Welcome back to the Regional Time-Sensitive Care Coalition's course. If you have any questions or comments regarding this course or the toolkit, please send them to ncdrmail at acc.org. In this lesson, we'll cover roles and responsibilities for the Regional Time-Sensitive Care Coalition or RETSCO, and if a given RETSCO chooses to have one, the RETSCO manager. In the first lesson, we talked about the advantages of well-designed and high-functioning systems of care for time-sensitive conditions. And we talked about some of the problems that can occur when provider organizations like ambulance services and hospitals work on these systems of care independently from each other rather than cooperatively. We also talked about the problems and inefficiencies that can arise when condition-specific systems of care, like those for STEMI or trauma, operate in silos rather than collaboratively on the many challenges they have in common. We then introduced the idea of a Regional Time-Sensitive Care Coalition to help address these problems through an organizational structure that includes stakeholders across the continuum of care for multiple time-sensitive conditions and that covers an entire region. As the RETSCO is being put together, several things should be kept in mind that the RETSCO itself will be responsible for. One of the first things that needs to happen once a decision is made by local stakeholders to form a RETSCO is to decide on an organizational structure. The RETSCO may become a completely new and separate organization, or the RETSCO may end up being embedded in an existing organization, or the stakeholders might decide to continue on but with an informal structure. Another facet in this early organizational development phase is bringing in any incumbent systems of care groups, as might be found for STEMI, trauma, stroke, or cardiac arrest. If an existing group is active in the region, and if it's operating without significant real or perceived biases, and if the stakeholders are well-represented and satisfied with the current group, steps should be taken to bring it into the RETSCO. Conversely, if the group does not have these traits, it may be worthwhile to consider modifying it or maybe even replacing it with a new group with a fresh start within the RETSCO framework. If an existing group is brought in, the leadership and members of that group would be transformed into a condition-specific committee, and their incumbent leader could be left in place to chair that new condition-specific committee, but in a manner consistent with the operating rules or bylaws of the RETSCO. It is also suggested that the chair of each of the condition-specific committees serve ex officio as members of the RETSCO stakeholder committee. Now, if any of the existing systems of care groups already have a formal organizational structure that's working well, perhaps the scope of that existing group might be adapted to serve as the multi-condition RETSCO rather than just for the one single condition, but with all the prior caveats taken into consideration. I've mentioned the stakeholder committee and the condition-specific committees a couple times already. We'll get into the details of these committees in more depth later on, but for now, think of the stakeholder committee as a group that looks at issues that impact multiple time-sensitive conditions. It's composed of executive-level stakeholder group representatives that have clinical, operational, financial, or political interests and can have influence in how these time-sensitive systems of care operate. Once any existing systems of care groups are brought into the RETSCO, the stakeholder committee will need to decide if any other time-sensitive conditions will be targeted with establishment of new condition-specific committees. If there are no existing systems of care groups in the region, the stakeholder committee would be starting with a clean slate, and it would probably be best to start with a smaller number of condition-specific committees. As the first committees get up and running smoothly, others can then be added. One of the responsibilities of the RETSCO is getting a baseline on how well each system of care is performing for each time-sensitive condition, along with having the various types of provider organizations—hospitals, ambulance services, non-transport rescue agencies, 911 centers, and so on—see how well they are each performing on their part in each time-sensitive condition. After these baseline levels of performance are measured, the RETSCO should create a plan to reassess performance in each condition on a regular basis so that progress can be tracked over time and help them set priorities. This will be particularly important in processes that apply to multiple conditions. For example, STEMI, stroke, and trauma will all have to have processes in place for emergency inter-hospital transfers of patients from referral hospitals into the tertiary receiving hospitals. It will make sense to measure how well the emergency transfer process is working across all of these conditions, rather than separately, and any improvements made to that emergency transfer process will impact all of the time-sensitive conditions, not just one of them. Another thing that the RETSCO can do is look for ways to leverage ideas and resources across multiple conditions. For example, the STEMI committee might be working on an improvement project to transmit 12 ADCGs from the field to the receiving hospitals. Some of the solutions that improvement project team comes up with may have utility for other conditions. Some of the smartphone apps for field-to-hospital communications can not only transmit 12 ADCGs, but they might also be able to send other types of images and data useful for trauma or stroke. This creates an opportunity to leverage a resource that might have started out as something just for one condition and apply it to multiple conditions. This is one of the advantages of not working in silos. Another decision to be made by the RETSCO is whether or not to hire or appoint someone to be the RETSCO manager. This obviously has some significant funding implications, but the participating organizations may prefer that option over trying to add that responsibility onto an existing position when the RETSCO is going to be embedded into an existing organization. If the RETSCO is established as its own organizational entity, a RETSCO manager will be a necessity and would be employed by the RETSCO directly. Alternatively, if the RETSCO has a less formal organizational structure, the manager may be employed by one of the stakeholder organizations, preferably a regulatory or oversight agency, health department, or something similar. But regardless of which organization the RETSCO manager is employed by, the manager plays a key role in coordinating efforts between the participating organizations and the various committees within the RETSCO. They'd be the primary point of contact for the coalition, they'd handle the scheduling and other details of organizing the meetings, and they would be a support resource to each of the condition-specific committees and the stakeholder committee. I think you can see how this could quickly take up an entire FTE or more, depending on the level of activity of the coalition and its committees. Alternatively, the stakeholder committee chair and each of the condition-specific subcommittee chairs could be asked to handle logistics of their separate committees with their own administrative support person or finding some other way for the organizations to chip in by helping to share the workload. To help you consider the option of having a RETSCO manager and to guide their actions if one is brought on board, a sample job description is provided in the appendices of the toolkit. So that covers the major roles and responsibilities for the RETSCO and the RETSCO manager, and that gets us to the end of Lesson 2. Please ask questions and make any comments you want to share by sending them to ncdrmail at acc.org. I hope you'll join me for Lesson 3, where we'll talk about how to decide what the RETSCO catchment area should be.

Regional Time-Sensitive Care Coalition

coordinated systems of care

provider organizations

system performance

stakeholder representation