BACKGROUND
International models of pre-hospital care vary widely with differences in definition, legislation, governance, management and delivery. Concerns are growing over whether variation in services signals variation in quality and access. Debate also exists over how to measure performance, effectiveness and identify what affects these and how, raising questions about how regulation and governance may affect care delivery and ultimately patient outcomes.
OBJECTIVES
- To describe and compare paramedic based pre-hospital emergency care regulation and governance models internationally.
- To achieve international multidisciplinary consensus about:
a) The advantages and disadvantages of different regulatory and governance models across service providers
b) Principles of effective regulation and governance of pre-hospital emergency care
METHODS
In part 1, a literature search was carried out to identify papers which described different models of regulation and governance. This was supplemented with semi structured telephone interviews with senior managers and practitioners responsible internationally for prehospital emergency care delivery and research. Five paramedic-based international systems were selected: 1) Ireland; 2) Ontario, Canada; 3) Pennsylvania,USA; 4)UK; 5) Victoria,Australia.
In part 2, a modified Delphi consultation and review was carried out to review models identified in the first part of this study and to identify principles of effective regulation and governance.
RESULTS AND DISCUSSION
The research provides new results by describing existing models of regulation and governance, assessing strengths and weaknesses of these models and identifying best practice. Two models appear to operate in the international system: a single organisational process integrating all regulation and governance systems; and a multi-organisational process working across and within existing structures. |
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International experts consulted through the Delphi process identified more advantages and fewer disadvantages for the single organisational model. Benefits of the single model included coordination, interoperability and improved communication but it was felt to be vulnerable because of its reliance on a single funding source and reduced opportunities for innovation through multi-organisational working. Benefits of the multiple model included opportunities for innovation from multiagency working and integration of prehospital care into the local health system. The experts considered that multiple organisational models potentially challenged cross-border working, intraoperability, strategic planning and risked confusion from a diverse international nomenclature. Principles of effective regulation and governance included emphasis on open communication and provision of evidence-based and high quality care.
These study findings suggest strong support for integration in specific areas of pre-hospital regulation and governance where it may improve the effective delivery of pre-hospital care. A single organisation model may be the most coordinated way to achieve this if steps are taken to minimise disadvantages, such as ensuring effective communication (to maintain the profile of pre-hospital care priorities and take on improved and new ideas) between such an organisation and the wider health system. The legislative framework and operating structure of PHECC, which includes a council made up of key individuals from aspects of national pre-hospital emergency care in Ireland, appears to encourage engagement on all aspects of pre-hospital emergency care and may provide an opportunity for a consensual and coordinated approach to regulation and governance. Effective regulation and governance of paramedic-based pre-hospital care should also prioritise the implementation of evidence-based practice, good intraorganisational communication and high quality of care as the main performance measure.
The challenge now is to consider how these findings can be used by those working in existing models of regulation and governance to improve delivery of service and patient outcomes.
A full copy of this study is available on our website in publications.
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