At least two full years of direct operation is required to accumulate enough data to offer a true financial picture which can accurately be used for comparison with previous service provision. During our first year of operation, many costs were incurred which are more related to one time startup events than ongoing operational activity. Some examples are, items required to address Health & Safety issues, computers, basic inventories of medical supplies and training costs for orientation. Currently, the East Region is showing a favourable 1st quarter variance.
Emergency Medical Services Eastern Region Budgets
| 2001 Contractor | $3,402,200 |
| 2002 Contractor | $3,900,690 |
| 2003 Contractor (1) | $4,244,709 |
| 2003 Direct Provision | $4,141,100 |
| Difference | $-103,609 |
(1) Projected Contractor costs including salary increases, rent increases, response time framework adjustments and economic cost increases assuming the Contractor would have been required to implement the same service level improvements initiated by the direct service provider.
Based on the above, it is estimated that the cost of remaining with contract service providers would have been $103,609 higher than direct service provision in 2003. After a full year of direct service provision, it may be evident that further efficiencies can be identified. This will be reviewed during the budget process for 2004.
One cost which substantially increased was station leases. Of the ten stations transferred to direct service delivery only three previously included rental funding as part of their budgets. All three were paying above normal market value and these fees were negotiated down to more appropriate levels. All leases are in the process of being finalized. The increased costs in rent for the stations that did not previously have rental budgets will form the basis for a submission to the Ministry of Health to get their funding for 50% of these costs.
Operational Comparison
Prior to Direct Service Provision, there were four managers, and one operator who functioned more or less as a manager. In addition, there were three leadhands. For comparison purposes we will use a total of five managers and three leadhands.
After Direct Provision, the new position of one Regional Manager was created, (similar to the structure in the western region) with one supervisor placed in charge of three to four stations and leadhands in alternate locations where the supervisor does not reside. Five management positions were reduced to one manager and three supervisors. Leadhands were increased from three to six.
Location | December 31, 2002 | January 01, 2003 |
| Red Rock | Lead hand | Lead Hand |
| Nipigon | Manager | Lead Hand Land of Nipigon Cluster |
| Beardmore | Lead hand | Supervisor |
| Schreiber | None | None |
| Terrace Bay | Manager | Leadhand |
| Marathon | Manager | Supervisor North Shore Cluster |
| Manitouwadge | Manager | Leadhand |
| Longlac | Lead hand | Leadhand |
| Nakina | None | Supervisor Greenstone Cluster |
| Geraldton | Operator | Leadhand |
Administrative
support | 1 FTE for Nipigon,
Beardmore, Red Rock | 1 FT for Region |
| Regional | N/A | Manager. |
The concept of the clusters is working well. Staff in each cluster are easily shared as they work for one employer. In the past, sharing of staff was much more difficult as they had to be hired at each station and re-certified or validated with Thunder Bay Regional Base Hospital. Sharing of personnel across the region is now routine and without major paperwork.
When Contract Service Providers for Nakina and Manitouwadge discontinued operation, difficulties regarding staffing were significantly reduced within four months. Manitouwadge now has a surplus of staff interested in working there. Nakina still has FT openings, but they are being well covered by part time staff. By applying the available resources of a larger service provider, the situation stabilized within days and resolved within months. Other areas that did not anticipate the severe shortage are now experiencing some difficulties.These services had anticipated hiring additional college graduates that were unfortunately not available. Steps are being taken to reduce the impending shortages in those communities.
Policies and procedures across the District are now standardized. All staff across the region have one uniform, one logo, letterhead, etc. which is helping reduce costs. Tenders have been issued for vehicle maintenance rates across the District. It is expected that by going to tender, competition will result in savings. Equipment choices are now made centrally with input from an Equipment Advisory Committee. Staff in both regions provide input.
After careful consideration of enhancements and budget implications, it was decided to move all remaining eight hour on site stations to ten hours on site to improve response times. The $27,900 cost was absorbed within the existing budget. By combining Response Time Framework Funding and efficiencies identified in transition, seven stations moved from eight-hour shifts on site to ten hours on site. This was implemented on January 1, 2003 and created the equivalent of one additional FTE position in those stations thus helping further to stabilize the workforce.
After assumption, it was found that certain stations were not staffing as per the agreed performance agreement. In fact, in some cases, the level of staffing agreed upon was not provided but the funding was used to support enhanced coverage at other locations. This has been corrected.
Other operational improvements were introduced on a smaller scale to address local issues. For example, a revised schedule in one municipality was instrumental in improving the quality of life of some full time staff so that instead of working three out of four weekends, they now worked only one and are able to take a well deserved vacation.
Two stations that were operated as one service in two locations are being converted to individual stations with staff hired to work specifically in one location versus both. It is expected that this course of action will reduce downstaffing significantly and improve local service response times.
Prior to assumption, most stations had two ambulances with one as a mechanical spare. A review of vehicle deployment indicates that one spare could be reduced in Greenstone and be replaced by a supervisory vehicle which costs less to purchase and operate. Supervisors in the other clusters drive Emergency Support Units as administration vehicles while in their cluster. In 2003, the number of ambulances will be reduced by one but the number of supervisory vehicles will be increased by one. Deployment review is ongoing to identify other fleet efficiencies.
Provincial Relationship
The Ministry of Health and Long Term Care continues to monitor service delivery. Prior to direct delivery, the province provided each contractor with a service number and area of operation. After January 1, 2003 we worked with the province to develope two service numbers, one East and one West which coincides exactly with our organizational structure. This facilitated the understanding of the organization by government dispatchers as their numbering system now matched the governance structure This helps facilitate the understanding of who manages which region.
Another benefit of being direct providers is access to information the province collects on staff. Under contract services this information was available only to the employer (contractor). As the new employer, we are now able to maintain one quality assurance file for all staff. This facilitates better training and continuing medical education of paramedics.
Human Resources
Early on in the transition, much emphasis was placed on the importance of meeting the needs of the EMS staff. City Human Resources and Nipigon Regional office staff put forward considerable effort to ensure that pay and pay information was properly addressed within each pay period. The staff was also very patient and understanding during this time. A total of 66 employees were brought on line at the stroke of midnight on January 1. Since then, SAP has been adjusted to resolve outstanding issues as they arise. Policies have been reviewed to improve delivery of services, for example, pay stubs were as much as a week late in getting to distant stations. Human Resources resolved the issue by mailing EMS pay stubs early in the week so that they now arrive on the Monday after pay week. Efforts are underway to have them arrive on the Friday as per all other City employees.
A major achievement was the amalgamation of nine contracts into one. With the introduction of the Eastern rural and remote stations to the existing West Region, Human Resources suspended negotiations with the group of West Region stations to allow the staff time to choose one union for all rural and remote stations in both regions. Thunder Bay remains under separate contract. A new contract was negotiated and ratified early in the year. This step was very important in reducing the number of different local contract clauses that previously applied to different work sites and created difficulty especially for staff working in multiple stations. Certain clauses limiting the hiring of paramedics were not included in the new contract. This will improve flexibility and allow choosing between enhanced training of existing paramedics or hiring already qualified paramedics based upon availability of resources.
Immediately after assumption, the Director visited each station and discussed concerns with paramedics. With the exception of one location, all were supportive of the move to go direct across the organization. All stations now receive identical salary, benefits and management programs. There is an improved sense of cooperation and sharing between stations versus competition as sometimes existed in the past. Many paramedics now see opportunity beyond their station to move into other positions, such as Education, Supervision, Advanced Care Paramedic etc. As a larger organization, we have been able to accommodate staff requiring modified work. In the past, small operators were unable to find appropriate work. In one case, such a paramedic has been key to providing training at no extra cost to the system. Normally training delivery has been very expensive due to scheduling issues resulting in overtime salaries.
Municipal Relations
Although the City of Thunder Bay is the Designated Delivery Agent and as such is responsible for provision of Emergency Medical Services across the district, it was important to maintain contact and ensure accurate information was provided to district municipalities. After the original announcement in June of 2002, there were some significant concerns in selected municipalities of the District. Presentations and or meetings were held with various councils and/or with their Mayors and CAOs as required. Others were contacted by phone. All District employees were provided with similar presentations. At present, there are no outstanding issues related to the transition.