This paper will discuss the internal organizational conflict that occurred in the Wake County Department of Emergency Medical Services (EMS) after the formation of the Advanced Practice Paramedic Division (APP). Wake County EMS (WCEMS) is the sole entity with in the Wake county Government structure that is charged with providing prehospital emergency medical care to the visitors and citizens of Wake County. This paper is based on the opinion of the writer; it does not and is not reflective of the department’s opinion or the stance of the county.
Wake County EMS responds to almost 90,000 requests for service annually and serves almost 1 million people, which places the WCEMS system in the top fifty EMS systems in the country based on call volume and size of population served. ("Wake county department," 2012) In response to ever-increasing call volume, a decrease in primary care, and the universal changes in healthcare, which have resulted in more people using EMS and the local emergency room for primary care and non-life threatening events, the EMS Department elected to change their service structure. The department would move away from the traditional EMS mantra of “you call we haul” and having a system being designed around reactive responses to healthcare issues in the community to an evidenced based incident prevention structure. No longer, would it be considered prudent or correct to just continue to add transport resources to address the increasing call volume and continue to place the actual burden of care on the local hospitals, it would become the burden of the EMS system to provide alternatives to properly address the actual healthcare needs of those who called 911. Wake County EMS had already utilized evidenced based ...
... middle of paper ...
...
Bacal, R. (2012). Manager's guide to performance management. McGraw-Hill. (Bacal, 2012)
Myers, J. (2008). Evidence-based performance measures for emergency medical services systems: A model for expanded ems benchmarking a statement developed by the 2007 consortium u.s. metropolitan municipalities' ems medical directors (appendix) read more. Retrieved from http://informahealthcare.com/doi/abs/10.1080/10903120801903793
Resolving conflict situations. (2013). Retrieved from http://hrweb.berkeley.edu/guides/managing-hr/interaction/conflict/resolving
Sayre, M. (2006). Cardiac arrest survival rates depend on paramedic experience. Retrieved from http://www.researchgate.net/publication/246149504_Cardiac_Arrest_Survival_Rates_Depend_on_Paramedic_Experience
Wake county department of ems about us. (2012). Retrieved from http://www.wakegov.com/ems/about/Pages/default.aspx
MSK has been effective in this area by implementing and continuously working towards efforts to educate and provide opportunities for everyone on all levels opportunities to be involved and succeed. The success of MSK over the years have not been left up to one individual but it has been a collaboration of individuals. The organizational structure and care model at MSK is aligned with their mission and value that reinforces the importance of safe, effective, and competent care. The collaboration efforts of various departments, units, programs and individuals all account for the sustainability of MSK’s organizational care model. This type of success has been implemented by holding everyone at MSK regardless of their position accountable for their overall
Some of the operational problems that Saintemarie Emergency Department is facing include issues with quality, work environment and economic issues, amongst others. In terms of quality, the wait-time targets are being met, however, a doctor sees only 2/3 of patients that enter the emergency department within the maximum delay period. This means that the quality of service suffers as well as patient safety for those that leave without seeing a doctor due to long wait times. As far as work environment issues, the department is struggling because experienced nurses and doctors are resigning since the environment seems to be too stressful. Lastly, Saintemarie ED is facing economic issues because the long wait times are having negative effects on revenues since there are lost revenues associated with patients leaving and not being treated.
The health care organization with which I am familiar and involved is Kaiser Permanente where I work as an Emergency Room Registered Nurse and later promoted to management. Kaiser Permanente was founded in 1945, is the nation’s largest not-for-profit health plan, serving 9.1 million members, with headquarters in Oakland, California. At Kaiser Permanente, physicians are responsible for medical decisions, continuously developing and refining medical practices to ensure that care is delivered in the most effective manner possible. Kaiser Permanente combines a nonprofit insurance plan with its own hospitals and clinics, is the kind of holistic health system that President Obama’s health care law encourages. It still operates in a half-dozen states from Maryland to Hawaii and is looking to expand...
Being a part of the paraprofessional team requires that I be knowledgeable on how to handle all kinds of difficult scenarios. Case study number one presents a possible situation that a Resident Advisor may have to deal with. There are many steps and processes involved in solving some problems that paraprofessionals will encounter. Case study number one presents an issue between the members of a community government. It is important to recognize though, that there is much more hidden beneath the few problems that seem to have surfaced. These issues may appear as much less on the surface, but beneath each problem, lies much deeper roots. These roots are what must be dealt with in order to do a thorough job of taking care of the issues at hand.
I believe that if you asked a group of people to list off issues regarding an emergency department then they would say long wait times throughout the process and being moved around to different areas of the emergency department. From what I have heard the long waits can be associated with waiting to get back to a room, waiting to see a nurse, waiting to see a doctor, waiting to go to radiology or lab, waiting on results, waiting to be discharged, or waiting to be admitted. All of these things in my opinion add up to one main problem, which is patient flow through an emergency department. In my opinion being able to have a controlled patient flow allows for improved wait times and decreased chaos for patients. So there are a few things
It is another extremely hectic Monday in the Emergency Department. The waiting room is building up fast with many new walk-in patients. Fire Rescue trucks are calling one after the next with several medical and trauma cases. The hospital supervisor is calling to inform the Charge Nurse of the Emergency Department that the Operating Room has several cases that need beds and will supersede the Emergency Department admits. Patient through put will now be further delayed. This is just one example of a typical Monday and why Teamwork and Collaboration are vital components to run an efficient nursing unit, especially in the Emergency Department. When a common goal is created to foster teamwork, health care professionals working cohesively together
Meredith, J.W (2008, May). The Lack Of Hospital Emergency Surge Capacity: Will The Administration's Medicaid Regulations Make It Worse? Presented at The House Committee On Oversight And Government Reform. Retrieved March 2014, from
Trzeciak, S. & Rivers, E. (2003). Emergency department overcrowding in the United States: An emerging threat to patient safety and public health. Emergency Medicine Journal, 20, 402−405. doi: 10.1136/emj.20.5.402
2011). This tool will assist hospital to more accurately measure the effects of improvement strategies.
The issue of off load delay is becoming ever more relevant as emergency departments (ED) are filling up and having longer wait times. This isn’t always an issue when there are free paramedic crews in the area but it often results in coverage lapses. The question becomes, should paramedics be leaving their less urgent patients in triage with walk-in patients so that they can get to other people in need? A balance needs to be found between leaving the CTAS 4 and 5 patients in the waiting room and leaving 911 callers at home to wait.
Walshe,K. & Rundall,T. 2001, Evidence based management:From theory to practice in health care ,Milbank Quarterly, Vol.79, PP.429-457
Emergency services face vast difficulties in the operations field when handling emergency situations, whether it comes from handling a minor accident to a catastrophic catastrophy. Many of the difficulties do not come from the actual incident, but instead they arise from forming a rescue team containing different agencies and people. For the benefit off all individuals participating, it is imperative that there be a unified command structure in place to effectively coordinate and oversee the tasks that need to be accomplished. The need of a unified command was seen from the hardships faced in incidents, bringing forth the development of the Incident Command System that was designed to be used in an array of conditions, to bring all individuals to a common ground. FEMA (n.d) stated “The Incident Command System (ICS) is a standardized, on-scene, all-hazards incident management approach…”
After analyzing the Coastal Medical Center, it is apparent that the employees and staff have no conception of the mission, vision, and values of this health care facility. In addition to this lack of structure, CMC has many projects in the midst of production that lack support of a common goal, employees are unsatisfied with their jobs, the two boards lack ability to agree on strategic decisions for the organization,, and the medical center has a dismal reputation when it comes to quality care.
At its most fundamental core, quality improvement of healthcare services and resources requires disciplined attention to the measurement, monitoring, and reporting of system performance (Drake, Harris, Watson, & Pohlner, 2011; Jones, 2010; Kennedy, Caselli, & Berry, 2011). Research points to performance measurement as a significant factor in enabling strategic planning processes and achievement of performance goals (Tapinos, Dyson & Meadows, 2005). Thus, without a system of measurement that accounts for the performance behaviors of healthcare professionals, managers and administrative employees, quality improvement remains a visionary abstraction (de Waal, 2004).
McCormick, S. (2003). Article 12. Major incidents, leadership, and series summary and review. Emergency Medicine Journal, 20(1), 70–74. doi:10.1136/emj.20.1.70