Complete the following from the IVEY Case Analysis Form:

1. Background
2. Immediate Issues and Symptoms
3. Root Cause/Basic Underlying Issues Background

   Medical Transport Emery (MTE) is a public company created by the Government of Emery in June 2007 to operate a standardized, government-wide emergency medical service.

   Situation before MTE

   • Emergency medical services in Emery were delivered through dozens of separate contractors. There were for-profit operators, non-profit operators (including provincial government systems managed by Regional Health Authorities), municipal medical transport services, and First Nations medical transport services. A private sector company provided air medical transport services. Some operations were subject to collective agreements and some were not.

   • There was no centralized dispatch. Four regional centres in the government received emergency calls and dispatched medical transports. There was no accepted standard for response times.

   • Thirty-five different medical directors set patient care protocols, resulting in different standards of patient care.

   • Paramedic training differed greatly.

   • Many medical transport operators provided on-call service during non-peak hours. At these times, paramedics had to be called into work when calls were received.

   Goals of MTE

   • Unify all medical transport services under a single body;

   • Create an improved, standardized response time for the government. The target is 90% compliance with a 9-minute response time in urban areas and 90% compliance with a 22-minute response time in rural areas;

   • Elevate training standards for all paramedics until 100% are trained as Primary Care Paramedics. Introduce Advanced Care Paramedics at a later date;

   • Improve consistency of care through a centralized approach to emergency care protocols;

   • Have 24-hour on-site schedules, eliminating on-call systems.

   MTE Responsibilities

   The government expects MTE to:

   • Operate land medical transport services, including patient transfers within and outside the government.

   • Deliver air medical transport service, including patient transfers within and outside the government.

   • Operate the Medical Communications Management Centre (MCMC) a government -wide medical emergency communications and dispatch centre;

   • Develop and maintain continual quality improvement processes;

   • Acquire and maintain assets required to operate the medical transport service.

   • Develop, test, and update the provincial disaster response plan for medical transport services, including an MCMC disaster and business continuity plan and emergency operations centre.

   • Respond to customer, media and public inquiries and complaints and manage community and stakeholder relations;

   • Work with related departments, organizations and agencies, including medical first responders (e.g. fire services) and 911.

   The core company MTE

   Medical transport Emery is a public sector corporation under the Public Service Labour Relations Act. The government is technically the employer of MTE front-line personnel.

   MTE bought required assets (stations, trucks) from former operators following negotiations for the transfer of responsibilities to MTE. Employees of the former operators who were not already public servants were offered employment with MTE and became public servants.

   The management company Emery -EMS

   Following a public tender, the government selected First Medical Inc. to develop the plan for MTE and to operate the provincial medical transport service. First Medical Inc. established a wholly owned subsidiary, Emery Emergency Medical Services Inc. (EMERY- EMS) for this purpose. The government negotiated a ten-year performance-based contract with EMERY -EMS to manage medical transport Emery and its personnel.

   EMERY-EMS employs the managers within MTE. The EMERY- EMS managers act as agents of the government to manage MTEs public service employees.

   Organization of EMERY EMS

   Collective bargaining structure

   The approximately 900 employees of Medical Transport Emery (MTE) consist of 625 paramedics, 35 dispatchers and 36 nurses and the rest in administration.

   Since the employees who were previously employed within the Regional Health Authorities remained provincial government employees, little changed when MTE was formed.

   The paramedics and dispatchers formerly employed by other operators were integrated into the CUPE local when they joined MTE. They were credited with seniority based on continuous service with their previous employer.

   The Emery Nurses Union represents the 36 nurses, who are all associated with the air medical transport service.

   A government -wide local of CUPE represents the paramedics and MTE personnel.

   Collective bargaining relationships

   MTE personnel are covered by collective agreements written to cover the entire health system of the government Regional Health Authorities plus MTE. The agreements focus remains hospital operations, and MTE is hardly mentioned.

   EMERY EMS places fewer demands on the government for HR support than the Regional Health Authorities did but must still work with the Provincial Department of Human Resources for job classification and for legal support in the arbitration of grievances.

   Managements pre-MTE experience affects early approaches to labour relations:

   • In the Regional Health Authorities, human resources management was reactive, and many HR affairs such as classification and labour relations were controlled closely by the government s Department of Human Resources. The labour relations climate between the RHAs and CUPE was mildly adversarial. The focus for management was always on hospital operations, and paramedicine was something of an afterthought. Former RHA managers came to believe that the unions view of issues would prevail over managements.

   • The Department of Health had little direct responsibility for labour relations matters. Any internal departmental issues were directed to the provincial Department of Human Resources. MTE managers who were formerly government employees also came to believe that the unions view of issues would prevail over managements.

   Context of your mandate

   The EMERY EMS management team has done an outstanding job at putting together a functioning, highly professional, state-of-the-art service in a year.

   During the first year, they hired more than 100 new paramedics, most of the flight nurses, dozens of dispatchers, upgraded the medical transport fleet, created new maintenance standards, developed new standard operating procedures, transferred, and equipped more than 1,000 employees, negotiated for the takeover of services from 39 contractors with more than 50 contracts, assisted in the negotiation of a new collective agreement, and established a central office and MCMC.

   But with the huge workload, EMERY EMS senior managers have not been able to work on a strategic human resources plan. They have not been blind to this need; they have simply been unable to find the time.

   Employee relations are hampered by the nature of the business. The MCMC and air medical transport employees are mainly based in Longville, but other employees are scattered across Emery. There are more than 60 stations, and for most of the day paramedics are on the road in their vehicles. Employee communications and personal leadership are difficult. Front-line managers have a heavy burden of administrative tasks, such as scheduling paramedics. It is easy to revert to management by email.

   Assume that the following symptoms have begun to emerge, reflecting the organizations difficulty to date in giving HR the priority that management knows it must have in the future:

   • There are concerns over the level of engagement by paramedics. It is obvious that there are pockets of front-line staff who have not bought into the new system. Paramedics are not generally motivated by career progression, since they have fairly limited opportunities to move up in their organizations. However, they take intense pride in their skills, abilities and technology, and are critical of anything that may take away from their public image. They sometimes express uncertainty about the new system.

   • Managers are reverting to their former employers business styles and there is a danger of multiple disconnected cultures emerging:

     • Managers who were previously private operators acutely feel their lack of freedom now that they are in a larger organization. They can no longer just buy a new truck when they want to. They cant have their own administrative assistants. They have to adapt to new and different standard procedures. In many cases they were non-union and now they have to comply with a collective agreement.

     • Many managers who were public servants believe that nothing can be done about many HR issues, because their former managers often did not deal with labour relations issues effectively. They believe the union is able to win any time they take a stand.

     • The employee experience differs across the organization, based on differing management styles among the Operations Managers or Regional Managers. Some are described as blunt and black-and-white about issues, while others are more like friends. Some hold information meetings with staff and others do not. In some cases, policies are discussed and in some, they are issued.

   • In a number of cases, HR has learned about serious issues too late to have an influence. Front-line managers have already taken a position. HR has sometimes had to modify the managers position at a later date. As a result, there has begun to be some friction between HR and Operations.

   • Tensions exist between dispatch and paramedics. While this is a common state of affairs in emergency services, it is undesirable and may be growing.

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