Hi, Mick Anderson here. Welcome back to the Regional Time-Sensitive Care Coalitions course, and you're now watching the sixth lesson in our series. Got questions or comments? Please send them to ncdrmail at acc.org. Here's our recap. Lesson one made the case for why a community or region should establish a Regional Time-Sensitive Care Coalition, or RETSCO. In the second lesson, we covered the roles and responsibilities of the RETSCO and the RETSCO manager. In the third lesson, we discussed ways to define the catchment area for the RETSCO and which organizations to invite to participate in its creation. The fourth lesson described how to make a preliminary assessment of time-sensitive systems of care efforts within that catchment area. The fifth lesson covered how to get things set up for a meeting of executive-level representatives from the stakeholder organizations to discuss formation of the RETSCO. In this sixth lesson, we're going to talk about how to conduct that first meeting. The first thing to talk about is having a meeting facilitator. Using a facilitator can be a big help. Without a separate facilitator, the champion trying to pull the RETSCO together might end up having to facilitate the meeting. Having a separate facilitator will let the champion participate as a stakeholder rather than having to balance their stakeholder and facilitator roles. That's particularly important for avoiding real or perceived facilitator bias when hearing from those who may have ideas that may not be in support of creating the RETSCO. So without a neutral facilitator, some may be inhibited from being candid in their remarks, and that can inhibit their buy-in. We want all attendees to feel that their interests and opinions are being heard and not being diminished by real or perceived facilitator bias. A local health department or EMS regulatory official, since they are not from a direct service provider organization, may be an appropriate local choice if they have good facilitation skills. Regardless of who the facilitator is, a good way to get the meeting started is having the champion or champions, along with a high-ranking public official or major payer executive, making some opening remarks and succinctly making the case for considering formation of the RETSCO. After the opening remarks, the facilitator should make it very clear that the purpose of the RETSCO and a guiding principle for the discussions is that patient and community interests must be prioritized over the proprietary interests of any individual group or organization in the formation and operation of the RETSCO. That is incredibly important to clarify at the very start. This can help to prevent any stakeholders from taking a stance of trying to protect their turf or other proprietary interests. The meeting and the RETSCO itself should be seen as an opportunity for all parties to focus on the needs of patients and the community in a way that transcends organizational boundaries and interests. Once that principle is made clear, there are several outcomes to try to achieve in that meeting. First and foremost, we want to try to reach a consensus on a decision in creating the RETSCO. Next, we want to get the executive-level representatives to commit to having their respective organizations actively participate and support the RETSCO. The details for everyone's participation and support can be detailed out later on, but assure everyone that they will have the opportunity to participate in deciding what that support will look like. Once there is consensus to establish the RETSCO and the organizational leaders have committed to support it and participate, a stakeholder committee needs to be established. It will address cross-condition issues as well as the more administrative, financial, and political aspects related to setting up and operating formal systems of care programs and improvement projects. The stakeholder committee should consist of executive-level representatives from each of the participating organizations. For that, we will want to get the executive-level representatives present to make a commitment to be members of the stakeholder committee. Recognizing that these are very busy people and that they may have some pushback on committing to another recurring meeting, executive alternates can be suggested if needed. But those alternates will need to have some decision-making authority to make their presence count on the stakeholder committee. The stakeholder committee should also include each of the chairs of the condition-specific committees once they have been determined and serving in an ex officio capacity. They will bring clinical leadership to the stakeholder committee as well as bringing up issues from their condition-specific committees that may need cross-condition collaboration, political or legislative support, or funding. That leads us to the next task of deciding which conditions we are going to create condition-specific committees for. This is where incorporation of any incumbent time-sensitive care groups come in. It should be made very clear that if an incumbent group is incorporated into the RETSCO, it will need to abide by the bylaws or operating rules that the RETSCO will establish. The incumbent leader can be offered an opportunity to continue on as chair of the condition-specific committee, assuming that there isn't discord or conflict with that decision. In some cases, an incumbent time-sensitive care group may be impaired by poor leadership. This change in structure coming into the RETSCO may create an opportunity to change leadership if needed. Once the initial set of condition-specific committees are determined, each organization's executive-level representative should be asked to recommend or designate someone from their organization to be their representative on each of those condition-specific committees. Get their names, titles, email addresses, and phone numbers. This may not be needed from every organization present, however. For example, payers and some of the other groups may not need to have a representative on each of the condition-specific committees. But when payer-related issues come up, the payers should be represented on the stakeholder committee and brought into condition-specific committee discussions as needed. The same applies to any other groups not directly represented in each of the condition-specific committees. Now, if there aren't any incumbent groups to incorporate into the RETSCO, you've got a clean slate. Consider starting with a small number of condition-specific committees, maybe one or two. After they get up and running smoothly, more can be added as the RETSCO gains some positive momentum. If time permits at this first meeting, it would also be good to consider the options for an organizational structure for the RETSCO. There are several options here. Push ahead as an informal organization, embed the RETSCO into an existing organization, or create a new standalone organization. Now, the informal route may be okay to get things started, but it will have some significant limitations. One of the organizations will have to agree to be the fiduciary if any funds are received to conduct projects or support any sort of ongoing programs. Not being its own entity, the informal coalition will have a harder time applying for grants or even asking the participating organizations to chip in to cover whatever costs might arise. If the informal group chooses to sidestep cost issues, that will significantly constrain the kinds of projects and activities that the coalition can undertake. So for those reasons and more, it's suggested that an informal structure for the coalition only be used as a temporary solution until a more formal organizational structure decision can be made and put into place. A formal organizational structure of some sort is not a must, but it is highly recommended. Another option is to embed the coalition into an existing organization. That's the fastest and easiest solution, but it also has some potential downsides. The organization running the coalition may have real or perceived biases, and its primary focus will not be on the coalition. That's why embedding the coalition within one of the provider organizations, such as a hospital, ambulance service, or fire department, should only be considered with due caution to these pitfalls. But if the coalition can be embedded in an organization with few real or perceived biases, and if it has a mission closely aligned to that of the coalition, it can make for a good arrangement. Organizations fitting that profile might include regional EMS regulatory agencies and local public health departments that already have some engagement in time-sensitive care, like trauma system stewardship. Indeed, many so-called Regional Emergency and Trauma Advisory Councils, or RETACs, or similar groups are already in place in many states. Given their multi-organizational structure and multi-conditioned scope, these RETACs and similar groups are perfectly positioned to be the RETSCOs, and many of them have already assumed that kind of role. For them, this whole RETSCO model and the toolkit may simply offer some additional ideas and resources. The other formal organizational structure option is creating a new standalone organization. It can be shaped into whatever the stakeholders want it to be, and it can be free of any biases that might come from embedding it into an existing organization. But that comes at a cost. The group has to be legally created and operated. It would likely be set up as a not-for-profit 501c3 organization so that it doesn't have to pay taxes on any funds it raises, and all of that will take some time and incur some costs. Another early issue for the Stakeholders Committee is considering funding needs, developing a budget and identifying ongoing sources of funding so that the organization is sustainable for the long term. An informal coalition will have different needs than a formal 501c3 structure. Funding options may include annual funding assessments to the participating organizations and grants. Grants may be helpful initially, but may not be appropriate for the long term. With an informal organizational structure, participating organizations may simply agree to share costs on an ad hoc basis or rotate the responsibility and costs for hosting meetings, etc. There's a lot to potentially cover in the initial meeting, and you might not have time to get to it all, but the points just described can provide some focus to the discussion and serve as calls to action. One of the appendices in the toolkit has a sample agenda for this initial meeting. There's 30 minutes at the start of the meeting for signing in, mingling, getting some food, and getting seated. This is followed by 90 minutes of actual meeting time for a total agenda of two hours. A couple last things to cover before you let everyone go and close the meeting. Schedule the next meeting to address items not covered in this first meeting and to follow up on action items. After the meeting, all of the attendees and invitees to the initial coalition formation meeting should get a follow-up email and or letter. It should thank them for their attendance or effort to attend and provide a very concise set of minutes. Decisions made and action items for follow-up should also be highlighted. Another one of the appendices in the toolkit has information that may be included in a flyer or brochure sent out with a follow-up letter to reinforce key points regarding formation of the RETSCO. So that's it for Lesson 6. In Lesson 7, we're going to assume that the RETSCO has been formed. The organizational structure, whatever that may be, has been selected and put into place. And the initial set of condition-specific committees are also in place and that regularly scheduled stakeholder committee meetings will start taking place. Lesson 7 will focus on the condition-specific committee meetings. Please send any questions or comments to ncdrmail at acc.org and I'll see you in the next one. Thanks for watching.

Regional Time-Sensitive Care Coalitions

neutral facilitator

stakeholder participation

organizational structure

funding sources