Rick Batt's article in the February 5, 2008 The Daily Bulldog
"NorthStar's Formation Can Inform the MSAD 58 and MSAD 9 School Reorganization Planning Process"
Thirteen years ago, five separate emergency medical service programs served this region. Three years ago, Franklin Memorial Hospital led an initiative to merge these services into one regional EMS, now known as NorthStar. While in many ways very different, the regional merger of these five local ambulance services provides many useful lessons for current school consolidation efforts by local school systems, including the potential merger of MSAD 58, MSAD 9, and Highland & Coplin Plantation school programs.
The five separate ambulance services that once served this region were Delta Ambulance, Community Emergency Service (CES), AMPS, Sugarloaf Ambulance and Rescue, and Rangeley Region Ambulance. Delta was a not-for-profit company, headquartered in Waterville and Augusta with a base in Farmington, serving Farmington, Wilton and five other local towns. CES was an independent not-for-profit service located in Livermore serving Livermore, Livermore Falls, and Jay. AMPS was also a not-for-profit service based in Phillips serving Avon, Madrid, Phillips, and for a time- Strong. Sugarloaf EMS was a small, independent for-profit company serving the towns in and near Carrabassett Valley. Rangeley EMS was a municipal service of the Town of Rangeley, serving Rangeley and adjacent communities. All were good services deeply rooted in community support, volunteerism, and significant taxpayer-supported subsidies. However, all five services were financially frail. All struggled with staff and volunteer retention and with the challenges of professional development. The towns supporting these services were quite concerned about rapidly rising subsidy costs and the long-term protection of quality EMS coverage in their community.
Over a period of 12 years, Franklin Memorial Hospital gradually came to sponsor all five services. In each case, the services or the towns supporting them came to the hospital to ask if we could help by operating the programs. We responded affirmatively. Wishing to honor local traditions and staff, we first tried to run all five services separately. Over time, however, we found that the separate operation of small rural units was inefficient, and we were losing important opportunities to protect and advance quality. We realized local taxpayers could not cope with rising subsidy costs unless these costs were moderated. We concluded that it was vital for quality patient care to merge the five local EMS services into a single program. For these reasons, three years ago we announced we would form a regional EMS organization.
We spent six months planning the merger. During this time, we set forth several basic principles, including a guarantee that no jobs would be lost as a result of the merger, and the intent to create a single leader, name, license, set of operational policies, governance structure, and a single standard of professional performance. We talked to the communities and individuals involved about our plans, but we also spent a lot of time listening. During this time, we held frequent meeting throughout the region to gain input.
At first, we met with a great deal of worry about the potential for loss of employment and loss of service, and fears that quality would diminish. Some individuals really distrusted the hospital. Some argued that the merger would not provide the tangible benefits of quality protection, efficiencies and tax increase moderation that we claimed.
We listened, and we altered our plans over and over again in response to what we heard. For example, originally we anticipated that the AMPS base in Phillips would be closed. With input from the residents and staff in Avon, Madrid and Philips we changed our planning and continued the base there.
And the rest, as the saying goes, is history. NorthStar was created by honoring the traditions of the five original services while working towards a new and better reality. The results? Higher quality emergency medical services for the entire region; a larger and more professionally trained staff; improved response times; better and more modern vehicles, equipment, and technology; more cost efficient services; and taxpayer savings. NorthStar is not perfect, but in just a few years it has become one of the best and most respected EMS programs in the state.
Throughout the process, we learned many important lessons about collaborating with others and merging services for the good of the collective community. Here are a few:
Reorganization discussions initially generated much worry and mistrust. The solution to this mistrust was continued dialogue, respectful discussions, patience, and persistence. The NorthStar reorganization effort wasn’t easy, but I never ceased to be impressed by how sincere and honest people were when expressing their ideas and worries. We respected the ideas and sentiments of everyone. We tried to accommodate most suggestions. Not every idea was used, but every idea was seriously considered.
At first, progress was slow and difficult. But as everyone involved got to better know one another and a respectful pattern of dialogue emerged, more trusting relationships developed and we found progress came easier and more quickly.
From the outset, we saw that the merger held the potential to benefit all the units. No single unit was better than another, and we never thought of the merger as the larger units, like LifeStar, helping to lift up or improve the smaller units. After NorthStar was created, every one of the original five units became better as a result the merger. Each of the five units contributed to making other four better.
Management continuity was a real problem for us at first. After the merger planning had gained momentum we were able to solve this problem with the hiring of David Robie, who has proved to be an uncommonly capable leader.
Although regionalization has brought significant benefits to local EMS services, it did not solve all our challenges. For example, through the years over the entire region we have saved local taxpayers millions of dollars compared to what subsidy requirements would otherwise have been, but financial challenges still continue. While merging services can create benefits and save money, we should not expect that this can ever fix all the challenges our communities face. This will likely prove to be as true for schools as it has been for emergency medical services.
Without reorganization, most of the five EMS services would have been greatly diminished or have required huge subsidy increases, or both. Without the merger, staffing would have declined and there would have been much less professional development. Some services may have collapsed altogether.
In the first year of operation, we saved no money and only began to make gains in staff recruitment, retention, and development. In year two, we began to see tangible gains in efficiencies, as well as clear gains in quality.
Trust was extremely important throughout this process. This trust had to be earned, and it took time to do so. However, once trust was gained, it opened the door for many wonderful opportunities, and for a vision of excellence for EMS in this area that transcended what existed. It also enabled us to work together and realize this vision of excellence.
Our story is not a perfect fit to the school reorganization efforts. Merging EMS services, while very complicated, may be simpler in many ways than the issues surrounding the consolidation of local school districts and programs. Some of the advantages gained through the creation of NorthStar are probably not comparable to the advantages available through school reorganization efforts.
Nevertheless, our experience does provide some lessons that can help inform the current school planning efforts. Any merger discussions involving important local services with different traditions and different systems of local control are going to be difficult. Progress is not always steady. Often, those who are involved will feel like they take one, two, or three steps forward only to move one or two steps backwards. Planning can go well for a time, and then stall, only to start up again. Tensions may flare, but over time trust can build.
I wish that the merger of the five ambulance services had not been necessary. There was a simplicity to the five small ambulance services, and exceptional local engagement. There is much to be said for small units of operation and maximum local identity. However, the reality of financial pressures and the complexity of the development of professional EMS services here and throughout the nation required us to consolidate the five units into one. The outcome has been outstanding. NorthStar has achieved a greatness that could not have been reached without the synergy of five great services merging into one.
Local residents will ultimately determine if the school reorganization should occur, and what shape they will take. Hopefully the creation of NorthStar can shed light on some of the considerations.
For more history about the formation of NorthStar go to http://www.fchn.org/NorthStar/History
Information about the present status of NorthStar can be found at http://www.fchn.org/northstar
Richard Batt
President
Franklin Community Health Network
