Body: RULAC Type: Agenda Meeting: Committee Date: 2015 Collection: Council Agendas Municipality: Frontenac County
[View Document (PDF)](/docs/frontenac-county/Published Agendas/Rural Urban Liaison Advisory Committee (RULAC)/2015/Emergency & Transporation Services- FPS Business Plan.pdf)
Document Text
Business Plan 2016 - 2020 Department: Unit: Director: Manager: Version/Date:
Emergency and Transportation Services Frontenac Paramedic Services Paul J. Charbonneau September 11, 2015
Department/Unit Strategic Goals To deliver excellent service to our communities. We will always strive to provide patient care and response that meets or exceeds objective and measurable standards and increase public awareness of health risks and injury prevention, with efficiency and accountability. Key strategic directions
- To support paramedic wellness, both physical and mental, to ensure a healthy workforce,
- To meet the legislated Response Time Standard,
- Maintain Unit Hour Utilization (UHU) to ensure resources availability and response demands,
- To lead a culture shift through focused investment on superindents’ role as effective managers of people. Alignment with Council Strategic Priorities Goal#1: Meeting the Aging Tsunami Challenge for Frontenac Seniors Community Paramedicine programs may assist with the Senior Housing strategy and help maintain seniors remaining in their own homes as they age. Goal#3: Respect for the taxpayer and focused economic development Demands for 911 Paramedic Services are increasing as the population ages. Innovative programs and projects to meet the objectives of the “Aging at Home Strategy” adopted by the Ontario Government will assist in reducing staffing demands and budget increases. Sustainability & Resilience Ensuring a strategic long term view of paramedic services to the communities served while maintaining financial sustainability.
Department/Unit Function Frontenac Paramedic Services (FPS) is a progressive team of highly qualified paramedic professionals committed to achieving and delivering the highest level out-of-hospital care in compliance to the Basic Life Support (BLS) and Advanced Life Support (ALS)
Standards. By responding to emergencies in a coordinated and expeditious manner, the citizens of the Frontenac Paramedic Services response area can be confident in the quality of out-of-hospital care provided. Frontenac Paramedic Services will provide Paramedic Services throughout the County of Frontenac and the City of Kingston 24/7/365. We will commit to the provision of paramedic services in a manner that allows the closest available and most appropriate ambulance to be dispatched regardless of location or jurisdiction, and will work with other municipal, provincial and international agencies, as required, to respond to requests for assistance in such instances. Our service will work cooperatively with other agencies to provide comprehensive emergency medical services that are accessible, integrated, seamless, accountable, and responsive. Community Paramedicine (CP) began within the County with Wellness Clinics commencing in 2014 on Wolfe Island and expanded in 2015 by expansion throughout the County. Paramedics will commence utilizing the “Ontario Paramedic Referral Program”, through the Community Care Access Centres (CCAC), utilizing the PERIL predictive rule in 2016; following paramedic training during the 2015 Service Continuous Medical Education (CME) session. Further initiatives in CP will come through the completion of a research project by Queen’s University, in consultation with many regional stakeholders.
Legislative Framework
The Ambulance Act R.S.O. 1990 Chapter A.19 http://www.elaws.gov.on.ca/html/statutes/english/elaws_statutes_90a19_e.htm The Ambulance Services Collective Bargaining Act, 2001 http://www.elaws.gov.on.ca/html/statutes/english/elaws_statutes_01a10_e.htm Occupational Health & Safety Act: www.labour.gov.on.ca/english/hs/ Pay Equity Act: http://www.e-laws.gov.on.ca/html/statutes/english/elaws_statutes_90p07_e.htm Labour Relations Act: http://www.e-laws.gov.on.ca/html/statutes/english/elaws_statutes_95l01_e.htm Employment Standards Act: http://www.e-laws.gov.on.ca/html/statutes/english/elaws_statutes_00e41_e.htm Ambulance Services Collective Bargaining Act: http://www.e-laws.gov.on.ca/html/statutes/english/elaws_statutes_01a10_e.htm Ambulance Service Documentation Standards: http://www.ambulancetransition.com/pdf_documents/standards_amb_service_documentation.pdf Ambulance Service Patient Care and Transportation Standards: Ambulance Service Patient Care & Transportation Standards - Oct 2007 (pdf 60KB) Ambulance Service Communicable Disease Standards:
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Ambulance Service Communicable Disease Standards (Rev Oct 2002) (pdf 19KB) Deceased Patient Standards: https://www.rppeo.ca/document/documentpop/id/c86a03c5cd1e652ec5164b8 81501bbb088e28491 Land Ambulance Service Certification Standards: Land Ambulance Service Certification Jun 2008 (pdf 37KB)
Clients FPS is committed to maintaining a patient centric focus in decision making based on evidence based research and practice. Internal: FPS serves the paramedic, administrative and logistics staff providing leadership, guidance and issues management. Community planning resource regarding new subdivisions. External: The patients and citizens of the County of Frontenac and the City of Kingston who request 911 response and/or attend community engagement activities.
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Employee Complement:
2015 2016 2017 2018 2019 2020 Full Time (non-union) Full Time (union) Part-time (non-union) Part-time (union) Contract Total Employees Total FTE Total Salaries/FTE
15 78 2 50
16 78 0 45
16 82 0 45
16 82 0 45
16 82 0 45
16 82 0 45
145
139
143
143
143
143
Chief/ Director of Emergency Services Paul Charbonneau
Executive Assistant Jennifer Dawson
Administrative Assistant Kathryn Aldrich Deputy Chief of Perfomance Standards Gale Chevalier
Performance Standard Assistant Carolyn Whitworth
Deputy Chief of Operations David Gemmill
Superintendent of Performance Standards Micheal van Hartingsveldt
Administrative Clerk Lisa Moreland
(2) Logistics Clerk
Richard Russell Ingmar Freitag Chris McBain
(7) Superintendents
Jeff Burgess
Rob Wright Andy Dawson
Sally Kane Todd Fisher Mark Podgers
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Existing Service Levels The County of Frontenac continues to respond to changing levels of request for 911 service. The addition of an ambulance station, by L&A County in 2013, in Loyalist has seen a shift in lower call volumes. That has allowed a focus of resources to respond to calls in the City of Kingston. The rural ambulance station study recommendations have all been completed with the building and opening of the Robertsville Station in July 2014. Statistics
FPS Total Code 1-4 Responses by year 22000
21463
21500 21000
20641
20536
20500 20000 19388
19500 19000
18518
18500 18000 17500 17000 2010
2011
2012
2013
2014
Policy and Program Review 2016 2017 2018 2019 2020 Legend
X = Major
Policy Review
X
Y
Y
X
Y
Response Time Standard
X
X
X
X
X
Unit Hour Utilization
X
X
X
X
X
Attendance Management/EAAP
Y
Y
Y
Y
Y
Performance Management Competency Program
X
Y
Y
Y
Y
Training and Development
Y
Y
Y
Y
Y
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Y = Routine
5
Department/Unit Objectives (will link to KPIs below)
- Meet and/or exceed Legislative Response Time Standards (RTS)
- To reduce the occurrence and effect of illness and injury on workforce productivity, to promote employee attachment and reduce/manage costs
- Maintain industry Unit Hour Utilization (UHU)
- Implement Collaborative Just Culture
- Continue to change leadership culture
Major Initiatives to meet Department Objectives
Implement Urban Station Study locations/colocations Description: In order to meet the County of Frontenac’s legislated RTS additional station locations must be opened within the City of Kingston Urban Development Area
Attendance and Disability Management
Description: Continue to support paramedic wellness, both physical and mental
- Add paramedic resources to ensure UHU is within industry guidelines. Description: As UHU increases the service’s resources are moving toward over-maximization and usage; this too can impact RTS. An additional 12 hour ambulance may need to be added to reduce the UHU
Timelines: 2017 through 2020
Timelines: 2016 - 2017
Timelines: 2018
Responsibility: Internal and in partnership with the Kingston Fire & Rescue
Responsibility: Internal
Responsibility: Internal
Resources: Internal
Resources: External and internal training at Continuing Medical Education (CME’s) $20,000
Resources: Internal
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4. Implement “Collaborative Just Culture” Description: Enhance patient risk by Improving Safety and Reliability With a Focus on Systems, Behaviors, Error Analysis, and accountability
- Leadership Culture
Description: Continue with the 3A’s of Leadership and Authority training
Timelines: 2016 - 2017 Responsibility: Internal
Timelines: 2016-2018 Resources: Responsibility: Internal Resources: Internal
External – Loyalist College ($30,000) and Internal with assistance of Human Resources
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Council received the Urban Station Study Report in September 2015. Although several factors remain fluid regarding co-location opportunities with the Kingston Fire & Rescue at the airport and Division /Elliot locations the need for a station in the northwest portion of the Urban Boundary should be addressed in 2017. Options will be presented to County Council as part of the 2017 Budget.
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Service Level Changes As call volumes increase so does the Unit Hour Utilization (UHU) number. The higher the UHU number the risk increases of falling response times and unit availability. Projecting a modest 2% increase in call volume would suggest that additional resources would be required when the UHU reaches .37. Factors that would influence the timing of this would be additional resources being contemplate for Lennox & Addington County and Leeds & Grenville County.
County Council has given direction for a new deployment model for the station located on Wolfe Island. It is anticipated that this new model will be implemented on or by January 1, 2016
2016
Proposed Service Level Change
- Increase Logistics Support
- Wolfe Island Deployment Model
2017 2018 2019 2020
Additional 12 hour ambulance
Rationale/ Relative to Objectives To support continued efforts to rationalize costs UHU and RTS compliance
UHU and RTS compliance
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Financial Projection 2016 BUDGET $
2017 PROJECTED BUDGET $
2018 PROJECTED BUDGET $
2019 PROJECTED BUDGET $
2020 PROJECTED BUDGET $
Operating Revenue Grants Federal and Provincial
8,196,938
8,373,638
8,781,338
9,160,838
9,374,738
Total
8,196,938
8,373,638
8,781,338
9,160,838
9,374,738
Salaries & benefits Materials Contracted Service Rent and Financing Project Proposals Brought Forward Depreciation
13,138,040 870,853 1,352,535 228,402 50,118 619,424
13,754,086 902,916 1,323,757 231,990 100,000 754,723
14,383,084 921,921 1,368,705 235,649 156,000 754,723
14,812,456 939,164 1,338,501 239,382 160,000 754,723
15,269,137 951,943 1,434,150 243,189 163,000 754,723
Total Operating Expense
16,259,372
17,067,472
17,820,082
18,244,226
18,816,142
650,861
663,877
677,155
690,698
704,512
16,910,233
17,731,349
18,497,237
18,934,924
19,520,654
8,713,295
9,357,711
9,715,899
9,774,086
10,145,916
619,424
754,723
754,723
754,723
754,723
NET MUNICIPAL CONTRIBUTION less depreciation
8,093,871
8,602,988
8,961,176
9,019,363
9,391,193
Other Municipal Contribution
-6,366,920
-6,754,345
-7,026,457
-7,062,586
-7,344,197
County Contribution
1,726,951
1,848,643
1,934,719
1,956,777
2,046,996
NET CAPITAL EXPENSE
321,901
0
72,000
0
0
Other Municipal Contribution
-314,453
0
-56,531
0
0
7,448
0
15,469
0
0
1,734,399
1,848,643
1,950,188
1,956,777
2,046,996
Operating Expense
Reserve Transfers
Total Operating Expense with Reserve transfers NET MUNICIPAL CONTRIBUTION less depreciation ( non-cash)
County Contribution
Requisition
Risk Analysis Level Risk Caution
Advisement
Issue
- The Land Ambulance (LA) Grant, to Designated Delivery Agents (DDAs) is discretionary on the part of the Ontario Government and not legislated
- Changes in land ambulance deployment by neighbouring municipalities may have either positive
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or negative effects on FPS call volumes, deployment and response times 2. The Collective Agreement with OPSEU paramedics expired on December 31, 2014 and we have not scheduled bargaining dates
Risk Mitigation Strategies Issue Risk Caution
- LA Grant
Advisement
- Deployment
- Collective Bargaining
Mitigation Strategy
- Continue to participate in discussions with EHSB, Municipal Treasurers and stakeholders to ensure the grant remains in place.
- Continue to participate in discussions with Leeds & Grenville, Lennox & Addington and Lanark Counties regarding future improvement/reductions in service levels in those municipalities’.
- The employer continues to offer dates for bargaining
Key Success Factors Attendance and Disability Management To further assist Paramedics in developing a clear understanding of the disability management strategy (including prevention, accommodation and support recovery) that will assist in preventing and managing absences from work. RTS/UHU Targets/Urban Station Study The service is meeting the RTS in those areas currently illustrated in red in the urban areas of the City of Kingston and maintain acceptable UHU levels. Collaborative Just Culture The service focusses on culture of risk management versus blame. Build on a culture of patient safety where paramedic self-reporting of errors increases. Leadership Culture The FPS leadership team is aligned by goals, mindset, values and behaviours.
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Manitoulin Sudbury Huron County EMS Haliburton Parry Sound Muskoka Prescott Russell Algoma EMS Bruce County EMS Grey Haldimand Lennox Addington Middlesex London Norfolk Rainy River Simcoe County Leeds Grenville EMS Hastings Kawartha Lanark Northumberland Prince Edward Renfrew Chatham Cochrane District EMS Dufferin County Elgin Kenora Lambton Rural Thunder Bay DSSAB Timiskaming Brant County Guelph Wellington Peterborough Cornwall Stormont Frontenac Paramedic Services Nipissing Oxford Perth Sault Ste Marie Thunder Bay City Waterloo Durham Region EMS Essex Windsor Halton Region Hamilton EMS Ottawa Paramedic Service Peel Toronto York Region EMS Niagara Sudbury Lambton Urban
Key Performance Indicators
Objective 1: Legislated Response Time Standard (RTS)
• RTS is a retrospective review of how we performed compared to what the County Council has set as its RTS targets. The County of Frontenac has one of the highest RTS targets in Ontario and has met and/or exceeded its targets since inception of new RTS criteria in 2013.
New Performance Measures Targets - Sudden Cardiac Arrests or CTAS 1 Within 8 Minutes
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
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The County of Frontenac set the following criteria under Regulation 257/00, as amended, for its response time targets for 2015: For the calendar year of 2015, from January 1 to December 31, i. Designated Delivery Agent (DDA) - SUDDEN CARDIAC ARREST 48% percent of the time, within 6 minutes from the time ambulance dispatch conveys the call information to the paramedic, the County of Frontenac will endeavour to have a person equipped and ready to use an AED at the location of a patient determined to be in sudden cardiac arrest. ii. EMS Designated Delivery Agent - CTAS 1 68% percent of the time, within 8 minutes from the time ambulance dispatch conveys the call information to the paramedic, the County of Frontenac will endeavour to have a PARAMEDIC as defined by the Ambulance Act and duly equipped at the location of a patient determined to be CTAS 1. iii. EMS Designated Delivery Agent - CTAS 2, 3, 4, 5 The County of Frontenac will endeavour to have a PARAMEDIC as defined by the Ambulance Act and duly equipped at the location of a patient determined to be CTAS 2, 3, 4, 5 within a period of time determined appropriate by the DDA and noted below in Table 1, or as resources permit (level of effort):
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Table 1, CTAS 2, 3, 4, 5 EMS Delivery Agent Commitment CTAS
Target Time from Paramedic Received Until on Scene
% Target
2
10 minutes
65%
3
10 minutes
65%
4
10 minutes
65%
5
10 minutes
65%
Objective 2: To reduce the occurrence and effect of illness and injury on workforce productivity, to promote employee attachment and reduce/manage costs. 80% of employees meeting the target for absenteeism Paramedics (OPSEU 462) – no more than 12 days in a 12 month period Objective 3: Unit Hour Utilization (UHU) UHU is predictive in nature based on historical data. It can be influenced by many factors such as out of scope call volume increases, episodic call volume events i.e. Homecoming, etc., deployment changes (+/-) by neighbouring municipalities. A target ceiling of .37 UHU is utilized to indicate when FPS may see system response pressures and need to consult with County Council on options to maintain or improve system performance.
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The key performance indicators for the FPS unit are intended to provide Council and the public with an indication that service delivery is on track
Respectfully Submitted,
Paul J. Charbonneau Director of Emergency and Transportation Services/Chief of Paramedic Services
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