It all comes down to this meeting doesn't it. The entire project, everything I hoped to learn comes down to sitting with Mark's supervisors and policy makers in the UK and making a solid impression that American EMS is not awash in profit driven patient care.But then again, we kind of are.
I started the meeting starving hungry from my hours in the dispatch center downstairs and was told this would be a kind of working lunch meeting.
Sandwiches and various appetizer type dishes were brought in and my personal favorite, fresh coffee. The conference room at the NEAS appeared to have been recently remodeled or redecorated as there were literally dozens of legal sized computer generated signs reminding those reading not to place cups directly on the table.
So what do I do?
Yes, and luckily I had Peter right behind me to place a saucer beneath the cup and shoot me a "Hey stupid" look. It was in this framework that the rest of the administrative team made their way in and began a presentation on the stats of the NEAS. Population, call volume, etc.
It was made clear to me ahead of time that Fiona, the Chief Executive's aide, had prepared the presentation and Simon Featherstone gave credit where credit is due.
Mr Featherstone, the aforementioned Chief Executive of the NEAS, seemed like any other person I had met on my travels so far and that made it very easy to listen to him discuss his system.
A few slides in he turned to the dozen or so folks in the room and suggested we do more interacting. This was, after all, common knowledge to all but one person in the room, me, and they wanted to hear from me, not their Chief Executive.
I went into a brief overview of my system in the SFFD and also explained other systems around the country. Much time was spent, and not surprisingly, with their fascination with the idea of for profit ambulance services.
Each member present asked a number of questions about billing and a person's ability to pay and I had to remind them many a time that that doesn't come into play until well after the call, but does drive policy decisions in the end, therefore changing our field care decisions.
Each time I snuck a bite to eat another question would have me or Mark discussing his observations of the system as well as his tales of life in a San Francisco Firehouse.
When it came to Mr Featherstone asking what differences we have observed patient care wise, I brought up CPAP and cardioversion and that those are widely used skills in the US. Pacing and cardioversion along with adenosine surely more common than CPAP, but it is such a wonderful tool more services should invest in it.
In true executive fashion Mr Featherstone turned to his clinical care person and said, "How soon can we look into doing these things?"
Bang.
Right then and there, slightly leaned back in his chair, the Chief Executive might be moving forward on something that can directly benefit the patients Mark encounters as well as giving him tools to help more people.
The meeting ended with handshakes and wishes of luck, but very little was said regarding the lack of Ted Setla and the Chronicles of EMS team in the room to record all of this fantastic learning and sharing of best practices.
But I understand that. England is a far less litigious society than the US, but they still have to concern themselves with the appearance of the service and those who function in it.
Everyone reading this post knows Mark and his blog are a source of incredible knowledge and a commitment to improving himself through new pathways. If Mark wrote a book about EMS I would buy it. If he had a radio show I would listen to it, but until those things happen (If he had a TV show I'd watch it) I will follow the media he uses to become a better Paramedic. Right now that is his blog http://999medic.com, twitter @ukmedic999 and on facebook. All media that is growing not only in popularity but usability and relevance to what we're trying to do in the pre-hospital care fields.
I don't expect every service in the world to be open to bloggers sharing patient care and contact stories, regardless of permissions, and the few that value the following some EMS bloggers have are doing so very carefully.
One of the things Mark and I hope to work on in the years to come is acceptance of new media and new ways to share information that still respects a patient's privacy while allowing those doing the care to share insight and best practices in real time.
A unique airway solution is discovered in Australia, blogged about, read by an ECSW in England who passes it along to their Paramedic who posts a link to twitter where I read it. Suddenly a technique that 5 years ago would wait months to get considered for a trade journal has been seen by thousands of caregivers who are about to share it with their friends and co-workers, and all in minutes, not months.
After a morning of listening to the Pathways system work in the dispatch center, then seeing the openness of the Executives to concepts and treatments, I think Mark is in a good place with the North East Ambulance Service.
In Conclusion-
The NEAS provides a high quality service in a straightforward manner to a well informed population. Powers rest with the Paramedic at the scene to determine transport, not the patient ahead of time like in my system. Front loading and getting eyes on a patient is a reliable way to handle system resources and gauge response.
The service is not reliant on insurance companies reimbursing for the services rendered nor are their paramedics passing perfectly capable ERs to reach a certain carrier's preferred spot.
Mark Glencorse was a gracious host and everyone I met from A&E tech to Chief Executive was welcoming and asked great questions about American systems and I did my best to represent all of us in a professional and knowledgeable fashion.
The food was great, the coffee we can work on in future visits.
Will the NEAS model work in San Francisco? I won't know until tomorrow when I get a tour of the Tyne and Wear Fire and Rescue Service by Station Manager Peter Mudie. Fire readers, this is the post you've been waiting for. But like most of what we do, EMS comes first and accounts for 80-90% of what we do. Why should my UK story be any different?
Comments
What you describe was much more akin to a business driven model than a bureaucratic model and I am curious to see if some of the challenges I see here are also present in the NEAS system.
What you describe was much more akin to a business driven model than a bureaucratic model and I am curious to see if some of the challenges I see here are also present in the NEAS system.
Apart from that though, thanks for the story of your collaboration - I've really enjoyed it all the way through.
What you describe was much more akin to a business driven model than a bureaucratic model and I am curious to see if some of the challenges I see here are also present in the NEAS system.
Apart from that though, thanks for the story of your collaboration - I've really enjoyed it all the way through.
Great questions. Mark can answer some of the hierarchy questions more specifically, but I can tell you that Mark had worked with most of the people in the room in the field at some point in his career. I did not get the sense of comfort in position, if I can create a term, that you get walking into some public offices. No one in the room appeared to be relaxing because they had "made it" to the top. They clearly were working hard at what they do and I think it is because if they do not perform they will be replaced by someone who can.
That was the impression I got from most of the positions I encountered there. it wasn't a sense of big brother pushing you forward, but a clear understanding of what your job is and if you can't perform, someone else will.
These are the impressions and understandings I left with, not the 100% truth of the matter.
I think I see where your questions are leading, to does the NEAS seem more like a bureaucracy or a private company.
Neither.
There was no striving for profit by undercutting the floor personnel, nor was there any heavy handed Chief wielding power for the first time unclear on how things work.
There are goals set. Meet the goals. Who sets those goals is the same the world over, law makers and policy deciders.
As far as the RN MD battle, I saw none while I was there, mainly because they are all in the same NHS family. Surely there are MD who feel some medics are below them, but when you have MDs out in cars responding to calls and actually participating in patient care, not nurse supervised prescription writing, they tend to change their opinions of us.
The private/public battle here in the states has already been lost by both parties. the privates can't keep up with costs and hold onto good people and the publics are seeing the same thing in the form of budget cuts.
So long as we try to stand on the profit model for medicine, no one wins, except the companies making a profit on premiums, then not reimbursing the agencies that give the care.
I hope Mark can fill in the gaping holes in my observations. Thanks for reading.