On Monday, September 24th Manitoba's Minister of Health delivered some very exciting news from the Notre Dame campus of Red River College. The provincial government has decided to fund Red River to develop and deliver a Primary Care Paramedic program in Manitoba.
This announcement follows months of speculation regarding the direction that our provincial government planned to take to assist with an education program for EMS in Manitoba. Just a few short days ago I had speculated that this news might be delivered, but in all honesty I certainly didn't expect it quite so quickly.
In very simple terms the announced partnership means the government will provide RRC with funding to develop a 12 month Primary Care Paramedic program. The course should begin in September of 2008, and will most likely be delivered in two rural sites as well as the RRC campus each year. Initial enrollment will be limited to 40 students a year.
The reason this announcement means so much is quite simple. Paramedicine will now be taught in a health sciences faculty at a post secondary institution...something PAM has been advocating for years. Not only does it make sense to teach paramedics in an environment that already has a successful nursing program among it's list of health curriculum, the very fact that paramedics will graduate from this environment adds credibility and respect for both the graduate and the profession.
There are most certainly many details yet to be uncovered, and I hope to have that opportunity as soon as I return from the East coast (yes...I'm holidaying in Nova Scotia!). The student numbers are low to start and we won't see a graduate until at least June of 2009. But it's a "giant leap" in the right direction. I applaud our provincial government for their decision to support the Red River initiaitive...I know it was both complicated and difficult to do.
Wednesday, September 26, 2007
Wednesday, September 19, 2007
Education Decision Close?
In June of 2001 Manitoba Health signed a Memorandum of Understanding with the Manitoba Emergency Services College (MESC) in Brandon to deliver EMR and EMT programs regionally. This MOU provided the Brandon College with significant funding to ensure that the educational needs of EMS in rural Manitoba were met. In simple terms, the agreement called for MESC to facilitate 10 EMT courses annually based on regional requirements. The memorandum expired in 2006, and for a number of reasons, including concerns expressed by the EMS Directors, it was not renewed. Alternatives have been explored for some time now, including government support to assist Red River College with the development of a Primary Care Paramedic program.
The Paramedic Association of Manitoba has long been advocating the need for a more professional education model for paramedicine in our province.Our desire to be recognized and respected as health professionals is met with certain challenges as a result of the educational processes used in the past.To validate our role and ensure credibility for graduates as they interact with other allied health professionals,Manitoba
The Paramedic Association of Manitoba has been supporting Red River's proposal to develop and deliver PCP education in our province. We've met on numerous occasions with representatives from the RRC Health Sciences faculty and officials from Manitoba Health to promote this concept. I'm confident that our arguments have been heard, and hopeful that Department officials have been able to convince their political bosses of the many benefits associated with moving in this direction. Based on responses to my many requests for information over the past few weeks, I'm somewhat optimistic that we may hear an announcement regarding this issue once the Legislature reconvenes early next week. Stay tuned...
The Paramedic Association of Manitoba has long been advocating the need for a more professional education model for paramedicine in our province.Our desire to be recognized and respected as health professionals is met with certain challenges as a result of the educational processes used in the past.To validate our role and ensure credibility for graduates as they interact with other allied health professionals,
The Paramedic Association of Manitoba has been supporting Red River's proposal to develop and deliver PCP education in our province. We've met on numerous occasions with representatives from the RRC Health Sciences faculty and officials from Manitoba Health to promote this concept. I'm confident that our arguments have been heard, and hopeful that Department officials have been able to convince their political bosses of the many benefits associated with moving in this direction. Based on responses to my many requests for information over the past few weeks, I'm somewhat optimistic that we may hear an announcement regarding this issue once the Legislature reconvenes early next week. Stay tuned...
Tuesday, September 18, 2007
EMS and Regionalization - Does it Work?
Ten years after the introduction of Regional Health Authorities in Manitoba, the provincial government has called for a review of the RHA system. The Regional Health Authority External Review Committee has been mandated to examine current RHA practices and recommend strategies for improvements in the future. Their report to the Ministers of Health and Healthy Living is to be completed by December of this year.
Without doubt Manitoba's emergency medical services system has seen both growth and opportunity over the past half dozen years. Some will argue that system improvements are a direct result of regional health authorities assuming responsibility for service delivery. But that perception may have more to do with the coincidence of timing than reality. While our rural system has evolved from primarily volunteer based in the 1990s to employee based today, the drive toward such change was more reactive to crisis than proactive management by the RHAs. Advancements in practitioner education and training have been driven in large part by the profession in response to increased demands placed on us by rising call volumes, longer transports and system needs. Improved communication, dispatch, and vehicle initiatives fall outside the responsibility of any single RHA, and in fact were conceptualized prior to the 1997/98 regionalization of our health care system.
Over the past decade and a half, many provinces have adopted a regional model for health care delivery. This strategy is said to be chosen in an effort to contain escalating costs, enhance public participation in decision-making, and improve planning, integration and accountability. Some critics, however, suggest government uses this authority strategy more to deflect criticism and avoid having to make tough choices as service expectations exceed existing capacities. It's also very interesting to note that not all health services are delegated to regional health authorities. Here in Manitoba a number of health services are excluded from RHA responsibility, including Pharmacare, Oncology, CancerCare Manitoba, many northern Nursing stations, fee-for-service physician services and others.
To my knowledge, only Manitoba, Saskatchewan and Quebec have opted to include ambulance services as health services administered by Regional Health Authorities. Other jurisdictions have chosen more centralized governance structures for EMS, perhaps recognizing that incidents and transports often don't align themselves with borders and boundaries. So what prompted our government to include ambulance and paramedic services in the list of regional responsibilities and was that the best decision to make?
The current Manitoba authority model has eleven RHAs, each with a very distinct and differing approach to the delivery of emergency medical services within their boundaries. The result is that Manitoba's EMS system is fragmented, not well coordinated, lacks efficiencies and accountabilities and has widely varying levels of performance across the province. The reality is that level of service and quality of care is dependant on a patient's location. And unfortunately, in our current model the system managers tasked with making EMS work aren't given the authority to make change.
Should EMS be administered by eleven regional health authorities, or would there be benefit to a more centralized management system? I'd suggest that with an RHA review currently underway, now is a very appropriate time to field this concept. Whether centralization meant public, corporate or a combination of the two, I can't help but think that such an entity would result in a more efficient and consistent level of prehospital care.
Without doubt Manitoba's emergency medical services system has seen both growth and opportunity over the past half dozen years. Some will argue that system improvements are a direct result of regional health authorities assuming responsibility for service delivery. But that perception may have more to do with the coincidence of timing than reality. While our rural system has evolved from primarily volunteer based in the 1990s to employee based today, the drive toward such change was more reactive to crisis than proactive management by the RHAs. Advancements in practitioner education and training have been driven in large part by the profession in response to increased demands placed on us by rising call volumes, longer transports and system needs. Improved communication, dispatch, and vehicle initiatives fall outside the responsibility of any single RHA, and in fact were conceptualized prior to the 1997/98 regionalization of our health care system.
Over the past decade and a half, many provinces have adopted a regional model for health care delivery. This strategy is said to be chosen in an effort to contain escalating costs, enhance public participation in decision-making, and improve planning, integration and accountability. Some critics, however, suggest government uses this authority strategy more to deflect criticism and avoid having to make tough choices as service expectations exceed existing capacities. It's also very interesting to note that not all health services are delegated to regional health authorities. Here in Manitoba a number of health services are excluded from RHA responsibility, including Pharmacare, Oncology, CancerCare Manitoba, many northern Nursing stations, fee-for-service physician services and others.
To my knowledge, only Manitoba, Saskatchewan and Quebec have opted to include ambulance services as health services administered by Regional Health Authorities. Other jurisdictions have chosen more centralized governance structures for EMS, perhaps recognizing that incidents and transports often don't align themselves with borders and boundaries. So what prompted our government to include ambulance and paramedic services in the list of regional responsibilities and was that the best decision to make?
The current Manitoba authority model has eleven RHAs, each with a very distinct and differing approach to the delivery of emergency medical services within their boundaries. The result is that Manitoba's EMS system is fragmented, not well coordinated, lacks efficiencies and accountabilities and has widely varying levels of performance across the province. The reality is that level of service and quality of care is dependant on a patient's location. And unfortunately, in our current model the system managers tasked with making EMS work aren't given the authority to make change.
Should EMS be administered by eleven regional health authorities, or would there be benefit to a more centralized management system? I'd suggest that with an RHA review currently underway, now is a very appropriate time to field this concept. Whether centralization meant public, corporate or a combination of the two, I can't help but think that such an entity would result in a more efficient and consistent level of prehospital care.
Wednesday, September 12, 2007
Ontario Closer to Paramedic Self-Regulation?
Late last week the Ontario Paramedic Association (OPA) issued a press release in response to a letter from Ontario's Health Minister to the provincial Health Professions Regulatory Advisory Council (HPRAC). HPRAC provides policy advice to the Ontario Health Minister on matters related to the regulation of health professions in that province, including advise on whether or not health professions should be regulated and amendments to the Regulated Health Professions Act.
In his correspondence, Ontario Health Minister Smitherman asked HPRAC to "advise whether paramedics and emergency medical attendants should be regulated under the Health Professions Act, and if so, what would be the appropriate scope of practice, controlled acts and titles authorized to the profession." The Health Professions Act provides direction for regulating health professions in Ontario, including the responsibilities of each professional regulatory college.
Although the reply time frame associated with this request is unclear, and may well take the better part of a year to obtain, the fact that Ontario's Health Minister has raised this issue with his advisory council has bolstered the spirits of the OPA. In the press release issued by OPA President Mary Osinga the Minister's request is applauded and called a "bold step forward for Ontario's Paramedics". If Ontario moves in the direction of paramedic self-regulation they will join the ranks of a number of other Canadian jurisdictions that have recognized the importance of such a move...Alberta, Saskatchewan, Nova Scotia and New Brunswick.
The Manitoba Government is currently reviewing the legislation of it's health professions. The Health Professions Regulatory Reform Initiative (HPRRI) is currently studying "umbrella legislation" options that would replace existing regulatory Acts in our province. I anticipate this umbrella legislation will define health professions and outline a common framework for all regulatory Colleges to follow in regard to administrative practices and complaint and discplinary processes. As such the Paramedic Association considers it imperative that we work to ensure our profession is recognized as a health profession within this legislation to set the stage for paramedic self-regulation in Manitoba.
PAM had requested to participate in the review initiative with Manitoba's other regulated health professions, however we were denied any official status in the process because we are not a regulatory body. But we were assured that we'd be kept abreast of it's progress, and just this week I received correspondence stating that both regulated and non-regulated professions should have access to a discussion paper on this subject in the near future. If need be we too will be asking our Health Minister to ensure paramedics are recognized as health professionals. Hopefully Manitoba will also find itself one step closer to paramedic self regulation through this process.
OPA News Release - Ontario Paramedic Self-Regulation being considered by HPRAC
Health Professions Regulatory Reform Initiative (HPRRI)
In his correspondence, Ontario Health Minister Smitherman asked HPRAC to "advise whether paramedics and emergency medical attendants should be regulated under the Health Professions Act, and if so, what would be the appropriate scope of practice, controlled acts and titles authorized to the profession." The Health Professions Act provides direction for regulating health professions in Ontario, including the responsibilities of each professional regulatory college.
Although the reply time frame associated with this request is unclear, and may well take the better part of a year to obtain, the fact that Ontario's Health Minister has raised this issue with his advisory council has bolstered the spirits of the OPA. In the press release issued by OPA President Mary Osinga the Minister's request is applauded and called a "bold step forward for Ontario's Paramedics". If Ontario moves in the direction of paramedic self-regulation they will join the ranks of a number of other Canadian jurisdictions that have recognized the importance of such a move...Alberta, Saskatchewan, Nova Scotia and New Brunswick.
The Manitoba Government is currently reviewing the legislation of it's health professions. The Health Professions Regulatory Reform Initiative (HPRRI) is currently studying "umbrella legislation" options that would replace existing regulatory Acts in our province. I anticipate this umbrella legislation will define health professions and outline a common framework for all regulatory Colleges to follow in regard to administrative practices and complaint and discplinary processes. As such the Paramedic Association considers it imperative that we work to ensure our profession is recognized as a health profession within this legislation to set the stage for paramedic self-regulation in Manitoba.
PAM had requested to participate in the review initiative with Manitoba's other regulated health professions, however we were denied any official status in the process because we are not a regulatory body. But we were assured that we'd be kept abreast of it's progress, and just this week I received correspondence stating that both regulated and non-regulated professions should have access to a discussion paper on this subject in the near future. If need be we too will be asking our Health Minister to ensure paramedics are recognized as health professionals. Hopefully Manitoba will also find itself one step closer to paramedic self regulation through this process.
OPA News Release - Ontario Paramedic Self-Regulation being considered by HPRAC
Health Professions Regulatory Reform Initiative (HPRRI)
Saturday, September 08, 2007
Staff Shortage Spells Ambulance Outages
In the month of August, Springfield Ambulance (Oakbank) was out of service for almost 200 hours due to a lack of staff. A service that still relies heavily on staff to take on-call hours during nights and weekends, Springfield is finding it more and more difficult to ensure it's ambulance is available 24/7. They are not alone in that situation...ambulances across the province are taken out of service daily because of staffing problems...and that includes ambulances with paid staff around the clock.
Before the September long weekend, CBC radio and television news contacted the Paramedic Association of Manitoba about concerns related to ambulance staffing in the Springfield area. When asked about the prevalence of the problem, I suggested that we had heard reports similar to that in question from many services across the province. Since doing the CBC interview, we have confirmed ambulance outages occurred due to staff shortages in at least 14 different services for various periods of time over the Labor Day Weekend in Manitoba.
Staffing models vary dramatically from region to region. Some regions have opted to try and staff units on a full-time basis 24/7. Others rely on staff to take some on-call hours outside of their regular working hours to maintain service. Some will pay overtime to staff cars...others won't. Some regions have restricted their hiring to a minimum Technician-Paramedic level, some will hire anyone with an EMS Provider License. Undoubtedly the inconsistent staffing models from region to region have some bearing on whether or not units are taken out of service from time to time.
But I think the real problem runs much deeper than whether or not a region will pay to staff a unit in-house or rely on paramedics to be available on-call. I'm sure many regions have been reluctant to even consider changes to staffing models until government provides more clear direction regarding the future of EMS in Manitoba. Many EMS stakeholders, including the Paramedic Association of Manitoba, worked for more than 2 1/2 years to develop an EMS Framework document for consideration by senior government...that work has yet to be formally approved. Another committee, which also included representation by PAM, spent countless hours considering educational criteria for EMS programs looking to meet Manitoba Health's licensing requirements. Outside of the rumor mill, no final decisions have been made in this area that we are aware of. And government support for a paramedic education program that was expected to begin at Red River College almost one year ago has yet to be confirmed...and may well be in jeopardy.
My fear is that the staffing crunch we're beginning to see will only get worse if government continues to drag their heals on these very important issues. We are almost two years behind in educating paramedics that would normally staff many of our rural services. High school graduates looking toward EMS as a career are oftentimes leaving the province to pursue education in other jurisdictions...regions of the country that offer certificate or diploma programs in paramedicine and more definite career opportunities once they graduate. Our politicians need to make some very difficult and important decisions in the immediate future that allow us to be proactive and work toward improved system delivery...if not, the reactive decisions they will be forced to make will hurt Manitobans a whole lot more.
CBC TV NEWS - Aug 30, 2007
Before the September long weekend, CBC radio and television news contacted the Paramedic Association of Manitoba about concerns related to ambulance staffing in the Springfield area. When asked about the prevalence of the problem, I suggested that we had heard reports similar to that in question from many services across the province. Since doing the CBC interview, we have confirmed ambulance outages occurred due to staff shortages in at least 14 different services for various periods of time over the Labor Day Weekend in Manitoba.
Staffing models vary dramatically from region to region. Some regions have opted to try and staff units on a full-time basis 24/7. Others rely on staff to take some on-call hours outside of their regular working hours to maintain service. Some will pay overtime to staff cars...others won't. Some regions have restricted their hiring to a minimum Technician-Paramedic level, some will hire anyone with an EMS Provider License. Undoubtedly the inconsistent staffing models from region to region have some bearing on whether or not units are taken out of service from time to time.
But I think the real problem runs much deeper than whether or not a region will pay to staff a unit in-house or rely on paramedics to be available on-call. I'm sure many regions have been reluctant to even consider changes to staffing models until government provides more clear direction regarding the future of EMS in Manitoba. Many EMS stakeholders, including the Paramedic Association of Manitoba, worked for more than 2 1/2 years to develop an EMS Framework document for consideration by senior government...that work has yet to be formally approved. Another committee, which also included representation by PAM, spent countless hours considering educational criteria for EMS programs looking to meet Manitoba Health's licensing requirements. Outside of the rumor mill, no final decisions have been made in this area that we are aware of. And government support for a paramedic education program that was expected to begin at Red River College almost one year ago has yet to be confirmed...and may well be in jeopardy.
My fear is that the staffing crunch we're beginning to see will only get worse if government continues to drag their heals on these very important issues. We are almost two years behind in educating paramedics that would normally staff many of our rural services. High school graduates looking toward EMS as a career are oftentimes leaving the province to pursue education in other jurisdictions...regions of the country that offer certificate or diploma programs in paramedicine and more definite career opportunities once they graduate. Our politicians need to make some very difficult and important decisions in the immediate future that allow us to be proactive and work toward improved system delivery...if not, the reactive decisions they will be forced to make will hurt Manitobans a whole lot more.
CBC TV NEWS - Aug 30, 2007
Wednesday, September 05, 2007
Has the Blogger/Author Died?
That's a question that's appeared in the subject line of many emails sent my way lately. So I'm here to say...I'M BACK!
I apologize for the lack of content in my blog over the past four months. It really doesn't seem like four months has passed since the provincial election was called and I last posted on this site, and as I think back over the course of that time I really can't justify, even to myself, why I haven't been able to find time to write. Having said that though, I have to admit that my frustration level has been over the top on more than a few occasions these past few months, and I found it difficult to communicate anything constructive. In fact, quite honestly I began to question whether or not "it was worth it" anymore.
Midway through the provincial election campaign, PAM released a White Paper on EMS in Manitoba. This document, entitled Emergency Medical Services - Manitoba's Quiet Crisis, makes a number of recommendations designed to improve ambulance and paramedic services throughout the province. There's nothing earth-shattering in the paper...in fact it's simply a more formal collection of the very recommendations we've been making to Government for the past five years. If you haven't already read PAM's White Paper you can download it from our web site by clicking here.
Reaction to the White Paper released by PAM has been quite positive. Some of the recommendations made in our paper formed the basis for the PC campaign during the provincial election...paramedic self-regulation and an expanded role for paramedics in our health care system. Many are supported by arguments made in a White Paper released earlier in the year by the EMS Chiefs of Canada. In off-record discussions, many of our Regional EMS Managers support most if not all of the concepts included within our recommendations. Yet little or no gain has been made in many of the areas addressed within that document, and that forms the basis of my recent frustrations.
The only funding increases seen by Manitoba's EMS system over the past few years have been in reaction to crisis. The long anticipated announcement that Red River College would begin offering a one year certificate program in paramedicine still hasn't been made, and I suggest may in fact be in serious jeopardy. Despite assurances that PAM would have opportunity to participate in the Health Professions Regulatory Reform Initiative (HPRRI), little or no information has been forthcoming in this area. Service delivery and the level of patient care provided by paramedics across the province is still very inconsistent. And to add insult to injury, it has been suggested that PAM did little more than summarize work done by the long awaited (and still unreleased) EMS Framework Project and call it our own.
Hence frustration has overwhelmed me at times lately. But after careful thought and consideration, I've come to this conclusion. Political interference is a very real problem when it comes to reforming EMS in Manitoba. Respectfully I suggest that those within Emergency Services on Ellice Ave get it, the Department of Health gets it, senior bureaucrats and administrators within Health get it...I think even the Minister of Health and at least a handful of other Cabinet Ministers "get it". Unfortunately the politicians at the top don't get it, and continue to stonewall much of the work done by those others I mentioned to make much needed improvement a reality. Now that I better understand the problem...I'm not nearly so frustrated:)
I apologize for the lack of content in my blog over the past four months. It really doesn't seem like four months has passed since the provincial election was called and I last posted on this site, and as I think back over the course of that time I really can't justify, even to myself, why I haven't been able to find time to write. Having said that though, I have to admit that my frustration level has been over the top on more than a few occasions these past few months, and I found it difficult to communicate anything constructive. In fact, quite honestly I began to question whether or not "it was worth it" anymore.
Midway through the provincial election campaign, PAM released a White Paper on EMS in Manitoba. This document, entitled Emergency Medical Services - Manitoba's Quiet Crisis, makes a number of recommendations designed to improve ambulance and paramedic services throughout the province. There's nothing earth-shattering in the paper...in fact it's simply a more formal collection of the very recommendations we've been making to Government for the past five years. If you haven't already read PAM's White Paper you can download it from our web site by clicking here.
Reaction to the White Paper released by PAM has been quite positive. Some of the recommendations made in our paper formed the basis for the PC campaign during the provincial election...paramedic self-regulation and an expanded role for paramedics in our health care system. Many are supported by arguments made in a White Paper released earlier in the year by the EMS Chiefs of Canada. In off-record discussions, many of our Regional EMS Managers support most if not all of the concepts included within our recommendations. Yet little or no gain has been made in many of the areas addressed within that document, and that forms the basis of my recent frustrations.
The only funding increases seen by Manitoba's EMS system over the past few years have been in reaction to crisis. The long anticipated announcement that Red River College would begin offering a one year certificate program in paramedicine still hasn't been made, and I suggest may in fact be in serious jeopardy. Despite assurances that PAM would have opportunity to participate in the Health Professions Regulatory Reform Initiative (HPRRI), little or no information has been forthcoming in this area. Service delivery and the level of patient care provided by paramedics across the province is still very inconsistent. And to add insult to injury, it has been suggested that PAM did little more than summarize work done by the long awaited (and still unreleased) EMS Framework Project and call it our own.
Hence frustration has overwhelmed me at times lately. But after careful thought and consideration, I've come to this conclusion. Political interference is a very real problem when it comes to reforming EMS in Manitoba. Respectfully I suggest that those within Emergency Services on Ellice Ave get it, the Department of Health gets it, senior bureaucrats and administrators within Health get it...I think even the Minister of Health and at least a handful of other Cabinet Ministers "get it". Unfortunately the politicians at the top don't get it, and continue to stonewall much of the work done by those others I mentioned to make much needed improvement a reality. Now that I better understand the problem...I'm not nearly so frustrated:)
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