IHSS2005 Is Air Medicine Unique? The Role of System Design

1. IHSS2005 Is Air Medicine Unique? The Role of System Design Thomas Judge CCTP Exec. Director LifeFlight of Maine

3. the healthcare challenge: Value = Quality Cost Defined by the purchaser.

4. tension points: healthcare alignment • the user of the service is not the purchaser of the service, • the provider of the service is responsible to the user, not the purchaser (maybe) • the purchaser of the service is responsible to the user, not the provider (maybe)

5. Figure 2 • access • pre-event unplanned health event • intervention • planning • completion • evaluation / • revision

6. factors in demand • external: • demographics • media • changing disease patterns and morbidity • internal: • changes in disease management • technology • structural changes in providers • inatrogenic / interface: • unintended changes in health care system, i. e. “consumerism” and provider initiated changes

8. healthcare reality: • uneven access and equity • uneven quality • inter provider competition without corresponding improvements in service • lack of cohesive system by design templates • high cost • questionable results • problems with demand and integration of services

9. System Design: "Is this the best we can do- with the money we have?" Of all the forces influencing an EMS system's ability to convert available dollars into clinical performance and response time reliability, system design is by far the most powerful.

10. the power and limitations of system design • Talented and motivated people can produce good results from a bad design, but not for extended periods of time. • Incompetence and poor motivation can produce poor results from the best design.

11. the power and limitations of system design • Talented people tend to be attracted to superior system designs. • Good system design makes excellence possible and superior performance probable, but guarantees neither. • Bad system design makes excellence impossible and inferior service probable.

12. Primum Non Nocere

16. system fundamentals the whole is not necessarily the sum of the parts

17. 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

18. tension points: regulatory frameworks • Local and provider policy • Regional / State clinical protocols • Municipal regulation (helipads) • County regulations • State regulations (health, public safety, transportation) • State law (health, public safety, transportation) • Federal law (FAR’s, ADA,) • International law

19. 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

20. culture • Vision • “Commonness” of Vision • Belief System • Value System

21. system design variables: • who provides what? • aviation management and personnel • aircraft • maintenance • facilities • communications • medical crew • medical oversight • administration

22. system design variables: • who is at risk? • aviation management and personnel • aircraft • maintenance • facilities • communications • medical crew • medical oversight • administration

24. Clinical ImperativeAeronautical Reality Finance Fiscal Incentives separation of drivers:

25. risk transfer: the hot potato • Behavior • Alignment • Incentives Disincentives • worthy of the public’s trust

26. THANK YOU