Does Non-Medical Authority Run Your Agency?

[mycrofft]

If you follow the table of organization upwards, you must eventually find someone running things who is not nor ever was a certified or licensed practitioner, and this person makes operational decisions affecting personnel and practice decisions. Sometimes they are not even in the chain of command but have somehow wormed their way into a staff position* to a decison-maker.

Any examples, funny and not, of their handiwork? How high up are they?



*Staff position here meaning a consultant, advisor, assistant-to, or administrative specialist like public relations or personnel analyst.

 

[daedalus]

You mean like the stock/share holders at AMR? LOL

 

[mycrofft]

Here's a little simple and sorta funny one.

Custody, (as opposed to Medical) decided we needed spineboards. Someone went out and made a beaut, almost two feet wide and made from 3/4 inch interior plywood with thick velcro straps riveted into place, lotsa handholds, and slots for head fastenings. They put it in an exam room and we were ordered to leave it there; it sat for fifteen years until I finally got permission to ditch it due to it having no runners (no way to get fingers underneath), wood was too fragile and starting to delaminate (never had a finish applied), and too wide to fit ambulance litters. Besides, with EMS as close as it is and as limited as our resources are, why move the pt?

 

[mycrofft]

Yes D, exactly!!

What kind of decisions? Examples?

 

[daedalus]

There are a few shady operations in Los Angeles where foreigners with no medical training whatsoever (mainly Armenians) set up a few ambulance IFT companies. They were also the operations managers, so they supervised the EMTs without a cert card themselves. Most of them have been investigated or shut down by medicare for fraud. Some of them are still around.

AMR is a publicly traded company, so corporate is accountable to them. I am not aware of any specifics, but eventually individual AMR operations have to make a profit, so maybe equipment decisions and hiring decisions are made at levels where they shouldn't be made?

 

[mycrofft]

How about bean counters inserting unnecessary care steps?

Either to CYA, generate more profit, or just 'cause they can?

 

[silver]

Does not every organization have an administration? Have they gone to school for management? Do they have degrees/training in public health or healthcare administration? Do they have advisors or a team below them to help make decisions?

You have to remember at non-academic community teaching hospitals some of the presidents have no degrees at all. Who is under them? VPs who have clinical experience, Medical directors, directors of nursing etc. The board of directors also make big decisions.

Its all about making money, increasing the quality of care, and managing people. You don't need any degrees, training, or certs for that just an understanding of people, business practices, and healthcare practice.

 

[ffemt8978]

The only non-medical authority involved in our agency is our District Commissioners, who are elected by the public.

 

[JPINFV]

I don't know when they got it or who ordered it, but when I was working first aid at a water park they had a few walkers folded up. I would have loved to have a third wheelchair at times instead of the walkers. There were a few other things strange things (really nice finger splints) that would have been for effective using the money elsewhere.

 

[MrBrown]

EMS here (mostly) is still run by the Johnno's so I think we are ultimately answerable to some dude in Jerusalim.

Our structure is very vauge and confusing to say the least; ultimately national medical decisions are made by the clinical advisory group who issues our guidelines and scopes of practice.

Regionally however we have local medical advisors (who also sit on the clinical advisory group) so there can be regional variance; example not every region has rapid sequence intubation, some use entonox some use methoxyflurane etc.

The ambulance "functional director" from what I understand is a career AO however don't quote me on that; outside that all our top level people have no medical training or experience whatsoever; our chief executive used to be head of Shell or Caltex or something.