Effective Administration

Although the transport team members might serve in administrative and clinical roles, the team also requires support from the sponsoring organiza­tion’s administrators. Ideally, one person will be assigned as the administra­tive liaison to the transport program and will be responsible for managing and monitoring issues related to team functions that are under the purview of hospital administration.

One way to mitigate the issues mentioned previously is to develop a dedicated transport team. The costs may be higher; however, mobilization times will be better, and in-house patient care will not be interrupted while the nondedicated team member transfers care to another hospital staff mem­ber to be freed up for transport-related responsibilities. In turn, the team members can assist the staff with components of care such as intravenous catheter insertions, intake evaluations, or procedures that allow them to leave quickly in the event transport services are needed.

It is important for the transport team's leadership personnel to have knowledge of the financial health of the program and its impact on the finan­cial status of the sponsoring institution. They should be conversant about the team's finances and have recent data that describe the team's activity, referral base, and costs. Because the transport team's direct costs might be high, it is imperative that the team's leadership maintain an understanding of finan­cial issues related to team operation and how the team affects the hospital's margin. Active involvement of the hospital's finance department can prove valuable. Appropriate financial information should be available to leader­ship of the hospital and the transport team to enable them to make the most appropriate fiscal decisions. When it becomes necessary to justify the cost of the team to the organization, it is extremely helpful to look at the down­stream revenue that is provided by bringing that patient into the facility. In the event a facility completes third-party transports in which patients are picked up and delivered to other facilities independent of their own, appro­priate contracting and procurement of all expenses are necessary to make this financially sustainable.

It is important to cultivate relationships with referral facilities to improve market share and the quality of patient care. In the current financial climate, many smaller hospitals are decreasing pediatric subspecialty services and referring more children to tertiary pediatric facilities. Transfer agree­ments that define the responsibilities of the referring and receiving hospital are being more frequently used. Typically, transfer agreements establish poli­cies that clearly define administrative procedures, professional responsibili­ties, and patient care goals. Many transfer agreements determine the level of care expected at each facility and might also address reimbursement issues. These agreements might also guarantee or streamline acceptance of acutely ill patients by the receiving hospital and establish the expectation that chron­ically ill and recuperating patients will return to the referring facility in a timely manner. Transfer agreements must, however, comply with local, state, and federal mandates such as the Emergency Medical Treatment and Active Labor Act (EMTALA [42 USC §1395dd]).

Effective relationships between the administrative staffs of referring and receiving hospitals will improve the ability of each facility to monitor trans­fer activity and intervene when problems are at a manageable stage. Because negotiating authority might rest with nontransport administrative and the legal staff of referring and receiving hospitals, it is the responsibility of trans­port team leadership to educate and partner with those participants about neonatal and pediatric transport team services.

How to Manage

Management texts suggest that leaders identify and communicate a vision consistent with the direction of the organization. They understand where the organization is going and work to move the organization in an appro­priate direction. Managers are responsible for implementing the leader's vision through a clearly articulated mission that is supported by goals and objectives.

Adults are intrinsically motivated and invest in that which is valu­able to themselves. The effective manager understands that employees seek work that is valuable, sustains an important self-image, and allows indi­vidual aspirations to be met. To negotiate successful assignments, managers must clearly communicate expectations, define the expected quality and quantity of the finished assignment, identify a deadline, and identify avail­able resources. When justified, the manager may need to make additional resources available. An effective manager monitors progress and offers appropriate feedback. The successful manager is a good coach who sup­ports and encourages team members while holding them accountable for their performance.