MCHB Conference Webcasts
2005 EMSC Annual Grantee Meeting
April 12-13, 2005
SHARRIE McINTOSH: Questions from the group? Come up to the mic.
STEVE CARL: Steve Carl from South Dakota . I have a couple questions. First of all, there was targeted issue spread a few years back that did site visits. Were any of you site visited? And if so, how does this compare with that process? Is this built on that process or this something new? That's one question. The second question is: I agree with you, Janet, that what gets measured gets done. But sometimes what gets measured and gets done gets done at the expense of everything else you're doing. Is this all that we're being asked to do now? Should we stop everything else? Is everything that's not measured not worthwhile? I think those are critical issues. And I'd love to hear your answers.
SHARRIE McINTOSH: Your first question to make sure I'm clear you're asking whether for the targeted issue grants they were site visited as well in a similar process?
STEVE CARL: No. There was a targeted issues grant that Jeanne Athey and a couple of others did where they site visited several programs. Did you build on that? Is that where this comes from? Or is this something entirely different? You know you were trying to evaluate the programs back then, are we working on this? Is this a continuum or is this something new? And were any of you site visited by that group?
SHARRIE McINTOSH: I can just answer the first part then turn it over to Jane. This beta test site visit process was exclusively around the performance measures. So to understand how the measures could be implemented and to get the feasibility of implementing those measures. So it wasn't part of evaluating the programs.
STEVE CARL: I would just like to make a couple comments. That particular targeted issues grant was looking to develop a process similar to the NTSA technical assessment team process and to try to find ways to integrate pediatrics within that whole technical assessment process that NTSA does for state EMS systems. The information from that targeted issues project was shared with the Luwen group as we went through the process of trying to develop some specific performance measures. So the process used was not the same. However, the information from that process was shared and was part of the development of the new performance measures. And in terms of whether or not this is, you know, only, the only things that are important, of course not. You know, we want to continue to improve systems of emergency care for children. However, we do need to have some ability to be accountable, that the program is making consistent progress in improving that system of emergency care and we needed some way to measure that process. So the efforts that we're making to develop performance measures are really to help us be more accountable within the federal program to share that, okay, these are important issues that are really part of developing an emergency care system. We're trying to now find ways to measure the qualitative issues that we think are so important. And that's the process that we've been going through. And we really are trying to make this reasonable. As reasonable as possible. But it is a new age. I mean we are asking you to all begin working together in a similar direction to help us measure progress.
UNIDENTIFIED SPEAKER: I just want to add to that, for example, one of the things we'd like to look at the new state partnership guidance, looking into next year in terms of incentivizing, is strengthening the EMSC state advisories in your state. We know a lot of states are strong. Maybe ones that were strong many years ago; maybe we haven't put enough emphasis there. So the idea is to give you some incentive to strengthen the EMSC advisory committees, which we hope will also stretch the dollars in your state. And I know one thing, I didn't hear was mentioned but I also want to be clear, these performance measures are specific to the state partnership guidance. For example, if you look at there right now the guidance we have for the pediatric emergency care applied research at the end it shows the performance measures for them that's related actually to publications and abstracts, publications and posters which would be also the same for new targeted issue grants. And actually those performance measures weren't in the guidance because those weren't approved by the time we got the new guidance out. So for eight new targeted issue grantees, we'll be working with them to get them the information they need in order to show us publications, posters that would come out of their targeted issue grants.
So just want to be clear, these are specific to state partnership guidance, not to targeted issues or PCARing guidance but all guidances will have some performance measures so that we can show some progress with these grants and how they're making a difference, because that's how the EMSC program continues to get funded, if we can't continue to show in the ways that the administration is asking us to show that we are making a difference, then that's where the funding can often stop.
SHARRIE McINTOSH: Thank you, Dan. Other questions?
I wanted to ask the grantees, I highlighted some of the potential data collection strategies and the challenges. I wondered if you could speak to this last bullet here about achieving buy‑in from staff and partners. What kind of work do you think the grantees will need to do to make sure that staff and partners are on the same page or have some buy‑in into this process? Do you see that as a potential issue?
JANET HOUSTON: I think we're going to have to show them that these activities are more about simply our grants and our funding, it's about EMS in general. And EMSC is part of the EMS system. So if we can make them see this, see that our activities are performance measures will improve EMS in general, then we'll be able to get buy‑in.
EVELYN LYONS : I agree. We had pretty good turnout at our site visit from our state, as well as our EMSC program. We had our chief of EMS there. We also had our EMS director, principal investigator was there. Representative from our EMSC advisory board as well as a few other individuals, and of course our EMSC staff. But we also talked about the need to reach out and also partner with other organizations and other entities that may assist us in collecting some of this information as well. For example, the interfacility transfer agreements. We have a facility recognition program in our state but not all hospitals participate. So for over half of the hospitals in our state, we can readily identify that they do have interfacility transfer agreements in place, removing the pediatric patient to a higher level of care. But what about the rest of those hospitals? And so we talked about the state hospital licensing bureau, that they might be a potential source for collecting some of that kind of information.
And so I think we need to look a little more outside of the box. Some of these groups may be groups you're already working with, but we are going to have to look at additional data sources and additional organizations that we can tap into for this information to make it easier for you so that you're not having to develop mechanisms or ways for collecting information that may already be obtained elsewhere.
MICHAEL MERRILL: And part of that, I think what reminded me most was, in Colorado , EMSC has been there for over a decade. It was kind of like going back and touching base with some of those collaborators that I hadn't paid attention to over for the past few years and sort of say whoops I should be going back and making sure that I'm collaborating, connecting and talking with people that originally I was over a decade ago. So it was kind of looking at the lifecycle, the evolution of EMSC and my state and sort of saying, okay, where are the gaps, the barriers and challenges. And I think part of that where we can help is in terms of ‑‑ every EMSC program is probably in a different stage of that evolution and probably we can help out with our regional, like the IREC for us, Rocky Mountain, and sort of say, okay, here's where we had success and here's where some of our barriers were.
SHARRIE McINTOSH: Thank you. Other questions? I was wondering if you could talk a little bit about ‑‑ I'm sorry.
LEE PILES: I just have a comment. Lee Piles from Minnesota . Right now in Minnesota we have funds coming to our EMSC program from the university, from the children's hospitals, and from a number of small grants. Once upon a time in West Virginia we had money coming in from the state Legislature. And I would propose that one of the ways that we could really get a multiplying effect is to ask people to provide an in‑kind match, a local match in their states for their partnership proposals.
I think it gets at one of your objectives. And I think that the issue would be to get states to really have to provide ownership. I think that ‑‑ I think that you start small, you don't want it to be enough that people would opt out of doing a partnership grant, but I think that there are a number of places that need a push, that would do better with the EMSC if they would develop more ownership. If anybody else wants to comment.
SHARRIE McINTOSH: Jane, did you want to respond?
UNIDENTIFIED SPEAKER: I figured I had my time to talk after this, but I'm happy to participate in the dialog here. We would love to have those of you in the states identify the in‑kind funding that you have when you put together your grant application. There is, in the budget pages that opportunity to reflect contributions that you have from volunteers, from office support, other resources that you've got within your state. That is a way to show that the state is invested in your program beyond the federal dollars. We don't really have a good handle on how much the states are contributing to the EMSC program. We can't really require that you put that information down, because the program does not require a match funding as some of the other federal programs do. But we would love to have you provide that information to us on a voluntary basis so that we do have the opportunity to look at that information.
SHARRIE McINTOSH: Right. We actually did talk about that during the site visits, as part of that performance measure that looks at perm unanimous, performance measure number 3, one of the ways to think about permanence potentially is funding, sustainability, leveraging state resources, be it foundations, other kinds of organizations; we did talk a lot about that as being an important way to potentially demonstrate permanence. But again we thought, in terms of a performance measure, it might be better at this point to look at the FTEs that are dedicated solely or partially for the EMSC program. But that was something we talked quite a bit about during the site visits.
Do you want to add anything to that discussion? It's a pretty lively discussion, if I remember correctly.
Other comments or questions?
MARK SEACHEF: Mark Seachef from Illinois , the EMS director that was at the meeting. One of the things to keep in mind for everybody is that in order to think outside the box, in order to get in kind gifts, in order to get outside funding, you're going to need to speak the same language as many businesses do. And that's the return on investment, what value are you providing, for the measurements being taken today or taken in this initial look will be of such value to give some idea of return on investment for the corporation. To end it with a quote, Jack Walsh, who took GE up to where it is today, he said, "If you can't measure it, it's not worth doing." And it's important to remember that, because that's what's going to be, that's the type of language that's discussed in the board rooms, when the decisions are made to give in‑kind gifts or matching gifts or matching grants.
SHARRIE McINTOSH: Thank you. Other comments? Questions?
I had a question for the panel. One of the things we, another thing we talked about during the visits was a mechanism for sharing information across the different grantees, again in terms of best practitioners, strategies, and even not related so much to performance measures. I think one of the things that came up was around a family rep and how do you define what a family rep did and does and could you talk about some ideas for kind of sharing strategies around data collection or other kinds of things you're interested in?
EVELYN LYONS: I know what we're planning to do for our regional meeting our CARE meeting that's come up in September is pretty much dedicating the meeting itself to looking at preparing our grant, looking at our preparation to begin to address the performance measures. And so we're going to use that as an opportunity to bring in speakers and also utilize that time so that we can share best practitioners and share resources with each other so that we have a better idea of how things are working and who is tapping into what and just identifying opportunities that we may be able to begin to investigate within each of our own states as well.
MICHAEL MERRILL: And IRec is doing the same thing in August. So hopefully it will provide us with some of the tools and some of the best practitioners and some of the ideas that we haven't had a chance to explore yet. But just trying to be better prepared.
SHARRIE McINTOSH: We have a few more minutes left, so I wanted to give an opportunity to NEDARC, NRC or HRSA to make any final comments as well as the panelists.
I think we have one more question. No, you're looking for your seat. Okay. Sorry. So Dan, do you have a comment?
UNIDENTIFIED SPEAKER: The only comment I want to make, I think we've seen over the last few days here a lot of progress has been made. I think what we're being challenged with is how do we communicate this progress in a way that the administration, the congress that funds us understands. Sometimes, you know, we have to speak in one voice to one group of people and another with another type of voice, another group of people. And I think we're being challenged here to how we need to speak in a way that is going to be in a way that our funders you know can understand. And what they're asking for in terms of what their expectations are of programs within HRSA, within the Maternal Child Health Bureau, which also includes the Emergency Medical Services for Children Program. I think it's a matter of not doing anything differently than what you're doing but just us being able to communicate it in a way that the administration, you know, wants to see it. You're all doing great work. That's what I want to emphasize, you're all doing great work. It's just that we need to translate that into a way that Congress and the folks in HRSA can understand.
SHARRIE McINTOSH: Right. And definitely just to concur with that. It is about documenting what you're doing. As Dan said you're all doing this work already. You're capturing the information so how do you then document that and use it in a way, again, to tell your story about your accomplishments.
Another comment, question?
UNIDENTIFIED SPEAKER: Yes, what's the timetable for this?
SHARRIE McINTOSH: We ‑‑ I know you'll talk about it a little bit later on, Jane and Mike, but Luwen is putting together the implementation manual and we'll have that ready in July in time for the July webcast, I think, that's being set up. And then the information is going to be also fed into the grant guidance, which is being issued in September ‑‑ fall.
UNIDENTIFIED SPEAKER: The issuance of the grant guidance, actually, we can't say a certain date when that's going to be issued. That's really going to be dependent upon the program, knowing it's going to be in next year's budget. I can't really give you a date. It could be it will be the usual, September of this year, with a November due date. But I can't say that for certain at this time. But the plan is that for it to be in the next state partnership guidance.
In terms of the time line, I guess Jane or Mike will be going over that, but in terms of the GPR measures, this is really looking at things from a five‑year standpoint of 2006 to 2011. So it's not just saying here's what you all need to do in one year. These are based upon a five‑year time line of us being able to show progress over a five‑year period. So if that helps people in terms of knowing a little bit how much time you have to do this. So it's really over the course of not only what a current state partnership grant would be but even over the course of the next one. So we feel we've made the time line in a very hopefully realistic manner for the states to show and communicate the progress that they have made and will continue to make.
SHARRIE McINTOSH: All right. Yeah, for the performance measures one of the things I did leave out is there was a date by 2010, by 2011, I think, was the time frame for most of the measures.
All right. I just want to thank you all for providing your input and also to thank the three grantees. We had a great time visiting you all and we hope it wasn't too painful on your part. But just such good useful information we can share broadly with the other grantees and also with HRSA and the resource center so that they can help you be responsive to these performance measures. So I thank you for your time.