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Better? Faster? Cheaper? Really!!!
Over the years, I have heard way too many claims of "Our way is better-faster-cheaper" than the guys and gals who are providing EMS in XXX community today.
Unfortunately, once again, history has not proven those claims to be true: http://www.kansascity.com/2012/03/08/3478432/the-stars-editorial-di...
I do so wish that, whenever considering such a proposal, the body politic would require (a) a performance bond in the amount of 5 years' proposed operating budget, and (b) a performance-based contract with the guy making the claims.
After all the trauma caused by one of these "total displacements" the community deserves (a) what it was promised, AND (b) replacement of those who made the false claims in the first place.
Unfortunately, nobody is left to come back and take it back over, or even to monitor the performance. Thank God the media in KC has been watching!
And I don't care WHAT color the vehicles are, or the corporate pedigree of the organizations!
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Replies to This Discussion
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Permalink Reply by Ben Waller on -
I agree that the community deserves to have a good EMS system, but I wonder if KC's EMS problems are a symptom of their reduced finances rather than mismanagement?
"Good, Fast, Cheap. Pick two." Captain Chris Garniewicz, Bluffton Township FD
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Permalink Reply by Skip Kirkwood on -
:-)
That quote is originally attributed to Jack Stout circa 1982!
I don't think that KCs problem is the result of a single factor. They thought they were going to get a "better deal" and it didn't work out. Something about not performing due diligence and letting politics sway decision-making.
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Permalink Reply by Ben Waller on
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I hadn't heard the quote connected with J.S. prior to this - thanks.
Iagree that a single factor is probably not the only causative factor, but reduced finances almost always are the 800-lb gorilla in this kind of discussion.
It sounds as if they're close to meeting the higher standard in their two most dense districts if I read the article correctly - 87% vs a 90% standard. I realize that missing by 3% is still a miss, and that close only counts in horseshoes, hand grenades, nuclear weapons, and slow dancing. :-)
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Permalink Reply by dr-exmedic on -
The worst part is that none of the targets talked about actually make any clinical difference whatsoever. Response time targets? What is this, 1990?
Ben Waller said:
Iagree that a single factor is probably not the only causative factor, but reduced finances almost always are the 800-lb gorilla in this kind of discussion.
Only because elected leaders don't want to talk about the failures in governance that they're responsible for:Other agencies’ budgets have been slashed in recent years, while firefighters have received large raises and increased their staffing.
If you're a city that hires and gives raises when tax revenues are low, is the *real* problem the reduced revenues, or failure of leaders to do their jobs? I think those are two inseparable issues, and you can't talk about one without the other.
From another editorial:
Two years ago taxpayers provided an average of $78,100 annually in pay and benefits to Fire Department employees. This year that figure is scheduled to hit $91,100 — soaring by 16.7 percent over two years.
The comparable two-year increase for the Police Department is 7.1 percent, from an average of $75,300 to $80,600 annually. But the average for the Parks and Recreation Department is actually down 3.5 percent.
Maybe I'm just bitter because I have plenty of friends in the private sector who haven't had a raise in 2-3 years, or had a raise but watched their health insurance price increases eat up 120% of it, or even lost their jobs.
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Permalink Reply by Skip Kirkwood on
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I think this whole "public employee pension" bruhaha is really "Elected officials didn't do their job and gave away the farm!"
The problem with public employee collective bargaining is that the guys on the other side of the table don't do their job (bargain in the people's interest) while the union guys do their jobs well. The "people" side see that if they give a lot away, they will get more votes - and they will be gone before it's time to pay the piper!
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Permalink Reply by Chris Azevedo on -
I've heard it frequently, in the name of advancing the profession, how those bemoaning lousy wages, retirement, benefits, unhealthy work schedules and being treated "unethically" do it to themselves because despite the above, they don't quit the job and find the satisfaction they seek elsewhere. Apparently, this fact allows those those employers to just keep right on dishing out lousy pay, lousy benefits, debilitating schedules and continue on with conduct that's been termed "unethical." Have I not read such things here??
I've also read among EMS leadership that until such things are fought for and won, EMS will always be regarded as a dispensible "technician" occupation instead of a more "professional" and career-oriented occupation along the lines of nursing and other allied health professions. Have I not read such things around here?
That's why I find it so interesting that the other side of some of those very same mouths are begrudging the fact that those represented by collective bargaining have received "large raises" and increases in staffing while those not so represented (let's say for agument's sake- corporate EMS employees) have not. Absolutely fascinating.
Oh, wait a minute. Do I have that wrong?
Is it the corporate employees protesting so loudly? Perhaps it's the corporate managers? Wow! Is this doctoral work to find the source of this apparent conflict of paradigms here? I've only got a bachelor's, but I'd bet I could nail it down to two words here: "money," and "profit." What a strange place for anyone to mention ethics, but with since Chief Kirkwood started the thread, let's talk about it for a minute. At least, let's allude to it. Ok, I'll try to get to it, anyway. Eventually.
Would I be naive in assuming that corporate EMS managers are just jumping at the chance to give employees the decent salaries, benefits, ethical treatment, &cet that those fire department folks had to negotiate for?? Boy, I bet I'd make a poor business manager if I though that, then. Wouldn't I? If I thought that way, I, just as sure as the butter on my bread, wouldn't be able to understand why multitudes of EMS providers have been suddenly relieved of their corporate employment commitments at the mere mention of the word "union."
And those public officials just NOT doing their jobs-- "giving away the farm!" Can you believe that? And for what? For money? Well, maybe, some. But I don't think that's quite it. Hmm...for profit? If there's no money, what kind of "profit" can there be? Somebody help me here. For votes? That's what a politician wants--votes? Hmm, is that really a "profit?" Boy, those politicians....!
Now, somebody please tell me that the private sector is going to get in here and do EMS, and not make a profit. Anybody?? Will all the crickets please remain quiet so I can hear the corporate EMS managers telling me that their organizations are going to get in to my county and provide EMS in perpetuum and not make a profit? Ok, at LEAST that they are not going to just GET UP AND LEAVE when they are not making a profit. Hmm, must be a bunch of Chicagoans here.
Ok, then can I hear all the corporate EMS managers who are going to come into my county and provide EMS and give the field providers the salaries, educations, benefits, and ethical treatment that all the "leaders" in the EMS field have been trumpeting are necessary to make this a "real profession" along side nursing and other allied health professions--oh, and make a profit on top of that? What's that? Hey you, with the halo!! Please, sir, can you come to Maryland? We've only read about you in storybooks. We've never actually seen anything like you here before, just read about you in Jack Stout books. Oh, not there, either? Darn.
Now, I KNOW what you're going to say about that little education I mentioned, but really, I live 5 blocks down the street from Johns Hopkins University--they're as corporate as you can get. My wife works there, (and I used to as well) and I just happen to know that they will PAY your education tuition for an employment commitment there. I couldn't get Rural/M--(oops!) to pay for my ACLS recert, and I was a critical care paramedic there.
To try and close, I've never seen ethics, profit and EMS mix and live together very long. Eventually, one or more of them has always got to go. You want ethics? Here is some fodder for discussion.
Is it "ethical" to tell the general public that they have to take responsibility for themselves, educate themselves and those whom they are responsible for so that the municipalities can cut down on the number of medically unnecessary EMS calls and transports that has driven the necessity for EMS services to be far greater than the financial framework that supports it was ever designed to be able to support?
Is it "ethical" to draw a line delineating what a 911 call is and is not, since the cultural norms which defined "emergency" and the need for calling 911 for such a transport have significantly changed?
Is it "ethical" for the general public, who pay a separate "fire tax," in which funding goes not to the county general fund, but directly and only to the fire service (which provides fire, EMS, and rescue services), to be billed for EMS service because the fire tax which funds EMS was NEVER intended to be able to support the demand for EMS services which that same public now has?
Is it "ethical" to suddenly turn over EMS services to an entity who is not (for any degree of legitimate reasons) otherwise prepared to handle it because of the speculated possibility of "profit?" You can define "profit" as votes--for politicians, or $$--for the private industry who lobbies to get in there and provide the service.
Is it ethical for the corporate entities to publicly berate unions, who fight for their members, when they, themselves would never in a million years give their own employees--let alone allow their employees to bargain for--the benefits the union fights hard for?
Is it ethical for bloggers, pundits, and journalists, who are paid by private entities and who have never worked fire, rescue or EMS in their lives (but have no issue calling an ambo for a stubbed toe), to publicly berate and slander public employee unions? I can think of some journalists at the Baltimore Sun who seriously need to "walk a mile in our shoes."
We all have the same choices to make. We must all live with the consequences of those choices. I chose municipal employment for the benefits of a pension and because of the instability of corporate employment. In making that choice, I had to sacrifice the ability to pick up and leave anytime I want and go someplace else any time I want, for any reason I want. I made my bed, I lay in it. So it goes with corporate employees who are suffering the effects of corporate climate worse than I am. Is it ethical for corporate employees to look down on municipal employees because we have decent pay, benefits, and stability, and they don't--or because they think we have it better than they do?
Perhaps a better question to ask would be, is it ethical for the private sector (any moreso than for the unions) to spend the money they do in propaganda and gaining favor in political decision-making (yes, they do) to make public services look unfavorable because they're interfering with corporate ability to make and/or increase their own profit? It it ethical for the pot to call the kettle black?
Yessir, let's talk about ethics.
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Permalink Reply by Duncan Hitchcock on -
A couple quick thoughts in response to some of the comments in this thread…
Unfortunately, the “response time” measure is the predominant factor still being used by too many EMS-based fire services throughout the country to demonstrate performance. It’s easy to track and the NFPA has guidelines for fire responses. So, money is still directed towards meeting the easy “standards” not the clinically significant ones.
Jack Stout…..I’m not going there…..
Quality fire, police and EMS are the “Big 3” that citizens routinely indicate on questionnaires conducted by county and municipal leaders during budget time. This happens with such frequency that many such questionnaires are beginning to state “…other than fire, law enforcement and EMS…what are the important services that the county (or city) provides its citizens and visitors?” But they do not endeavor to further question about what makes a quality fire, police or EMS service.
Yes, the folks negotiating for their union members are doing a much better job than those charged with operating a wide range of public services during this time of tightening public revenues.
“Good, fast, cheap. Pick two.” I really hate that mindset. Ooops, sorry, I said I wasn’t going there.
Profit is the driving force behind private enterprise. That doesn’t make it evil; just conflicted.
Of course, the last thing private enterprise wants is a union…or talk of a union…or rumors of a union...or thoughts of a union. Just the word causes nightmares and indigestion.
The primary union associated with the fire service has been a driving force for many positive changes in the safety of firefighters, working conditions and benefits. But to maintain folks on the job during tough economic times, you have to give, too. Negotiations are a two way street; give and take.
EMS has saved and transformed the fire service. Depending on the area of the country, up to 90+% of an EMS-based fire service’s work load is EMS related. But do the funding sources reflect that? Do quality of service assessment and measurement processes reflect that?
The role of EMS has and continues to evolve. Anyone in this business for over 10 years has seen the change in the types and dynamics of the requests for service. But access to health care has and continues to evolve. The face of EMS before us today is very different for us old folks. The face of EMS to come needs to be molded back into an emergency medical service.
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Permalink Reply by Chris Azevedo on
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On your first thought, I could not agree witih you more.
On your second, our funding source does not reflect that in the most damaging and severe way. This is mostly a function of the fact that EMS (where i work) has always been "managed" as a collateral duty of the fire department. Perhaps this is because in years past, EMS, like firefighting and rescue, was viewed here-as in many places- as a noble cause type of public service, like law enforcement, that should be absorbed into the public safety budget. However, the growth in demand for EMS that has made that mentality long obsolete has not yet translated into proper funding to suport it. Unfortunately, the culture shift that has made everything these days into an obligatory emergency response, has not translated into the realization that if you want to dance, you have to pay the fiddler.
As for quality of service assessment and measurement processes, I think nation-wide (certainly here) they leave alot to be desired. Many of them change with the wind. As well, if we continue to restrict our measurements of efficacy to response times and cardiac arrest save rates, these tools will tell us little that will help advance the field overall and will keep us running the same "what's the next thing to come into fashion" circles we've been running in for years. "Evidence-based" is absolutely the cycle breaker there, and in my opinion, help improve the "better, faster, cheaper" paradigm to an extent. Also, it seems, unfortunately for the profession, that some of these are culture-driven, which in the fire service-based system I work in, is slow to change or react. So, my answer to your open question is "no." We still have a number of retirements/changes of guard and landmark events to happen before they do.
Duncan Hitchcock said:A couple quick thoughts in response to some of the comments in this thread…
The primary union associated with the fire service has been a driving force for many positive changes in the safety of firefighters, working conditions and benefits. But to maintain folks on the job during tough economic times, you have to give, too. Negotiations are a two way street; give and take.....
EMS has saved and transformed the fire service. Depending on the area of the country, up to 90+% of an EMS-based fire service’s work load is EMS related. But do the funding sources reflect that? Do quality of service assessment and measurement processes reflect that?
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Permalink Reply by dr-exmedic on
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Duncan Hitchcock said:
The face of EMS to come needs to be molded back into an emergency medical service.
The problem is, who defines what's an "emergency"?
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Permalink Reply by dr-exmedic on
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Chris Azevedo said:
That's why I find it so interesting that the other side of some of those very same mouths are begrudging the fact that those represented by collective bargaining have received "large raises" and increases in staffing while those not so represented (let's say for agument's sake- corporate EMS employees) have not. Absolutely fascinating.
It's not as "fascinating" as you think. While a few localities have managed to stick a gun to taxpayers' heads (figuratively) and get themselves enormous wage increases in a time of general economic stagnation, the profession as a whole is still sitting along with stagnant wages. The actions of a few cities aren't exactly good for the profession as a whole. If I were interested in making things better for *all* professional ball players, including minor leaguers, why would I cheer on the latest $20 million/yr pitching deal?Ok, then can I hear all the corporate EMS managers who are going to come into my county and provide EMS and give the field providers the salaries, educations, benefits, and ethical treatment that all the "leaders" in the EMS field have been trumpeting are necessary to make this a "real profession" along side nursing and other allied health professions--oh, and make a profit on top of that? What's that? Hey you, with the halo!! Please, sir, can you come to Maryland? We've only read about you in storybooks. We've never actually seen anything like you here before, just read about you in Jack Stout books. Oh, not there, either? Darn.
But despite nurses having done just that, there are scores of for-profit places that actually hire nurses! Amazing! :)Now, I KNOW what you're going to say about that little education I mentioned, but really, I live 5 blocks down the street from Johns Hopkins University--they're as corporate as you can get. My wife works there, (and I used to as well) and I just happen to know that they will PAY your education tuition for an employment commitment there. I couldn't get Rural/M--(oops!) to pay for my ACLS recert, and I was a critical care paramedic there.
And yet I can go to Sheetz (one of the gas station/sandwich shop chains, if you don't have any near you) and get some college reimbursement. Wendy's offers adoption benefits. (The last time I checked, both of them were also paying better than entry-level EMT jobs here.) Perhaps this is because being a cashier is not so exciting that people will do it in their spare time for free? Do you really think that R/M (and everyone else) would fail to offer benefits if there weren't a steady stream of people to fill their jobs? Because without employees, they can't make a profit....The biggest problem is that bettering the profession is really, really hard and takes a lot of people over a long time, while union negotiations can happen over a few weeks and result in higher salaries next year. So is it any wonder that the former hasn't paid out yet, while those of us who talk about it the most are perfectly willing to criticize the latter?
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Permalink Reply by Skip Kirkwood on
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....Perhaps this is because being a cashier is not so exciting that people will do it in their spare time for free? Do you really think that R/M (and everyone else) would fail to offer benefits if there weren't a steady stream of people to fill their jobs? .....
Bingo!
So how about we work to advance the entry level standards of the profession so that it rises above the status of "hobby" in most of the country?
"We?" Who is that?
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Permalink Reply by Duncan Hitchcock on
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Currently, the caller defines the "emergency" when they punch-in 911.
But part of the evolution of EMS (in my dreams, hopes and desires) would be such that this too would be addressed.
dr-exmedic said:Duncan Hitchcock said:
The face of EMS to come needs to be molded back into an emergency medical service.
The problem is, who defines what's an "emergency"?
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