CME attendance requirements 98%
% satisfaction of in-house training 93%
Deployment Staffing and unit hours to
meet call volume demand
Fleet /
Materials
Clinical
Services
100%
100%
100%
0
0
0
<1
<.6
Timely processing claims
% Workers Comp cases reported less 24 Hours % OSHA 300 log reported within 7 days
100%
100%
Accurate pay
Accurate PCR
% accuracy of paychecks Total fines for un-billable PCR Hardware/ software
reliability
% CAD uptime % network uptime
employee safety
Informa
tion Technology
99%
93%
# validated OSHA violations # substantiated EEOC complaints # substantiated ethics complaints # of employee injuries per 10,000 hours worked # significant exposures per 1,000 patient contacts
Safety & Risk Ensure patients and
Employee
Services
2009
Goals
2.5.3 Proposers should describe their method
for regularly assessing compliance with Alameda
County EMS policies.
Paramedics Plus will develop monthly CQI
98%
$0
100%
100%
data to produce these reports.
In Paramedics Plus operations, compliance with
system policies is monitored through scorecards
and reports included in Appendix 12. These reports,
reports similar to those provided in Appendix 9 in
designed in collaboration with the EMS Authority
cooperation with Alameda County EMS and the
and the Medical Director, show both operational and
County EMS Medical Director to assess and measure
clinical data using Control Charts and graphs.
compliance with Alameda County EMS Policies.
Paramedics Plus will provide the technical
Data sources will include the computer aided
and clinical expertise to produce similar reports
dispatch system, the patient care record, and internal
developed in collaboration with Alameda County
information data bases. We will work closely with
EMS leaders.
the County Dispatch Center to obtain the necessary
paramedics plus
2.5.4 Describe how your organization makes
The chart found in Section D 1.1.1 Clinical
performance data and analysis available to
Quality Improvement provides a list of meetings,
employees, customers, the County, and other
frequency of meetings, attendees and purpose that
system partners.
one Paramedics Plus operation uses for providing
The Pinellas County, FL Paramedics Plus
feedback and receiving feedback.
operation uses multiple mechanisms to make
2.5.5 Describe your organization’s approach
data and information available to the workforce,
to learning and performance improvement using
customers, and partners. The types of information
industry and non-industry benchmarking.
communicated are based upon the needs and require-
Key sources of comparative and competitive
ments of each group. Methods are outlined in the
data from within our industry include other local
chart below.
and national EMS providers, the International
WORKFORCE
Organizational &
Department scorecards
Critical Success
Factors (CSF)
Monthly newsletters
Performance
evaluations
Bi-weekly scoop
newsletter
Bulletin boards
Face to face
mandatory
employee meetings
Weekly directors
meeting
Open door policy
Code of conduct
Mission/ Vision cards
Strategic plans
Role modeling
Employee orientation
Pulse meeting
SUPPLIERS / PARTNERS
CUSTOMERS
Contract agreements
Satisfaction Surveys
Personal contact
Email
Regular meetings
Email
Website
Website
Conferences and trade
shows
Monthly report to county
Community meetings
Community involvement
Annual report
Monthly Quality Council
Meeting
Stats pages
paramedics plus
City/County Management Association, Journal
use of industry best practices which include frequent
of Emergency Medical Services annual multi-city
changes of passwords; authentication requirement
survey, and National Academy of Emergency
before granting access to the web server; a fire
Dispatch and the Coalition of Advanced Emergency
wall between the network and the outside (county,
Medical Services. Key sources of comparative data
personal, internet); antivirus on servers and worksta-
outside our industry include Baldrige quality award
tions; and the use of a product to filter out inappro-
winning organizations, National Bureau of Labor
priate content and block websites that distribute
and Statistics, and American Customer Satisfaction
malware.
Index (ACSI). Limitations in obtaining data include
In the event of an emergency, the IT department
a lack of common data definitions and differences in
ensures the continued availability of hardware and
community demographics. In addition, due to HIPAA
software systems, and information through daily
regulations, proprietary concerns or the specificity
backups, vendor agreements, backup servers, backup
of the measure, some external benchmarks are
power, and contingency plans.
unavailable but comparisons are often made between
historical and current performance.
2.6.6 Describe your organization’s information
Accuracy, Integrity, and Reliability: Reports
used to determine compliance with the Ambulance
Service Agreement are generated via Crystal Reports
technology system used to support the
to utilize CAD data. Several daily reports are run to
measurement, analysis, and reporting process.
check for common data entry errors such as a call
Paramedics Plus will employ a staff of IT profes-
that shows a transport but also may show a cancel
sionals to support the technology system and the
reason, or a call that has a response time of zero.
measurement, analysis and reporting process. These
Transports with mileage less than one mile or over
professionals will ensure data integrity, timeliness
15 miles are also flagged by an automated report for
and security.
manual verification.
Paramedics Plus operations employ full-time staff
Security and Confidentiality: Few personnel
responsible for maintaining hardware and software
have rights to make changes in the CAD and there
systems. Paramedics Plus IT departments assure
is an audit trail including the information prior to
software systems are reliable through standard
the change, the new information, the initials of the
procedures such as providing needed patches/
person logged on, and a timestamp. Any patient
updates to keep software current and scanning for
information transferred between the paramedic’s
problems; active support agreements with hardware
laptop and the server is encrypted (128 bit AES) per
vendors; and having spare hard drives, monitors,
HIPAA standards. The web reports page is password
and laptops available that can be quickly deployed
protected.
if the need arises. Security is addressed through the
paramedics plus
2.5.7 Proposers shall provide sample checklists to improve clinical care for EMS patients and to
improve the reliability of other key processes.
Position and Responsibilities
Personnel Assigned
Pit Crew Leader
• Overall team dynamics
• Scene control
• Assigns roles
• Big Picture” view of the scene and assures duties of
other personnel are being performed
• Obtains patient information from bystanders, patient family,
medication bottles, patient belongings, etc.
• Makes On Line Medical Control Contact
• Monitor time intervals (2 min. CPR, drug intervals, etc.)
• Documents interventions and times
(via Quick Log in ePCR or notes)
• Communicates necessary changes of care or needed actions
• Collaboratively determines resuscitative efforts with team
First Paramedic to arrive on scene
(Fire or transport Paramedic). Clinical Field
Supervisor at arrival on scene will support the
Pit Crew Leader in his or her responsibilities and
provide oversight.
Airway Coordinator
• Performs appropriate airway techniques, procedures
• Confirms tube placement via six methods including Capnography
• Secures airway device and reassesses tube placement after each
move of the patient
• Ventilates Patient- Supervises/monitors airway through remainder
of the call
• Assists with documentation at hospital
• Defibrillates if needed
Fire or transport paramedic
Perfusion Coordinator
• Supervises and performs CPR assuring adequate rate and depth
• Ensures timely implementation of mechanical CPR device
• Helps Pit Crew Leader monitor time intervals
(2 min. CPR, drug intervals, etc.)
Fire or transport EMT or paramedic
Medication Coordinator
• Defibrillates
• Initiates IV or IO
• Administers medications when indicated
• Monitors EKG for changes and advises team of changes
• Advises Pit CrewLeader of interventions for documentation
• Communicates with family or law enforcement if needed.
• Collaboratively terminates resuscitative efforts with team
Fire or transport paramedic
Team Member (s)
• Assists with CPR
• Assists with Equipment
• Assists with set up IV
• Assists with ventilations if needed
Fire or transport EMT or paramedic
paramedics plus
2.5.8 Include a team approach to the treatment
The team approach described in Table 2 of the
of cardiac arrest, and other Echo calls where team
RFP is an appropriate place to begin in the design of
members are assigned specific roles to improve the
a team approach to the treatment of cardiac arrest.
efficiency of EMS interventions.
Our experience in other systems working with the
Paramedics Plus shares a desire to include
Fire Department responders to develop a similar
“team members” in the development of team
model has prepared us for success in working with
approaches for effective design and implementation.
the Alameda County Fire Department responders
Paramedics Plus will meet with the local Fire
to design and implement a model in this operation.
Departments, the EMS County Medical Director
We cannot overstate the importance and benefits
and other system partners the County may wish to
of employing a collaborative team methodology to
include in developing team approaches to cardiac
designing “team approaches” to treatment protocols.
arrest and other Echo calls where team members
are assigned specific roles.
paramedics plus
2.6 Process Management
use are leveraged through and deployment of
2.6.1 Describe the organization’s core
ambulances based upon data analysis to achieve the
competencies and how these were determined.
Using the six-step Strategic Planning Process,
previously described in detail in Section D2.2,
critical success factors of Responsible Financially
and Quality and associated measures.
Organizational agility is demonstrated through
Strategic Planning and in the attached document,
the systematic review of performance, based on
2009 Florida Governor Sterling Award Application,
historic 911 call volume patterns analyzed on an
Paramedics Plus will identify the core competencies
hour-by-hour basis. Daily, deployment levels are
present in the new Alameda County Paramedics
established for the next day based on predicted call
Plus EMS organization. We will engage our First
volume and patterns during Performance Utilization
Response colleagues, the County EMS Medical
Late call System Evaluation (PULSE) meetings
Director, Alameda County EMS as well as other
facilitating real-time improvements for optimal
stakeholders in this process.
performance on a daily basis. Demand graphs that
Paramedics Plus identifies core competencies
show projections in emergency call volume and daily
based on analysis conducted by its Leadership
performance graphs that monitor performance are
Teams. As one example, one Leadership Team
analyzed to determine if any actions are required for
identified three core competencies: agility, data
improvement. Late call reviews and verifications are
analysis, and optimal resource use. These core
performed in PULSE meetings as well.
competencies were determined during step 1-3 of the
The system for ambulance deployment is also a
Strategic Planning Process described in Section D 2.2
key to agility. All Paramedics Plus operations utilize
of this proposal using a variety of inputs including
System Status Management and a dynamic post plan
environmental scan, SWOT analysis (Strengths,
that changes every hour of the day and day of the
Weaknesses, Opportunities and Threats), voice of the
week to assure an ambulance is located where the
customer results, identification of strategic challenges
next emergency is anticipated. Based on seasonality,
and advantages, and performance against bench-
the post plan is reviewed quarterly by the Director of
marks.
Communications and the Deployment Manager.
By leveraging each core competency, Paramedics
Paramedics Plus uses data analysis during the
Plus achieves the critical success factors and
planning process to examine anticipated call volume
associated measures contained within the organi-
to determine future staffing needs. The Deployment
zational scorecard. For example, data analysis
Manager performs a demand consumption analysis
is optimized through the systematic analysis of
based on historical call volume data to determine if
historical call data to predict when and where 911
the necessary unit hours are available to meet the
calls are likely to occur. Agility and optimal resource
predicted peak call volume demand for the upcoming
paramedics plus
year. Zoll’s Resource Planner (formerly ISERA), a
2.6.2 Describe how the organization designs
deployment planning software application, is utilized
key processes with the involvement of patients,
to analyze target staffing levels and find the most
customers, front line employees, and system
efficient allocation of shifts to match ambulance
partners.
resources with call volume demands. Based on
Paramedics Plus operations design and innovates
this analysis, a field EMS operations schedule is
its overall work systems through the annual strategic
produced. Zoll’s Resource Planner is then used to
plan, contract requirements, industry standards,
test and validate the schedule. Due to seasonality
accreditation, best practices, and customer require-
and increase in call volume during certain months
ments. Work systems are designed to support the
of the year, the organization capitalizes on agility to
mission-- the delivery of compassionate quality care
expand capacity during these months by adjusting
and service to our community in a systematic and
the schedule, if needed, through a shift bid process,
integrated delivery system that includes both opera-
increasing part time work requirements, and altering
tional and support work systems. The Performance
schedules with four 12-hour shifts one week and
Scorecard System is used to align department activ-
three 12-hour shifts the second week to four 12- hour
ities with organization’s mission, vision, and critical
shifts in both weeks. Initiatives to address anticipated
success factors.
growth may include tuition reimbursement programs
The decision to operate a process with internal
for employees who wish to go to EMT or paramedic
resources is based on two criteria: “Is the process a
school, sign-on and relocation incentives for
key work process?” and “Can an external resource
recruiting, and retention bonuses to retain employees.
do it more cost effectively while maintaining quality
Resource optimization is achieved through System
standards?” Key work processes are central to
Status Management and a dynamic ambulance
public trust and, therefore are operated with internal
deployment plan that changes by hour of day and
resources. Paramedics Plus directly manages these
day of week. Resource optimization dictates that
areas to monitor the quality of outputs on a daily
ambulances are staffed at the levels dictated by
basis and to have the necessary agility to adapt to
proven demand analysis; consequently, the number
changing customer requirements and community
of ambulances deployed fluctuates throughout the
emergencies.
day based on call volume demand.
Key work processes that involve the majority of
our workforce and produce customer value, including
business and support processes, are shown in the
figures in Section D 2.5.2 Measurement Analysis and
Knowledge Management. Core competencies and
critical success factors are used as the foundation in
paramedics plus
the design and management of key work processes to
customers, suppliers, partners, and results of the
leverage the success of these processes in achieving
environmental scan are used to determine key work
the Mission and Vision, as well as customer key
process requirements. Customer key requirements are
expectations and requirements. Key work processes
captured through a systematic Customer Relationship
contribute to the delivery of customer value, profit-
Management Model. Additional methods include
ability, organizational success, and sustainability
best practices, regulatory and accreditation require-
through the critical success factors, voice of the
ments, and contractual obligations. The Leadership
customer (see Section D 2.3 on Customer Focus),
Team analyzes this information during step three of
identification of key customer requirements,
the Strategic Planning Process and establishes targets
designing key process to meet and exceed customer
in step four.
requirements, customer satisfaction surveys, perfor-
Key work processes are designed to meet all key
mance measures, identification of key process
requirements through input from process owners
requirements and measures monitored daily during
and front line staff, utilizing evidence-based,
PULSE meetings and monthly scorecard meetings.
medical and scientific research; best practice infor-
Key work process requirements are formally
mation; regulatory and accreditation requirements;
determined during the annual Strategic Planning
technology; benchmarks and comparisons; industry
Process and are updated as necessary to keep current
trends; contract and medical oversight requirements;
with business needs and direction. Feedback,
results from measurement systems; and input from
data, plus information from internal and external
customer, partners, and suppliers.
paramedics plus
Paramedics Plus—
using data and education to improve patient care
The CQI committee determined it is also significant to measure how long it takes field
personnel to place capnography. A 60 second goal was set and an educational program
implemented. The time to ET CO2 monitoring has dramatically improved and is having a
significant impact on reducing the number of esophageal intubations.
paramedics plus
2.6.3 Describe the organization’s continuity
a full-time Medical Response Coordinator to lead
of business plans for management of incidents
this continuous process which will occur in two main
or disasters, which disrupt the normal ability to
venues: joint planning with outside agencies, and
provide EMS service.
internal operational processes and plans.
Paramedics Plus recognizes and accepts its
External partners including Bay Area UASI,
responsibility to the citizens of Alameda County to
law enforcement, fire departments, emergency
take all possible actions to help ensure continuity of
management agencies and the area hospitals will be
business operations during significant incidents and
consulted to obtain both an existing hazard vulner-
disasters. While most of Alameda County’s natural
ability analysis and information on specific threats
and technological threats differ from those found in
that may create situations where EMS operations can
other parts of the country, the all-hazards approach to
be adversely affected. Just as important, Paramedics
business continuity involves the same principles and
Plus will consult with these agencies to obtain
proactive actions. These principles include planning,
current capabilities, resources that may be available
resource acquisition, and fiscal strength before the
for deployment (such as generators), as well as local
incident coupled with adaptation, resource allocation,
expectations of the EMS provider. This information
personnel management and leadership during and
will help determine the external environment in
after the incident.
terms of threat, capabilities, and expectations.
Planning for business continuity activities during
Internally, employees will participate in planning
and after a disaster or significant event occurs in
meetings to analyze actions to past disasters,
conjunction with the overall disaster response
thoughts and ideas on improving response capabil-
planning to ensure a cohesive strategy, which not
ities for future disasters, and identify gaps in the
only addresses the needs of the stricken area(s),
ability to meet both a specific disaster response
but also provides continued service elsewhere. The
need while maintaining service to an unaffected
ability to adapt to the circumstances presented by the
population in the County. Internal planning will
disaster is another important element in Paramedic
include a review of current EMS-specific resources
Plus’ business continuity approach. No matter
available such as those found on Ready.gov, Flu.gov,
how thoroughly successful the proactive planning,
or state planning templates. Planning will continue
unanticipated circumstances will arise during a
with appropriate changes to policies and procedures
disaster.
that may be required to strengthen existing opera-
Upon contract implementation, Paramedics Plus
tional plans, and mitigate gaps. The final result of the
will immediately conduct proactive planning for
process will be a needs analysis generated from local
disaster response and continuity of business opera-
agencies, existing templates, employee input, and
tions during a disaster. Paramedics Plus will employ
management experience. This initial analysis will be
paramedics plus
completed within nine months of contract start date.
address the needs of the incident while husbanding
During the process of developing specific
other resources to address ongoing response obliga-
plans, Paramedics Plus will take steps to acquire or
tions and any additional or supplemental responses.
arrange for the use of resources that may be needed
The flexibility of a daily System Status Management
to provide service to the citizens of Alameda County
response system will allow for rapid changes in
during a disaster or significant incident. These
coverage patterns and unit placement that may be
resources may include newly identified equipment,
required due to the inaccessible areas or closed
facilities, or services, or a continuation of resource
roads that may be encountered during a disaster.
provision agreements already in place. The process
Paramedics Plus will work with County Dispatch to
for obtaining the equipment or services will begin
devise a System Status Management plan to allocate
immediately upon recognition of the need rather
resources during a disaster.
than at the conclusion of the gap analysis. Once
Paramedics Plus will not commit all available
the analysis is complete, an initial needs list will be
resources to an incident until it identifies a reserve
generated. A procurement or mitigation strategy to
capacity through units staffed with management,
address the identified needs will be created within
extra units filled by on-call personnel, or mutual aid
90 days of the final gap analysis.
support. Paramedics Plus is committed to Alameda
A successful business continuity plan is enhanced
County and does not have outside contractual
by an organization’s fiscal strength. A financially
obligations that will require the movement of
strong organization is statistically less likely to
equipment and/or personnel away from the County.
fail and cease operations based on a large-scale
Paramedics Plus will maintain the ability to provide
emergency response. Such an organization can
an Ambulance Strike Team to a regional response
weather sudden changes to its economic status
of requests, and will honor mutual-aid requests
created by a disaster while it continues operations.
from neighboring counties if such a response can
The organization also has the ability to engage
be accomplished without jeopardizing coverage for
multiple vendors and rapidly obtain needed supplies
Alameda County.
and equipment for continued operations. Paramedics
All levels of the management team must be able
Plus has verified its fiscal strength elsewhere in this
to quickly assess the situation, make decisions, and
proposal.
communicate decisions to appropriate personnel.
Post incident, Paramedics Plus will implement
Mid-level managers and supervisors also should
processes and plans to ensure optimal resource
be comfortable making rapid decisions, if needed,
allocation. While this allocation will be incident-
without prior approval from senior managers.
specific, any disaster response plan will include the
Paramedics Plus will foster the ability for managers
concepts of committing the needed resources to
and supervisors to adapt, make decisions, and
paramedics plus
communicate by including supervisors in disaster
overall safety of each employee is the driving
planning, providing multiple redundant means
force behind scheduling and deployment decision
of communicating with employees, creating
processes.
and maintaining resource and option lists, while
supporting and empowering supervisors.
Paramedics Plus recognizes that effective and
Paramedics Plus has learned from practical
experience that a company must address the
welfare of both the employee and his or her family
visible leadership is critical in times of unusual
during times of disaster. Once an employee feels
stress; however, circumstances surrounding disasters
comfortable that these needs are being addressed,
may preclude the presence of individual leaders
he or she will be willing to provide the extra effort
during a response. These challenges are addressed
needed during unique situations. Past efforts to
in several ways: establishing a succession chain
support Paramedics Plus employees and families
for decision makers; training managers and super-
include hot meals to units on stand-by, warm
visors in multiple roles to ensure depth; recognizing
and comfortable shelter for employee families in
and utilizing the innate leadership capabilities of
Paramedic Plus buildings with food and laundry
employees not currently in leadership positions; and
service, and sending supervisors out to check on
ensuring that the leadership is visible to employees
the welfare of families and the status of employee
whenever possible during a response to or recovery
properties.
from a disaster. A management succession plan will
Paramedics Plus is intimately familiar with
be provided within 60 days after the start of the
the actions needed to continue business opera-
contract.
tions during large-scale disasters. It successfully
Finally, Paramedics Plus considers its employees
responded to disasters affecting entire service areas
to be its most valuable resource. The business conti-
and requiring adaptations in resources and personnel
nuity capability will be enhanced by maintaining and
management. Hurricane Charley pummeled urban
managing a healthy, protected, well-trained, properly
Pinellas County in 2004 and Hurricane Ike impacted
equipped and motivated workforce. Processes
a huge rural response area of the East Texas Medical
which ensure a quality workforce for daily response
Center EMS in 2008. In 1999, Paramedics Plus
activities pay off during times of disaster or unique
successfully provided a disaster response in one
response situations. These processes start during
area while maintaining stringent response time
orientation with disaster training, and continue
standards in an unaffected area. During the May 3rd
through employee health programs, continuing
F5 Tornado in south Oklahoma City that created over
education, effective supervision and management,
800 injuries, EMS personnel continued to respond to
the provision of appropriate personal protective
a normal call volume in the northern part of the city.
equipment, and effective response utilization. The
paramedics plus
The lessons learned from previous incidents
Paramedics Plus will employ a full-time
will be applied to the continuous planning process.
Medical Response Coordinator in Alameda County
Paramedics Plus also recognizes the need to assess
to augment disaster planning capabilities. This
and plan for the potential challenges unique to each
individual will not only be involved in developing
jurisdiction’s political and geographic landscape,
continuity of business plans, but will also contribute
a process which will begin immediately upon
to operational response capability, regional response
assuming the contract. Immediate needs will be
planning, public health integration, and medical
addressed upon discovery where possible, and a
system coordination.
completed business continuity plan will be produced
in the first year of assuming the contract.
paramedics plus
2.6.4 Describe the organization’s experience
EMS Medical Director, created a plan where Level II
with trials related to clinical innovation (new
and III hospitals provide specialty care on a rotating
medications, equipment and clinical protocols).
basis resulting in system efficiency and better care
Clinical Innovations
u
A Paramedics Plus operation was the first large
for patients. This organized back-up of the Level I
and II Trauma Centers eliminates redundancy and
EMS system in the country to measure the time
expense since multiple hospitals no longer need to
between insertion of the endotracheal tube until
maintain a full complement of specialists 24/7.
attachment of ET-CO2. This innovative approach
assures proper placement of the endotracheal tube
u
In 2006 , bed delays (EMS patients awaiting
while providing other clinical indicators and influ-
an ED bed) in the emergency departments in one
encing outcomes. This project was a poster presen-
Paramedics Plus operation were at an all time high
tation at the National Association of Emergency
with a total of 919 hours of bed delays. With the
Medical Services Physicians 2010 Conference in
implementation of bed-delay teams and a new
Phoenix and is one example of Paramedics Plus
consolidated care process where one crew assumes
industry leadership in patient safety and clinical
care of up to two other EMS patients, bed delay
excellence.
hours were reduced to 736 in 2007 and then further
reduced to 533 in 2008. An article in EMS Magazine
u
Two Paramedics Plus systems, working in
partnership with local hospitals, are currently using
highlighting this innovative approach is included in
Appendix 13.
mild therapeutic hypothermia to improve neurologic
outcomes in cardiac patients with return of spontaneous circulation.
u
When system data showed Level I and II
Trauma Centers in one Paramedics Plus operation
were being inundated with lesser injured patients,
medical direction in the system used data gathered
from ePCRs completed by Paramedics Plus crews
to drive development of communitywide on-call
systems for the two major metropolitan areas in the
state. A scarcity of specialty care in the system was
identified as one cause. Using data generated from
the field, Trauma System designers, including the
u
In 2003 when ambulance diversions escalated
to 3700 patients in one Paramedics Plus system,
the Office of the Medical Director worked with
Paramedics Plus, EMS oversight and strategic
partners including hospitals and physicians to solve
the problem. Multiple iterations of protocol changes
later, a new approach of delivering stable established
patients to their hospitals of choice, regardless of
diversion status, is combined with the communitywide on-call system to greatly reduce the number
of ambulance patients diverted. Over the first ten
months of 2009, the average number of ambulance
patients diverted was just under 24 in the system.
paramedics plus
This improvement is due to several factors: excellent
remains highly vulnerable (50% probability) to have
data, cooperation among shareholders, strong
a recurrence of SCA within the first 12 months after
medical leadership and the willingness of field crews
the initial collapse, the survivors are offered a free
to embrace change.
home AED for 13 months. CPR and AED training is
arranged for the patient and his or her family.
u
The work of Paramedics Plus field crews is
currently contributing to a study in one Paramedics
u
One Paramedics Plus operation has had an
Plus operation called SMART-e or Salvaged
established but evolving STEMI system since 2002
Myocardium Achieved by Rapid Transmission
and is part of an active county collaborative STEMI
of ECGs. The SMART-e study is based on the
workgroup.
hypothesis that reperfusion therapy will be more
rapidly initiated when the responsible cardiologist
u
A Paramedics Plus location has been enrolled
has support for the reperfusion therapy decision via
in a major multicenter research study (“The Tale
immediate access to patient data including a standard
of Seven Cities”) examining the effects of “new
12-Lead ECG. It is also hypothesized that earlier
CPR” plus an Impedence Threshold Device (ITD)
treatment will result in increased myocardial salvage
on sudden cardiac arrest patient outcome. This
and improved clinical outcomes. Data collection for
system submits the largest group of data of the seven
this study ends in December, 2009. All Paramedics
EMS systems contributing. An article regarding the
Plus locations transmit 12-Lead ECGs except one
conclusions of the study to date was published in the
where the medics make the diagnosis in the field and
December, 2009 AHA Circulation.
alert the hospital.
u
u
A Paramedics Plus operation, under the
The Strategic Based EMS Blueprint developed
through leadership of the Office of the Medical
direction of medical oversight, has participated in a
Director in one Paramedics Plus operation along with
“Cardiac Arrest Survivor Follow-up Program” since
participation from EMS oversight, Fire Department
2002. This program surveys cardiac arrest survivors
and Paramedics Plus leadership has been used as a
and family members directly involved in their care
foundation by the U.S. Secretary of Transportation’s
to learn more about the causative factors of the
National Emergency Medical Services Advisory
cardiac arrest and the benefits of pre-arrival medical
Council to develop national guidelines for EMS.
instructions provided by EMS. The study also
gauges the effectiveness of education and treatment
of these high-risk patients after hospital discharge.
Since research suggests that this group of survivors
paramedics plus
u
In 2000, a Paramedics Plus operation was only
the second service in the country to incorporate
Paramedics Plus is nationally known for its
leadership role in new EMS technology
the use of Continuous Positive Airway Pressure in
patients with pulmonary edema and various other
u
A Paramedics Plus system was the beta test
respiratory problems. Today CPAP is the standard of
site for one of the first successful ePCRs when it
care for EMS providers in the U.S.
worked hand-in-hand with the vendor to identify core
functionality and develop software specifications
u
All Paramedics Plus systems maintain cardiac
and tests. Clinical personnel supported the project,
arrest registries but the cardiac arrest registry
providing insight as to CQI needs and requirements
maintained in one Paramedics Plus system is
of medical oversight. The Paramedics Plus operation
considered one of the most extensive in the country,
was the first implementation of this product in a large
having collected nearly 16,000 cases since its estab-
scale urban EMS system.
lishment in 1993. The registry, which adheres to
uniform reporting for adult and pediatric resusci-
u
A Paramedics Plus system was also an early
tation, includes hospital outcome data. The objec-
adopter of the technology which facilitated the
tives of the registry include: quantify the incidence
electronic transmission of EKGs from the field to
and location of cardiac arrest events; track the
multiple receivers designated by local hospitals.
performance of each component of the EMS system
This innovation greatly reduces the time required for
including bystander care; determine the outcome;
STEMI patients to receive definitive treatment.
evaluate how well the EMS system achieves each
link in the AHA’s chain of survival; identify and
u
Paramedics Plus benefits from collaborative
prioritize opportunities to strengthen the chair of
relationships with major defibrillator manufacturers,
survival; and determine whether and why the burden
is routinely asked to provide input and is typically an
of cardiac arrest and survival outcomes differ by
early user of new technology.
race/ethnicity, gender and socioeconomic levels.
u
u
The EMSA Paramedics Plus operation began, in
A Paramedics Plus system is working with
Docvia, a privately held software venture that
2000, participation in a nationwide study to compare
provides secure, HIPAA-compliant access between
the use of Amiodarone to Lidocaine in patients
established patients and health providers. Through
with pre-hospital shock resistant ventricular fibril-
their revolutionary “Invisible Bracelet” technology,
lation. Over the course of the study, a Paramedics
our EMS providers have access to up-to-date medical
Plus operation submitted more cases to the ARRIVE
records for over one million potential patients.
cardiac registry than any other system in the country.
In the near future this EMS operation will take
paramedics plus
full advantage of this technology by integrating
patient transport process while medics wear seat belts
“Invisible Bracelet” into its ePCR which will bridge
during transport for safety. The devices are simple to
the “Silo’s” of patient records.
use and portable.
Proposed New Treatments
Paramedics Plus welcomes the opportunity to
LIFEPAK-15s will be provided to Paramedics
Plus crews and 110 LIFEPAK-15 cardiac monitor /
work with the EMS County Medical Director in
defibrillators will be purchased and provided to First
exploring and implementing clinical innovations.
Responders representing a significant move towards
The Paramedics Plus Medical Director will support
clinical consistency across the EOA. These devices
the County EMS Medical Director in his or her
will be capable of transmitting EKG’s to receiving
development of new clinical approaches.
hospitals.
With a focus on quality patient care and
Paramedics Plus will also place an Autovent 3000
clinical innovation, Paramedics Plus will purchase
Transport Ventilator on each ambulance unit and in
and provide several system enhancements. As
each Clinical and Operations Supervisor unit. This
Paramedics Plus has learned, disparities and incon-
device can be utilized on all intubated patients to
sistencies exist across the County in terms of
allow the paramedic to focus on assessments and
equipment available to First Responders. Several
further treatment.
upgrades directly improve the equipment available
Our preliminary research into other issues of
for First Response and bring consistency and clinical
particular concern to Alameda County indicates that
sophistication to all sections of the Alameda County
asthma may be an area where we could collaborate to
EOA.
improve care for area patients. With more than five
New equipment for First Responders includes
million Californians diagnosed with asthma and three
both hardware and software for the ePCR, LIFEPAK
million suffering from current asthma, this disease
-15s and the Physio-Control Chest Compression
leads to significant hospitalizations. According to the
System LUCAS device which will be provided for
Strategic Plan for Asthma in California 2008-2012,
all First Responder apparatus as well as each of
“About 13 percent of people hospitalized in 2005
the Paramedics Plus Clinical Field and Operations
had more than one asthma hospitalization during
Supervisor vehicles. Our plan actively deploys nearly
that year, indicating a critical level of uncontrolled
one-hundred devices in the system during peak times.
asthma.”
The LUCAS system provides effective, consistent
More than 450 asthma-related deaths occurred
and uninterrupted compressions in accordance to
in California in 2004, according to the report which
AHA guidelines. The devices provide hands-free
also indicates “considerable disparities” by race and
compressions providing good circulation during the
ethnicity, income, age and other factors.
paramedics plus
High acuity respiratory patients are often
Under the guidance and direction of the County
challenging for Paramedics. Clinicians that perform
EMS Medical Director, Paramedics Plus welcomes
medical rescue for this patient population encounter
the opportunity to develop cost effective, clinically
patients in severe distress and often near respiratory
innovative approaches to asthma, cardiac arrest and
failure. A public education effort could encourage
other conditions to enhance this already clinically
earlier calls to 911 for asthmatic patients.
excellent system.
paramedics plus
2.6.5 Describe the organization’s approach to
improve work processes to achieve better perfor-
improvement of work processes and provide an
mance, reduce variability, and keep processes current
example.
with health care service needs. Process owners use
As an example, the Paramedics Plus Leadership
segmentation of data to dissect processes to help
Team in one operation completed Six Sigma Yellow
identify areas for improvement or analyze problems.
Belt and Baldrige criteria training. The Leadership
For example, response time performance data
Team and process owners use several methods to
reported on a monthly basis may appear to meet
identify improvement opportunities: customer,
requirements, but segmented by day of week, time
partner, and employee feedback; SWOT analysis;
of day, or response areas, may bring deficiencies
review of performance measures; and benchmarking.
to light. For more extensive processes, we perform
The Leadership Team and process owners continu-
process mapping to dissect each piece of a process to
ously monitor, audit, and provide suggestions for
identify areas for improvement (process waste).
process improvements and recommendations for best
practices.
The PDCA Performance Improvement System
described in section D1 of this document is used to
As an example, it was identified that new
employees were attending orientation only to find on
day two that the results of background checks made
them ineligible for employment. After completing
paramedics plus
process mapping with all parties involved present,
Processes are kept current with healthcare needs
a root cause was identified in that the applicants’
through listening and learning methods that become
signed permission for background checks was
part of our environmental scan and used for strategic
obtained late in the hiring process. By obtaining
planning. One of our partner groups (hospitals) has
clarification that a faxed signature was acceptable on
indicated a desire to reduce the time it takes for
the release form and moving this action earlier in the
Acute Myocardial Infarction patients to go to the
process, we were able to ensure all pre-hire required
cath lab. One way to accomplish this is to receive
elements were completed by the first day of orien-
the 12-Lead EKG as soon as possible. As a result,
tation.
Paramedics Plus added 12-Lead EKG transmission
Another improvement opportunity identified
implementation to its strategic plan. The implemen-
through review of performance measures was
tation of this technology allows paramedics in the
compliance for the use of end tidal CO2 monitoring
field to transmit the patient’s 12-Lead EKG well
on all intubated patients in the field. In 2007, 8%
before hospital arrival which enables the hospital
of intubated patients did not have end tidal CO2
time to confirm that the patient needs the cath lab and
monitoring. This topic was added to the county
facilitate the process.
system continuing medical education sessions, along
Improvements and lessons learned are shared
with a letter from the Medical Director outlining
throughout other departments via PULSE,
the importance of this assessment tool that was
department, director, Quality Council, and scorecard
forwarded to employees. As a result, the “not used”
meetings; and the Performance Scorecard System.
rate was reduced to 0.3%.
paramedics plus
2.7 Results
in meeting key work process requirements. Daily
2.7.1 Describe the results the organization
PULSE meetings review results in real-time to allow
intends to produce through effective management
for necessary adjustments to achieve successful
of its key result areas. Include descriptions of the
staffing or deployment.
results which can be expected.
The table below reflects some of the results stake-
Paramedics Plus reports results on areas in
holders can expect with Paramedics Plus.
2.7.2 Describe the organization’s commitment
alignment with the critical success factors/strategic
objectives. The critical success factors reflect key
to measurably improve the health status of the
result areas which are People, Quality, Financial
community through prevention, chronic disease
Responsibility, and Service. Critical success factors/
management, or public education activity.
strategic objectives create focus and accountability
Paramedics Plus believes its role in prehospital
for all key stakeholder groups. Our organization
care is to address the needs of the community as
scorecard represents the high level measures/results
well as the needs of patients. The Mission Statement
reviewed monthly.
reflects this philosophy: “To provide compassionate
Department scorecards with additional measures
quality care and service to our community at a
that may be “in process” or “outcome” measures
reasonable cost.” Our mission surpasses patient
are also reviewed monthly. Department scorecards
needs alone.
include measures identified to track performance
Stakeholder
Measure
Pinellas Okla
Patients
% Cardiac Arrest Survival-Utstein Template (2008)
29%
36%
Patients
% ROSC - Utstein Template (2008)
42%
51%
Patients
General liability injury claims per 1,000 pt. contacts (2009) 0.08
0.075
Patients
% Overall patient satisfaction (2009)
96.50%
* Patients &
Hospital
Stroke Alerts called when indicated (2009)
100%
EMS Authority
& Community
% of time Emergency Response Time Compliance
Standards met (2009)
100%
95%
Community
Vehicle crashes per 100,000 miles(>$250) (2009)
0.91
0.67
Workforce
% Overall Employee satisfaction (2009)
81%
Workforce
# employee injuries per 10,000 hours worked (2009)
0.73
1.20
* Transitioned to new method and consulting firm during 2009. Results not available.
paramedics plus
Each Paramedics Plus operation has a unique
with a great deal of information regarding lifestyle
public education program reflecting the specific
changes and ways to reduce the risk of complica-
needs of the community it serves. Management and
tions; however, family members frequently lack
clinical coordinators in Alameda County will work
CPR training. Paramedics Plus will mail the family
the County EMS, the local health department, and
members a training schedule for upcoming CPR
other EMS stakeholders to identify and implement
classes and keep track of certification expiration
a meaningful public education program uniquely
dates for reminders on keeping certifications current.
designed for Alameda County.
Paramedics Plus is committed to providing
Citizen Cpr
The chain of survival for cardiac arrest
Alameda County more than 30 hours of community
victims is dependent upon the strength of each
education each month. Through a partnership/joint
link. Statistics show that for each minute an
venture with First Responder agencies, we anticipate
individual is in cardiac arrest, the chances of survival
a comprehensive approach to community education
decrease by seven to ten percent. The first element
in Alameda County.
is to have an educated public willing and capable
We propose the following initial schedule of
Community Education and Programs:
of providing bystander CPR during those critical
minutes until EMS arrives. Paramedics Plus will
Speakers’ Bureau
offer free CPR classes to the public at least once a
Paramedics Plus will offer its Speakers’ Bureau
month.
to neighborhood, civic and service organizations
Aed Distribution and Registry
throughout the Alameda County EOA. Topics
Paramedics Plus will participate in the Alameda
include: CPR training, basic first aid, signs and
County Public Access Defibrillation Program. The
symptoms of illness such as stroke, heart attack,
purchase of 10 AEDs is budgeted each year to
allergic reactions etc. In addition, Paramedics Plus
support this program. The emergency management
will develop a presentation to explain the Alameda
of sudden cardiac arrest remains one of the core
County EMS system, when to call 911 and what
purposes of any EMS system. The cornerstone
to expect. These topics will also be available via a
for optimized care of these patients is timely and
Paramedics Plus website.
effective intervention by the community, the EMS
Cpr Training Classes to Families of Heart
Attack Victims
Paramedics Plus will offer free CPR training to the
system, and other healthcare organizations. We will
enthusiastically support the Alameda County Public
Access Defibrillation Program just as we have
families of heart attack patients we transport. Our
supported similar programs in other communities we
research has shown that when a patient is released
serve.
from the hospital, they are typically provided
paramedics plus
Car Seat Check
project. As a result, Paramedics Plus established a
Part of a parent’s job is to protect his or her
highly visible child passenger safety program which
child from danger. Unfortunately, thousands of
has resulted in more than 17,000 seats given away
unprotected children are killed or seriously injured
and properly installed over the past nine years.
each year in auto accidents. Restraining a child in
Other Community Education
an appropriately sized and properly installed car
Another Paramedics Plus operation is involved
seat reduces his risk of fatal injury in a crash by 71
with a County Fall Prevention Coalition, Safe
percent.
Kids Coalition, American Heart Association, 911
More than 90 percent of parents who use car seats
education, Blood Drives, Toys for Tots, and free
use them incorrectly. Paramedics Plus proposes
monthly CPR classes to the community. Paramedics
to begin a car seat safety check program where
Plus is eager to partner with Alameda County to
specially trained Alameda County personnel
create an effective public education program tailored
inspect families’ car seats to ensure proper fit
to community needs.
and installation. Paramedics Plus will also seek
Key Performance Indicators
grant funding to provide car seats at low or no
To accurately measure the success of our
cost to families in need. The number of free car
community education programs, Paramedics Plus has
seats available will be dependent on the amount of
established the following key performance indicators
funding that can be secured.
to measure effectiveness. All results will be reported
In one Paramedics Plus operations, we met
to Alameda County EMS on an annual basis or more
with the Injury Prevention Section of the State
frequently as requested. Other measures may be
Department of Health to identify an injury prevention
created based on new initiatives.
Title of KPI:
Defined:
Measured: Target:
Community CPR Program
The total number of citizens successfully completing the
Paramedics Plus sponsored CPR training
To measure the effectiveness of our efforts we will track the
number of people we train and add to the number of CPR
trained citizens in Alameda County.
Increase the number of trained individuals by 5% each year.
paramedics plus
Title of KPI:Level of satisfaction with Paramedics Plus sponsored training programs.
Defined:Determine the level of satisfaction with all programs sponsored and taught by Paramedics Plus.
Measured:
Through post training written surveys we will determine the level
of participant satisfaction with the content, materials, and
instructors of individuals attending our training programs.
Target:
95% positive feedback.
Title of KPI:Car Seat Safety Checks
Defined:Determine the effectiveness and community response to the Car
Seat Safety Check program.
Measured:
To determine the effectiveness of the Car Seat Safety Check
program we will track the number of car seats that we inspect as
well as the percentage of incorrectly installed seats we discover
and correct.
Target:
Perform 40 car seat inspections each month.
Contribute to 1% increase in use of car seats in County as
measured by County or State observation studies
paramedics plus
2.7.3 Describe the approach to commissioning,
Improvement projects directly in line with our
managing and tracking improvement projects.
strategic plan are managed through the Strategic
Contractor will be required to provide a report that
Planning Process and the scorecard system which
updates progress on projects.
ensures that projects are assigned to managers or
The Paramedics Plus Leadership Team is fully
directors and results are tracked. There are several
engaged in the initiation of improvement projects
tools available to help organizations manage and
or action plans. Projects are identified through the
track improvement projects. A couple of tools with
Strategic Planning Process where strategic initia-
which we have had success are the project tracking
tives are identified to improve performance measures
tool shown below as well as Gannt charts. The
on our scorecards or help achieve a strategic goal
project tracking tool, adopted from the Institute of
aligned to one of the critical success factors/strategic
Health, allows us to see the list of active projects,
objectives. The monthly Quality Council meetings
who has been assigned, the anticipated outcome of
involving other stakeholders of the EMS system
the project and its relationship to goals, and time-
identify improvement opportunities through the
frame for completion. Gannt charts help track the
review of clinical performance data. This committee
assignment and time-line for task completion to
can charter an improvement project to make a
make sure deadlines are met. Each task has a bar
measurable difference in performance.
extending across the time columns, representing the
Weekly Director meetings are also opportunities
duration of the task. Milestones and critical path lines
for identification and commission of improvement
may also be used to add further detail to the chart.
projects based on the review of scorecard perfor-
Milestones are important checkpoints or deadlines
mance measures and feedback from our workforce
represented by small symbols in the time columns.
through Fresh Ideas Start Here (FISH) forms. In all
Critical path lines connect task bars to indicate a
cases, these projects are assigned to individuals with
dependence of one task upon another’s completion
timelines set for accountability. We recognize for the
or commencement. Microsoft Project is also a tool
success of many improvement projects, input and
being used with success in some of Paramedics Plus
feedback from all involved stakeholders is important.
locations. Appendix 12 contains more examples from
In our improvement processes, Paramedics Plus is
Project Tracking Tool. Updates on the progress of
committed to a process that results in meaningful
projects will be reported to the entity which chartered
community involvement.
the project and to the County’s performance
improvement committees as required.
paramedics plus
Section E: Commitment to Employees
1. Workforce Engagement
Describe the process for assessing the
engagement and satisfaction level of employees.
Paramedics Plus will utilize the Baldrige National
Quality Program as the foundation for creating an
extensive process for the management of employee
engagement with measurement of key performance
indicators of engagement and satisfaction. This
process has been successfully implemented by
Paramedics Plus elsewhere.
The primary method of determining key factors
affecting workforce engagement and satisfaction
used by Paramedics Plus is information gained
through research studies conducted by the Gallup
Organization over the past 25. The Gallup Organization interviewed more than 80,000 managers and
105,000 employees to reveal the 12 questions (key
requirements of employees) that are predictors for
higher employee engagement. In the twice annual
1. I know what is expected of me at work.
2. I have the materials and equipment I need
to do my work right.
3. Paramedics Plus is a safe place to work.
4. At work, I have the opportunity to do what
I do best every day.
5. In the last seven days, I have received
recognition or praise for doing good work.
6. My supervisor or someone at work seems
to care about me as a person.
7. There is someone at work who encourages
my development.
8. At work, my opinions seem to count.
9. The mission/purpose of Paramedics Plus
makes me feel my job is important.
10. My co-workers are committed to doing
quality work.
11. In the last year, I have had the opportunity
at work to learn and grow.
12. I have a best friend at work.
employee survey, employees rate the following statements on a four point Likert Scale ranging from
Strongly Agree to Strongly Disagree.
For a more meaningful analysis of the EMS
operations, the workforce is segmented into two
groups, clinical and non-clinical (administrative/
support personnel). The results of the biannual
workforce engagement survey are used to discover
opportunities for improvement by identifying specific
questions where results are below three, or overall
results below established targets. The information is
provided to department directors who then use the
results to improve performance.
paramedics plus
SEction E: Commitment to Employees
Taken) form which are posted in a very visible
Other informal methods are also used to ascertain
factors affecting employee engagement and satis-
manner and placed in the employee’s personnel file.
faction such as inputs obtained from supervisor
PATs are accumulated by employees as points which
and Leadership Team interactions with employees,
result in awards of gift cards, recognition pins and/
department meetings, FISH forms, six-month
or a day off with pay. The figure below represents the
employee evaluations, walk-arounds, and Joint Labor
reward system and steps in the process.
Letters received from patients or their families
Management Committee meetings.
Employee Reward and Recognition
are published in monthly newsletters. The names of
Paramedics Plus recognizes that employee recog-
employees who reach a new status on the pyramid
nition and acknowledgement is a factor of employee
are also published in the newsletter and posted
engagement. Some approaches and deployment
visibly for communication to personnel and guests.
methods of employee rewards and recognition
The Chief Operating Office personally writes
include public praise for an individual employee who
thank you notes and includes a gift card or movie
goes beyond expectations in demonstrating STAR
tickets, all of which are sent to employees’ homes
CARE values or extraordinary performance aligned
in instances of outstanding performance supporting
to a Critical Success Factor. In these and similar
STAR CARE values or Critical Success Factors.
cases, employees receive a PAT (Positive Action
EMT MEDIC OF THE YEAR
MVP OF THE YEAR
PURPLE QAR
PT. LETT
20 STARCARE PATS
15 STARCARE PATS
10 STARCARE PATS
5 STARCARE PATS
DAY
OFF
GOLD
PIN
HOLIDAY PARTY
NEWSLETTER/TV
GIFT CARD
SILVER
GIFT CARD
BRONZE
GIFT CARD
COPPER
PIN
NEWSLETTER/TV
PIN
NEWSLETTER
NEWSLETTER
paramedics plus
Each year the Leadership Team signs and
adds personal messages in birthday cards sent to
employees. At the annual holiday party in December,
important topics for discussion and workforce
motivation.
1.2 Describe the organization’s mechanism for
employees are recognized for years of service with
encouraging, gathering, and providing feedback on,
the company. Throughout the year the Leadership
and acting on employee improvement suggestions.
Team nominates employees for local, state, and
Paramedics Plus will implement a system
national EMS awards. During EMS week in May,
to encourage, obtain and act on feedback from
employees and their families are honored through a
employees. The Fresh Ideas Start Here (FISH)
fun-filled week of events, such as a family picnic;
program will utilize forms on which employees
employee car-wash where the COO directors,
document suggestions for improvements and provide
managers and supervisors personally wash the
feedback on current processes. FISH forms will be
employees cars; EMS family night at a baseball
reviewed at weekly director meetings. The decision
game; breakfast and BBQ days where the Leadership
to implement an idea will be made by the Leadership
Team personally cooks for employees; day of shoe
Team after careful review. Some FISH forms develop
shines and chair massages; and game day.
into small projects or action plans. In one Paramedics
1.1 Describe the organization’s two-way
Plus operation, an average of 38% of FISH forms
communications process between front line
result in action by the organization. The goal to
employees and the leadership team.
provide responses on employee FISH forms within
Paramedics Plus will adopt and adapt for
10 days of receipt has been met 98.3% of the time
Alameda County the successful methods used at
for the past three years. Compliance with this goal is
other Paramedics Plus operations for two-way
tracked and monitored.
communication between front line employees and
1.3 Describe the organization’s method for
the Leadership Team. A chart on communication
providing system and individual performance
methods is included in Section D 2.1 Leadership
feedback to employees.
and outlines the methods currently used and to be
considered for Alameda County.
Communicating with a mobile and 24/7 workforce
Paramedics Plus will utilize the Performance
Scorecard System to provide system and individual
performance feedback to employees. Employee
can be challenging for any organization. A method
performance is evaluated every six months with a
adopted in one Paramedics Plus operation ensures
scorecard with goals aligned with the organization’s
the time supervisors spend with the employees is as
Critical Success Factors. Feedback is provided in
effective as possible. The Leadership Team created
the areas of response times, hospital drop times,
“talking point” cards which reflect those topics the
out of chute times, attendance, safety, and customer
Leadership Team has determined to be the most
satisfaction. System performance regarding response
paramedics plus
times is communicated monthly via a TV screen in
The charter has proven to be very successful nearly
the Materials’ bay. System clinical performance is
eliminating lost equipment and improving the
also communicated during the biannual scorecard
process for the removal of expired drugs.
evaluation meetings with employees. Specific perfor-
1.5 Describe the Credentialing requirements
mance measures which need improvement are shared
for employees including but not limited to EMTs,
with employees to provide focus. Additional clinical
paramedics, dispatchers, and mechanics.
performance is communicated in newsletters and in
CE classes.
1.4 Describe the organization’s mechanism
for involving front line employees in quality and
performance improvement projects.
The following chart delineates the credentialing
requirement for Paramedics Plus employees both for
Alameda County and elsewhere:
Position Required Credentials
EMT State Certification, CPR,
belief that their opinions count and they affect
NIMS 100, NIMS 700, EVOC
change. For Alameda County, the Paramedics
Paramedic State Certification,
Plus Quality Improvement Teams (QIT) and/or
County Certification, CPR,
Process Improvement Teams (PIT) will involve
ACLS, BTLS or PHTLS, PALS
participation by field employees, materials, fleet,
or PEPP, EVOC, NIMS 100,
and others as appropriate. Paramedics Plus will
NIMS 700, EVOC
also utilize employees in other committees such
Mechanics
ASC Certification preferred,
as the Safety Committee, Equipment Committee,
Diesel Repair and Electrical Disaster Preparedness Committee, and Employee
Diagnostic experience required
One key driver of employee engagement is the
Engagement Committee. Employees are paid to
attend team or committee meetings.
At the beginning of 2009 a multi-disciplinary and
multi-level Materials Process Improvement Team
in one Paramedics Plus operation was chartered to
1.6 Describe the career ladder and professional
development process for the workforce. Include a
description of the succession plan for key positions.
The figure below shows a sample career
improve the counter check-out and turn-in processes
progression for key positions within the organi-
and reduce the occurrence of lost equipment. The
zation. Management of effective career progression
outcome of the Process Improvement Team was
is facilitated by defined job responsibilities and
a new counter process, the adoption of scanning
requirements. Employees are supported in career
software to check in and out equipment, and a new
advancement through flexible work schedules
Quality Check process to assure the removal of
to accommodate classes and pay differential for
expired drugs from ambulance and response bags.
specialized training.
EMS Operation Materials
paramedics plus
Materials
Management
Assistant
EMT
Materials
Training
Officer
Materials Lead
Specialty
Services
(SWAT. CCT)
EMT
Paramedic
BLS Preceptor
Paramedic
Preceptor
Assistant
Supervisor
Operations
Supervisor
Operations
Manager
Director
of Operations
Paramedic
Training Officer
BLS Training
Officer
To deliver the quality expected by the communities we are honored to serve, Paramedics Plus
Ongoing Training and Development Program
Paramedics Plus, nationwide, has implemented a
places significance and dedicates resources to the
management and leadership training program unique
creation and maintenance of a caring environment
to the ambulance industry. Based on the values of the
for our clinical staff. We provide these profes-
organization, the program emphasizes Paramedics
sionals with superb tools, training and support. Our
Plus’ commitment to clinical care and to those who
coaching staff or leadership talent, which we will
provide that care. The program is designed to allow
assemble both from people inside the community
individuals at all levels of the organization to identify
and others networked from outside the community, is
and pursue educational objectives and also give them
highly experienced and academically prepared. The
the tools to improve care delivered to patients.
management team’s focus is to help Paramedics Plus
Paramedics Plus is a clinical organization and our
medics reach their individual and collective potential.
management and leadership training is based on the
This process requires decision-making that is based
philosophy that we train clinicians to lead fellow
in Alameda County but founded on tested and proven
clinicians. Therefore, much of the leadership skills
processes and principles. Paramedics Plus has data
training is conducted in our clinical education depart-
management mastery, a thirst for statistics, great
ments. The training strategies include lectures, group
teachers and a philosophy that rewards performance
exercises and the use of the Internet and Ninth Brain
and innovation.
Suite (NBS) software.
paramedics plus
Minimum Prerequisite Curriculum
program allows superior employees to pursue
Training needs were initially assessed by inter-
careers in management and clinical leadership within
viewing managers at all levels in all operational sites.
Paramedics Plus.
Training Plan
Training needs identified are grouped into these
five areas:
An overall training program that focuses on
Leadership and Management is currently being
developed. Customized to meet the individual
needs of each operating unit, this program includes
modules that allow for rapid training of managers
and other staff. Individual educational plans will be
developed for managers, including classroom, online
and home study components. This type of program
improves the organization’s capability to learn by
sharing knowledge gained in individual operations
with the entire organization.
Needs Assessment
Commitment of managers to participate
One of the primary goals of this training
program is to not only address the needs of the
in the program
organization,but also to address the education needs
All leaders in the company at the level of Field
of individual managers. The management training
Training Officer and above are required to participate
program was designed to meet these needs. Inputs
in the training program. This would include Field
into the Paramedics Plus education and training
Training Officers, Supervisors, Managers, and
curriculum come from the Ambulance Service
Directors in the operation.
Agreement contract requirements, state creden-
Program content, instructional staff and
tialing requirements, strategic plan, patient satis-
time frame for implementation
faction survey results, new protocols, competencies,
Stephen Dean, Ph.D., Director of the program,
Quality Assurance Review data, learning needs
is a management educator with a doctorate in
identified, and workforce and management input. The
public policy, university teaching experience, and
workforce provides input into the learning delivery
experience in the design, implementation, and
systems through department meetings, employee
management of high performance EMS contracts.
engagement surveys, FISH forms, and e-mail
Using a combination of online teaching tools and
or discussions with the Education and Training
clinical educators to teach leadership skills, the
Manager. Supervisors and the Leadership Team

Paramedics Plus ExECuTivE SuMMAry

Transcription

Similar documents

News Bites - Continuing Medical Education

SUPITA(}IOTTIC

w hy choose your program

PARA-CORP Brochure

DPS - Cyberjaya University College of Medical Sciences

EMS Excellence Knowing matters National Accreditation

hands on - Bio Shield Tech

YOU`RE SO HOT! SUMMER BRINGS HEAT