Annual EMSC Grantee Meeting

Joint Session with State Partnership Grant

Managers and Family Representatives Advisory Committees:

How to Develop and Utilize the Best Team for EMSC Initiatives

June 20 – 22, 2006

RHONDA PHILIPPI: anything to do before our next meeting. What are the things that could possibly come and blind-side me, and if I’d done the homework to call people to get the right vote, because I didn’t and we lost that vote. And keep accurate records and pictures, that sounds kind of silly but numerous times I’ve had to send letters back to organizations’ presidents when something’s been decided and they say, “We weren’t invited. We didn’t make that decision.” (Inaudible) send you the information that was sent to your previous president. And pictures, you know it’s very difficult for somebody to say, “You know, I wasn’t at that meeting when you made those decisions about rules and regulations for what the hospitals didn’t have when there’re pictures at that retreat. So, a picture does speak a thousand words.

Members with other agendas (inaudible) said that before, but when I say agenda, I mean what motivates them? (Inaudible) going to be on your committee, that their agenda is (inaudible). They want to improve emergency care for kids. But there’s other people in your committee that are going to be there for self-serving purposes. Is it because they want to be on the state committee and build their CV or they’re trying to build their CV to become from assistant professor to associate professor to professor at a medical school. Are they trying to protect their own institution? But figure out what is their agenda?

And then, you can get them on the right committees or keep them off certain committees and use a team approach to make that happen, because when you implement strategies, you need them to be with your EMS (inaudible) against you. The EMSC manager is the consistent thread through everything and through the group settings so that’s an important key.

And also, utilize your principal investigators. They’re very busy people, but if you come to a barrier that you can overcome or whatever, give them a call and make sure you tell them all the information. You don’t want to set them up to be blind sided because they’re not going to be real energetic to help you the next time. But make sure you tell them all the information to help you solve the problem.

And then, facilitate those in the (inaudible) maybe have their own agenda to work on certain aspect of something and stroke their ego so that you’re keeping that flame under control, yet they’re helping the EMSC agenda move in the direction you want to go. It’s really hard to have a delicate balance of the loop, but it really helps prevent in imploding the loop, which we’ve had happen before.

Something to look at with personalities is that the over-committed person typically wants concise information with what you need to ask them. The squeaky-wheel person typically needs to be diverted to an activity; assign them something to do. Quiet folks typically want to be asked. They just need more information. Maybe they’re not aware of what’s going on. Competitive: use turf to your advantage. If they want to publish something, use that to your advantage of them doing some work for you. And non-committed: sometimes there’s always going to be dead wood on your committee. And so, we’ve established the attendance criteria with that in mind, so that sometimes, you just have to prune. And if you have every two years to recycle, then people can stay on if they’re fulfilling the requirements, but if they’re not.

And I cannot stress (inaudible) achieving your grant objectives. It is a team (inaudible) coordinators role to (inaudible). It is a team. And parent representatives are such a key. In our project, we have four parent reps in our committee currently, and we’re fixing to get five because Conni Wells is moving to Tennessee.

CONNI WELLS: Can you believe that?

RHONDA PHILIPPI: It’s the only time Melia has looked at me with darts. Yes, I know she’s moving.

MELIA JENKINS: Conni’s moving to Tennessee. I said, “I know.”

RHONDA PHILIPPI: But we have moved from having a parent rep committee to having a parent on each committee. We used to have a parent sub-committee and we’ve switched to having them on every committee. Currently, we have, like I said, four parent reps with five oncoming. And one of them, like the family voice person was very much through the legislative process. She’s the one that geared us towards passing the legislation in ’98. We have another person that knows Robert’s source of orders, so she’s our parliamentarian. We have another person that has a child with special needs, and we’re about to undertake, if ever we get the contract signed with the Department of Health, which is where I spent a lot of my time doing, is incorporating pediatrics into our state emergency plan, and our state PTA president, which is always a voting (inaudible) on COPEC. She’s with us today, also, Evelyn Pelletier, and she’s over here. But she’s also–not only is she with the PTA, but she has extensive experience with the Red Cross, and so she’s not a token member of our committee. She is an integral part of it. And that’s really important. And if you don’t have a parent rep, we have been very successful with our PTA over the years. They are highly trained volunteers. They come with a significant skill set. And we had them on, practically since our inception, so for over 10 years.

And lastly, but most important, (inaudible) they are your committee’s conscience. When we were writing rules and regulations, one of the parent reps, and I would just have this look (inaudible) and she would interject, “Well, aren’t we talking about children?” And that would just flatten out the conversation. There will be no more discussions about the consensus point.

UNKNOWN SPEAKER: Excuse me for a second. Is Jackie Grogan in the room? Okay. Go ahead.

RHONDA PHILLIPPI: Okay. And then, this is my – notes for my next and last slide. Let me quickly (inaudible) facilitative leadership be diplomatic, don’t bully people, built consensus, of course, (inaudible) not caught in the loop, because the community members, truly are, your vehicle to getting things done. Persistent, persuasive, this is not a job for the faint of heart. You have to be persistent. And you need to be self-confident and believe in the program, and if you feel like you don’t have the leadership skills to move things forward, it’s been proven by research that leadership skills are a learnable skill, just like anything else. Go to a workshop on it. I’ve used EMSC monies for leadership development and stuff. EMSC managers are really a key in leadership role, and so, (inaudible) gets them education, and willing to (inaudible) nothing – hardly anything can break your integrity more (inaudible) when you’re the one that made the mistakes. So, it’s important to be honest, and to be truthful.

And this is my last slide. And someone told me way back when my job was to herd cats, “And you really are a herder of cats.” But really, I have had this job for a year and a half, since I took a two-year break and did something different. And so, I wanted to tell you what my hugest mistake was at those eight years, is that I never had a succession plan in mind (inaudible) When I left, what was the committee going to be like without me? And unfortunately, I realized that my leadership style result in poor outcomes after I left, because I was such an integral part of the structure of COPEC. And when I left, there’s this huge void and things just didn’t get done, because before, I did everything to make sure the sub-committees moved forward, and got things accomplished. Well, I did realize, is that I was handicapping them for the future, and they weren’t learning the skills of how to be an effective member of a board. And this sounds kind of silly to say this now, but I just equated in my mind, that if they were a highly functional ER physician, that they–or other things, a trauma nurse manager, or other things that they just, obviously, could have the skill set to be a board member. That is crazy thought. They need to be educated. They don’t know how to break down a project into steps, in a timeline, and all those things that we probably take for granted. So, that’s important to do.

And then, make sure that people know what they are supposed to be doing. That’s a consensus (inaudible) that they know what goals are supposed to do. (Inaudible) this on the conference calls, because it’s really her point, but project manager, she only need to take risks. Sometimes, we’re type A control freaks. I don’t know. Is there anybody like that in the room? But, you know, to get–yeah, no hands. But to get things done, you cannot do everything for a long term, and if you do, you’re hurting your own state, because there’s someday you’re going to either die or get a different job. It’s true. We’ve been here a long time, so, you need to take risks, and let people take on some other leadership roles within your committee, and help grow them into effective board members. It’s true. We’ve been here a long time. So, you need to take risks and lot of people take on some other leadership roles within your committee and help grow them and into effective board members for you because if you help grow them into effective board member, they’re going to remember that and help you with other things and they’re going to go on to other organizations and use that skill set that you help teach them and it’s going to come back to you four fold from other people. Melia?

MELIA JENKINS: Okay, I have to tell you all that even though Conni is moving to Tennessee, she has promised me that she will find, not just one person but three individuals to replace her on the EMSC Advisory Committee in Florida. So there, we get three now, Rhonda.

RHONDA PHILLIPPI: It’ll take more than three to replace her.

MELIA JENKINS: Oh, it certainly will. Achieving grant objectives with the advisory committee, I don’t know but I probably get the sense that I know that you all sit out here and listen to the three of us; we are all very different in the way we approach things. And Florida might seem like it’s high in the sky and it might be, but I don’t even know if I mentioned this in the beginning, but we are fortunate to have our–we have two full-time FTE’s that are dedicated to the EMSC program in Florida. And the state of Florida pays our salaries so we do not have to use our grant funds to pay our salaries. So yeah, it is kind of high in the sky but maybe if you have some questions, we can talk about how we got the error. And I know, I mentioned earlier it didn’t happened overnight. And we’ve been fortunate with leadership at the Department of Health level that the kids are so important that they have supported this 100 percent and they continue to. And our bureau of chiefs continue to. So, we are little pie in the sky but we can get here. It takes a little work and we’ll be glad to help you along the way.

One of the ways that we have found to help us achieve our grant objectives is to establish a voting position on our statewide EMS Advisory Council. Our EMS Advisory Council–I don’t know any of you all have, do you statewide EMS advisory councils in your state? In Florida, it is a very powerful political group. And not much gets done in Florida without the consensus of this group. So, we are in the process of trying to establish a voting position on that council. That council is also mandated but it has bylaws and the mandate is a lot more detailed for the EMS Advisory Council.

Currently, it is a liaison position. Julie does sit at the table during the quarterly meetings. She does report on EMSC activities and we have been very fortunate that the chairperson of the council, EMS Advisory Council, has included us willingly in all of their activities. And we always kind of get on their soft side about the kids and they agree that a lot of times they just forget about it. If we’re not at the table, they forget and it’s not done on purpose, they just forget. So, we’re revising our legislation, the legislation that governs our bureau of EMS in Florida. And as part of that revision, we wrote in a voting member on the EMS Advisory Council. And you’ve got to know, the firefighters didn’t take this lightly. I mean, they thought, “Oh, another voting person.” So, we said, “It’s okay, we’ll complement what you do.” So, one of the other ways that we have been successful in achieving our grant goals is to establish work groups. I mentioned that earlier, our work groups are actually tailored to our performance measures and we just did that a couple of months ago in our January or April meeting but it’s worked out quite well.

And the other thing that has been instrumental in us being able to achieve our grant goals and objectives and our performance measures is to have an EMSC advisory (inaudible) member represented on some of our advisory council subcommittees. Our advisory counsel, our statewide EMS advisory counsel has subcommittees established. In particular they have one for EMS education, they have one for EMS legislation, they have one for data and they have one for PIER, which is Public Information and Education Relations. We made it clear to the EMS advisory chairperson that we really needed pediatric representation on these subcommittees. And wow, they just loved it.

Julie went to the first EMS education subcommittee meeting and she said, “Look we have these performance measures in place, one of them is a requirement for pediatric CE use for recertification for paramedics.” Well, in the state of Florida, you have to have 30 CE used--32, 30. It has to go with the DOT--does it have to follow with the DOT guidelines, Juile? And 30 with the guidelines of (inaudible). It does not specify in statute or rule that (inaudible) of these 30 CE use need to be pediatric for continuing education. So Julie went to this EMS education subcommittee meeting and she said, ”We got these performance measures and we really need you to help us out.” And they said, “How many do you want?” And she said, “I’m not really sure. What do you think is realistic?”

So they came up with this number and (inaudible) said, wow, I’m not really sure we can get that passed but you know let’s try and find a happy medium here. They were very receptive. It currently does not say in our statute or rule that part of the CE use will be pediatric but that is proposed in our legislation. And as I said, we have this EMS Legislation subcommittee as part of our statewide EMS Advisory Council and they lead the way. So we also participate on that group because if you rate your performance measures, at the end, it says you need to incorporate the priorities of the EMSC program into your rules or statutes. And all of the things that they talked about in the 66 and 67 are in that 68, at the end, that last subcomponent. Right, Jennifer? Okay. So we found it was very important to include one of our EMSC Advisory Committee persons on these subcommittees.

The other thing we have done, I don’t know what you all have been faced with data issues but Florida is the continuing saga. For some reasons, wow, these providers just don’t like to be told what to do. So we recently signed a memorandum of understanding with the people at National to try and adopt the National Emergency Medical Services Information System, the NEMESIS Project. We have a data unit at the bureau level at the state of Florida. They’re working very hard. We’ve hired consultants and we made sure that we incorporated them, because we have the resources available to us in our EMSC partnership grant. So we are supporting some of the activities of this data group in order to be able to--it’s kind of a carat, in order to be able to have some say in what they do.

I believe some of the national elements, they are EMSC elements in the national data set. And then each state is able to develop some of the other data point that they want to collect. So we very, very, very actively support the EMS data collection efforts. And we’re at the table with everything that they do. We’re in the process of trying to identify a member of our committee to sit in on the EMS data technical advisory panel that they have to ensure that we have a voice. And I’ve got to say that we haven’t met with resistance with any of these groups because like Rhonda said, when you mentioned kids, I mean they really take it to heart.

MELIA JENKINS: And this is the last slide that I’ll be speaking to, and I just want to tell you that I will be glad to help any of you, particularly the new coordinators. If you have any questions, I can provide you with sample letters that we use, our rules, what they say in particular--anything that you need, I’ll be glad to help you, and these ladies are tremendous resource, and I know that they will help you as well.

SCOTT HOGAN: Our advisory committee had an opportunity to look at the performance measures, and they just started salivating, saying, “Oh, look at the opportunity that what we can possibly work on.” And I said, “Well, you know, there’s probably only a few things that you can do off the bat,” so they decided that they would work on these two that are up here, the on and off-line medical direction, and the equipment that list there. The on and off-line medical direction is something that’s probably going to take quite a while, and the equipment list is going to take some time, too. Both of them are going to require their work, plus working with other committees and working with other groups of people. The situation right now is the medical program directors in each of the counties are currently responsible for writing the off-line and medical direction, and they’re fairly autonomous group, and they might work with a local–I mean, a neighboring medical program director to say, “Well, what did you put together for such and such a topic?” but usually, we call them cowboys, and they’re very independent, and so, they write what they want to write, and so very few of them have specifically written pediatric protocols.

Some of the larger counties have specifically written protocols, and so this going to be a challenge and I’m already collecting them from around the country, and gathering to them together. So, that’s going to be one of the first things that the tech does is to have it in front of them, and see what they want to do as far as putting together some suggestions and drawing actually guidelines.

And so, what we can do, as a state, is to take these as recommendations, and pass them in front of the medical program director group, and say, “Well, what do you guys and gals all think?” and then they’ll hem and haw, and throw up their hands--probably that we’re even considering putting state guidelines together, and probably get a couple out of all this, but we’ll see. It’ll be a slow process, like I said, but we’ll do what we can do.

And on-line, we also have probably the same difficulty, but we’ll see what we can do. It’s probably a little bit better because there are the pediatric designated trauma facilities around the state, and so a lot of them are base stations, and so they get the phone calls, and there are people answering the phone calls who have pediatric training, so we’re in a little bit better situation there, but it is not a universal situation, so that’s going to be a slow process, but probably not as long as the off-line. The equipment situation–the guidelines that were put together by the AAP in a (inaudible) to be perhaps not so difficult, when I saw that, I put it up against our existing state requirement list, and we currently do not have that full list for all of our ambulances, and so, the pediatric tech looked at that list and they say, “Well, this is a very reasonable list. Why don’t we just have this? Just put it in place. And it’s going to be a situation where we have to put that through as a requirement that needs to go through a lengthy process to get approval for our administrative code.

So it takes probably a year and a half and we’re looking at making other changes as long as I’d mention earlier this afternoon that we’re evaluating their entire system. And so probably, we’re going to have all types of changes, little tweaks and modifications made here and there. So, we’re probably going to put them all together as a package rather than let’s just do one page here and one page there. We’re probably going to do the whole ball of wax at one time. So, we’ll see how long that takes, probably going to take two to three years before that happens. Maybe we may meet the deadline. But we’ll get there, but it’s something that they are all very excited about, accomplishing to having all the ambulances meet the performance measure. So that’s the last one that I have. I know they’re going to work on the other performance measures as well, but that’s the only two that I know to talk about.

JANE BALL: Okay.

SCOTT HOGAN: So, Jane, are you next or is there somebody else? Not me.

RHONDA PHILIPPI: Okay, is it me?

JANE BALL: Yes.

RHONDA PHILIPPI: Okay. Identify your milestones and point out accomplishments. People sometimes get caught up and forget what they’ve done over the last year. So it’s important to kind of keep a broad list of those and let your community members share in your successes when we won our state award, we went back and had big luncheon with the commissioner of health care and everything, and so that was a lot of fun. And also, like our next committee meeting we’ve had a lot of work that we’ve gotten done. And so, our next one in August, we’re having a picnic and everybody’s dressed in casual; we’re doing some team building exercises. But our main goal is having fun and fellowship, and doing a little bit of strategic planning. So, we’re doing that. And then, make sure you give accolades to people when they do things for you, and to share the credit with other people, because everybody working together, you get a whole lot more done.

JANE BALL: Okay. I think we kind of went over a little bit of our time and I don’t know if we’ve got any questions that maybe we can try to answer quickly. Okay, well. I’d like to thank Melia, Rhonda, and Scott for the information they shared with you. And as they said, they’re going to be here for the rest of the meeting. So, you might want to get them one on one to talk about some of your challenges with your advisory committee. Thank you very much.