IHSS2005 Is Air Medicine Unique? The Role of System Design

Thomas Judge CCTPExec. Director LifeFlight of Maine

Value =

QualityCost

Defined by the purchaser.

the healthcare challenge:the healthcare challenge:

tension points: healthcare alignmenttension points: healthcare alignment

the user of the service is not the the user of the service is not the

purchaser of the service, purchaser of the service,

the provider of the service is responsible the provider of the service is responsible

to the user, not the purchaser (maybe)to the user, not the purchaser (maybe)

the purchaser of the service is responsible the purchaser of the service is responsible

to the user, not the provider (maybe)to the user, not the provider (maybe)

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unplannedhealthevent

Figure 2

•pre-event

•access

•intervention

•completion•evaluation /•revision

•planning

© 2005 National EMS Medical Directors Course

factors in demandfactors in demand

• external:external:• demographicsdemographics

• mediamedia

• changing disease patterns and morbiditychanging disease patterns and morbidity

• internal:internal:• changes in disease managementchanges in disease management

• technologytechnology

• structural changes in providersstructural changes in providers

• inatrogenic / interface:inatrogenic / interface:• unintended changes in health care system, i. e. unintended changes in health care system, i. e.

“ “consumerism” and provider initiated changesconsumerism” and provider initiated changes

© 2005 National EMS Medical Directors Course

© 2005 National EMS Medical Directors Course

• uneven access and equityuneven access and equity

• uneven qualityuneven quality

• inter provider competition without corresponding inter provider competition without corresponding improvements in serviceimprovements in service

• lack of cohesive system by design templateslack of cohesive system by design templates

• high costhigh cost

• questionable resultsquestionable results

• problems with demand and integration of servicesproblems with demand and integration of services

healthcare reality:healthcare reality:

© 2005 National EMS Medical Directors Course

System Design: "Is this the best we can do- System Design: "Is this the best we can do- with the money we have?" with the money we have?"

Of all the forces influencing an EMS Of all the forces influencing an EMS system's ability to convert available system's ability to convert available dollars into clinical performance and dollars into clinical performance and response time reliability, system response time reliability, system design is by far the most powerful.design is by far the most powerful.

© 2005 National EMS Medical Directors Course

the power and limitations of system designthe power and limitations of system design

1.1. Talented and motivated people can Talented and motivated people can produce good results from a bad design, produce good results from a bad design, but not for extended periods of time.but not for extended periods of time.

2.2. Incompetence and poor motivation can Incompetence and poor motivation can produce poor results from the best produce poor results from the best design.design.

© 2005 National EMS Medical Directors Course

the power and limitations of system designthe power and limitations of system design

3.3. Talented people tend to be attracted to Talented people tend to be attracted to superior system designs.superior system designs.

4.4. Good system design makes excellence Good system design makes excellence possible and superior performance possible and superior performance probable, but guarantees neither.probable, but guarantees neither.

5.5. Bad system design makes excellence Bad system design makes excellence impossible and inferior service impossible and inferior service probable.probable.

Primum Non Nocere

AMS Accident

No: 20 Bell 206L-1

Pilot: 8221 hrs; 7026 hrs h/c;

NTSB Number: BFO94FA013 Night/ IMC

3640 hrs m/m; 345 hrs instr;

Date: 11/19/93   1218 nite hrs

TIme: Event:Problem

Statement: Remarks:

2039 EST

Engine loses power due to

Inadequate preflight planning;

Fuel 310 lbs at t/o; burn rate

 fuel exhaustion

insufficient fuel for mission in

of 220 lbs/hr equals 1+24 hrs

   exisiting conditions

to flameout (t/o 1912 1+24 hrs. =

      2036 EST)

© 2005 National EMS Medical Directors Course

system fundamentalssystem fundamentals

the whole is not necessarily the sum of the parts

issues: growth / governance variation

• Aviation Provider Aviation Management or entire operation FAA Rules Part 135 /91 Public Aircraft Part 145 / Maintenance Aircraft Ownership Pilots / Mechanics

• Medical Oversight Provider Hospital or EMS System Air Operator

• Clinical crew provider Hospital Air Operator EMS Agency

• Communications Provider Hospital Air Operator 911

tension points: regulatory frameworkstension points: regulatory frameworks

Local and provider policyLocal and provider policy

Regional / State clinical protocolsRegional / State clinical protocols

Municipal regulation Municipal regulation (helipads)(helipads)

County regulations County regulations

State regulations State regulations (health, public safety, (health, public safety,

transportation)transportation)

State law State law (health, public safety, transportation)(health, public safety, transportation)

Federal law (FAR’s, ADA,)Federal law (FAR’s, ADA,)

International law International law

the hard edge:

Environmental Matrix:

• evidence--need vs. demand

• healthcare market behavior

• competition within vs. for markets

• need for growth (margins)

• safety/quality costs? pays?

• ambulance reimbursement

• risk transfer

culture

• Vision

• “Commonness” of Vision

• Belief System

• Value System

system design variables:

• who provides what?• aviation management and personnel• aircraft• maintenance• facilities• communications• medical crew• medical oversight• administration

system design variables:

• who is at risk?• aviation management and personnel• aircraft• maintenance• facilities• communications• medical crew• medical oversight• administration

separation of drivers:

Clinical Imperative Aeronautical Reality

Finance

Fiscal Incentives

risk transfer: the hot potato

• Behavior• Alignment

• Incentives Disincentives

•

• worthy of the public’s trust

THANK YOU