Strategic project management can work in a fire and EMS organization — if the fire chief is behind the project and everyone in the organization knows it.

Chesterfield Fire and EMS is a combination department that provides a full range of emergency services to Chesterfield County, Va., a county of 446 square miles with 280,000 full-time residents. The department has 425 full-time employees with 350 firefighters and officers assigned to the Emergency Operations Division and 150 active volunteers. Four volunteer rescue squads that provide EMS in conjunction with CFEMS also serve the county.

The County Board of Supervisors had commissioned several consultant studies over a span of 15 years, each of which recommended that the county seek reimbursement for EMS expenses by billing Medicare, Medicaid and private insurance companies.

In May 2001, the board voted to table such a proposal until they could evaluate revenues at the end of the fiscal year, which ended June 30. At the time, the U.S. economy already had begun a downward turn so for political purposes, the proposal was all but dead.

Then came Sept. 11, 2001, and with it a wholesale reevaluation of the preparedness of America's emergency services to respond to acts of terrorism on the local, state and federal levels. Chesterfield County's Board of Supervisors may have been influenced by these events; they approved the revenue recovery proposal on Nov. 14, 2001, as a means to meet those challenges locally. With their approval came the mandate that CFEMS fully implement the proposal by July 1, 2002.

Fire Chief Steve Elswick saw this as an opportunity for the citizens of Chesterfield County, CFEMS and the county's EMS system. He also recognized charging for services was a major change for CFEMS. He decided to assemble a strategic project management team dedicated solely to the implementation of revenue recovery.

How they did it

In November 2001 Elswick announced that he was appointing a six-person Revenue Recovery Implementation Team to plan and implement a fee-for-ambulance transportation billing system.

For the project manager position he selected Deputy Chief of Operations Paul Shorter. From the Emergency Operations Division he selected ALS Bttn. Chief Gene Reams, EMS director; ALS Bttn. Chief Robert Avsec; ALS Firefighter Robert Trimmer; and ALS Firefighter K.C. Sehlhorst. The sixth member of the team selected by Elswick was ALS Senior Capt. Paul Newton from the Training and Safety Division.

The RRIT team would work 8:30 a.m. to 5 p.m. Monday through Friday with the sole focus of enabling the members of the organization to meet the program start date of July 1, 2002. The entire team met for the first time Jan. 2, 2002. The chief's instructions to the project team were to conduct the analysis, planning, implementation and evaluation necessary to make the revenue recovery program successful. Elswick further directed the team to make a change in the way it did business so that:

• The department would continue to deliver high-quality patient care to those who need the services while obtaining the necessary billing information through an easy-to-use system.
• The department would continue to have good working relationships with the county's volunteer rescue squads.
• The program would positively reflect the confidence expressed by the board of supervisors in our organization when they approved the program.

The team's makeup played a huge part in its success during this project. Each member brought a variety of knowledge, skills and abilities to the table; the variety of tasks that members ultimately became involved in extensively drew upon the talents of everyone on the team.

There was equality between members of the team; rank didn't matter. The team overcame the obstacles innate in a very hierarchical culture through daily team status meetings and fact-finding trips to other localities. These working situations early on in the project provided many opportunities for team members to gain confidence as communicators and develop a feeling that they were valued as team members.

The team had clear authority and direction. Everyone in the organization knew that the implementation of revenue recovery was a top priority for the organization and for the fire chief. In addition, the individual team members enjoyed credibility with the rest of the organization. Their years of experience, the range of their duty assignments and personalities all added up to a group of people trusted by others in the organization. The team had operations people, experienced field medics, middle managers, computer people and good teachers. All of this added up to a team composed of people who others in the organization felt could talk the talk and walk the walk.

Communications strategy

With a graduate of the Executive Fire Officer Program on board and another in the middle of the program, the team developed a change-management plan that was a crucial component in its efforts to have a positive influence on the organization's members as it embarked on this major change.

The first step for the RRIT members was to communicate well within the team. The team established an electronic revenue recovery mailbox and calendar on the county's intranet so that members could keep a common schedule for the team and have a venue to share information and documents.

Each morning began with a status meeting that lasted no more than 50 minutes. These meetings became an excellent forum for sharing information and solving problems. For many of the team members, these were the first meetings they had ever participated in where people brought an issue to the table with no idea about what to do with it, actively engaged others in discussion about it and eventually came to a successful resolution that was someone else's idea.

Shorter, the team leader, provided a project status report to Elswick every Friday afternoon. These briefings kept the team's “chief sponsor” informed and educated about progress, challenges and any need for additional resources. When Elswick had to approach other county departments for resources and assistance, he was able to do so with full faith and confidence in the team's work and needs.

The team's communications strategy included developing one consistent message that would be delivered multiple times. The RRIT made a commitment to engage members of the organization by communicating early, often and consistently but more importantly by seeking their input. Through focus groups at every fire station, meetings with the battalions, presentations at company officer meetings and ALS continuing-education classes, the team demonstrated a commitment to listen more than it spoke. The members of the RRIT focused on two-way communication; they didn't just ask for feedback, they actively sought it.

The team also developed and delivered one consistent message to the public: The pursuit of reimbursement for ambulance transportation was going to help fund future improvements to the county's EMS system. Using a variety of media, including tv broadcasts, newspaper articles, Internet postings and direct mailings, CFEMS sent that message to the citizens of Chesterfield County to inform and educate them about revenue recovery prior to July 1.

Avoid the creep

The team focused on the “billable ticket,” what it needed to do as a project team to enable CFEMS firefighters and officers to produce patient-care reports that contained the necessary clinical and billing information for the call to be reimbursed.

There were many opportunities for “project creep,” or work on things that have some connection to the project but really take away from the goals and objectives. This was particularly true when the RRIT started working on an electronic patient-care reporting system. They soon found themselves talking about fixing other problems associated with the organization's EMS operations: patient-care documentation practices, supervision of EMS providers, lack of battalion staff involvement in EMS issues and more. When their discussion of these issues started to creep into the picture, they were always able to get back on track by asking the group, “What does this have to do with the billable ticket?”

The members of the RRIT did not have other job duties that took them away from completing their tasks in the project, which allowed them to be more responsive. As problems or issues arose, they could get together and work out resolutions quickly. They did not have to juggle schedules or worry about obtaining meeting space, because Elswick provided the main conference room in fire administration as the team's headquarters.

This tight focus enabled the RRIT to keep a hand on the wheel, especially when it was time to start putting parts of the plan into action, such as beginning a training program or collecting billing information. The team was able to process information quickly and take action as necessary to keep things moving forward.

Off the path

Not being experienced systems thinkers, the RRIT members occasionally made decisions and developed plans that caused problems. They learned it is better to think through solutions to problems as they arise and test those solutions prior to implementation, to lay out solutions to members at all levels of your organization and get feedback, and to stay flexible and emotionally detached from a position.

The team needed to view its project-critical path more like an incident action plan: Monitor it, ensure that they were meeting their objectives and make changes as necessary. They did not do that very well. For example, when the team decided that the best option was to replace CFEMS' paper-based patient-care reporting system with an electronic one using handheld computers, they didn't go back and rethink the critical path for the project. The team managed this major change as a subcomponent of the project; in reality it was a project within a project.

Another problem cropped up when working with outside agencies. The RRIT frequently needed the services of several other county departments — public affairs, county attorney and information technology — and these folks didn't work in a hurry. We in the fire service are programmed to see the problem, assess the problem and take action on the problem. We do this daily and we become good at doing it quickly. That method frequently doesn't serve you well in project management and interdepartmental relations.

In general, a strategic project team can reduce its problems if they:

• Have clear direction from the chief and ensure that everyone knows it;
• Develop a good project management plan and stay the course, making necessary corrections but always moving forward;
• Cross the goal line by sticking to a deadline;
• Be proactive by talking to people face to face, as communication is critical in developing support for the team and its mission;
• Collect and analyze data, as well as make data-driven decisions; and
• Respond to concerns with feedback and action where appropriate.

Storyteller strategy

The RRIT members recognized the enormity of the challenges they faced when they embarked on the project. They would not only be the guiding force for this monumental change in Chesterfield County; their efforts would serve as the model for future strategic project management teams.

The organization's strategic business plan already contained several other projects of importance for the organization, including implementation of a new staffing management system and development of a succession-management program. Members of the team knew that how they went about getting the job done would be just as important to the organization's future as the results of their efforts. Throughout the project, team members diligently maintained copies of the information they collected and analyzed as well as the documents they produced so that others could follow in their footsteps.

Following the successful July 1 implementation of revenue recovery, however, the team began to look at this aspect of the project in a different light. While it had volumes of documents in both hard-copy and electronic-file formats, the members began to question how user-friendly all of that information would be to those who followed in the future.

The use of story as an effective means of communicating a business organization's history from one generation to the next is a best practice that more organizations are embracing. The team members felt that such a story also would encourage members of the organization to step forward when it came time to form those future project management teams. Therefore, they wrote and published an 82-page document, “The Revenue Recovery Implementation Team — The Story of a Strategic Project Management Team,” which was distributed to every fire station and work unit within the organization.

Since the conclusion of the RRIT's work, Chesterfield Fire and EMS has used the strategic project management team concept to analyze its staffing-and-leave management program and its system for delivering ALS services. The recommendations from those teams are now part of the department's strategic planning and budget preparation processes.

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Bttn. Chief Robert P. Avsec is a 22-year member of Chesterfield Fire & EMS and currently serves as the director for the department's Training and Safety Division. He is also a contract instructor for the National Fire Academy.

SKILLS BRING TEAM TOGETHER

One of Gen. Norman Schwarzkopf's five guiding leadership principles states: “Foster loyalty and camaraderie in the team, because when things get really rough in combat those are the only things that you can count on.”

Some may think that comparing the work of a project team to combat is a bit over the top, but the point is that your team has to be flexible and actively create contingency plans because stuff happens.

The Chesterfield Fire and EMS team members ultimately made modifications to practically every task associated with the project, including training programs, implementation plans, and plans for sharing information and obtaining provider input. They were able to successfully make those adjustments because of the positive can-do attitude every team member brought to the job.

The team members were chosen for the skills they could bring to the project. For example, Paul Shorter had been a key member of the team that had been engaged in conversation with various public groups to develop support for a revenue recovery initiative; he knew the issues and concerns first-hand, especially those of the volunteer rescue squads. As a member of the chief's executive leadership team, he had many years of experience working with members of the board of supervisors, the county administrator and his staff, and other groups inside and outside county government. Chief Steve Elswick also felt that Shorter's more than 30 years of experience in various work assignments throughout the organization made him ideally suited for blending the various talents of the other team members and bringing out the best each had to offer.

Gene Reams and Robert Trimmer, through their work in the EMS Division to develop the revenue recovery proposal that the board ultimately approved, brought historical perspective to the team. Reams also would, through his role as EMS director, have a significant role in the administration of revenue recovery after the team completed its work. In addition, he was knowledgeable about Medicare and Medicaid rules and regulations and the workings of the health insurance industry in regard to reimbursement for emergency ambulance transportation.

Trimmer brought to the team his recent experience as a fire department ALS provider and previous experience working for private-sector EMS agencies that billed for emergency ambulance transportation. His strong background in the computer sciences, especially in database management and computer graphics, also was key in his selection for the team.

Robert Avsec brought to the team his knowledge and experience as an ALS provider, operational perspective as a battalion chief in emergency operations, and past experience working for private-sector EMS agencies. Elswick also believed his knowledge and skills in the areas of project and process management and strategic management of change as a graduate of the Executive Fire Officer Program would benefit the team.

As an ALS firefighter, K.C. Sehlhorst was selected for his knowledge and perspective as a current EMS provider in the field. Of all the team members with private-sector EMS experience, he had the most current knowledge of working in a system that bills patients for its services.

Paul Newton brought his experience as an ALS officer and provider to the team, as well as his experience as a battalion staff officer in the emergency operations division. Having just been assigned to the training and safety division, he was also counted on to provide that perspective to the work of the team. Newton also was a graduate of the county's total quality improvement university and had completed the strategic management of change course as a graduate candidate of the Executive Fire Officer Program.

Several team members had received training in project management, data collection and analysis, and focus groups, but many had not actually worked with those concepts. Therefore, they brought in a “Quality Coach,” Chief of Administrative Services Jo Lin Rohr, who had extensive private-sector experience in these areas, to give them a refresher course. Often in these sessions Rohr walked them through the material using the data they were working with; the team learned by doing the work itself.