How to develop a Medical Transport Service

(1)

How to develop a Medical

Transport Service

(2)

1. Introduction

Many organisations, groups and individuals provide transport to medical appointments for people in their community. Some services have volunteers using their own vehicles to transport people; others may use a volunteer bus driver with a coaster bus owned by the organisation.

The model used by the majority of community transport organisations is to transport consumers in a variety of vehicles - coaster buses, sedans, station wagons, etc. using a mix of paid and unpaid workers. These trips are controlled and scheduled by the community transport organisation.

This document discusses a brokerage method of transport using a partnership

arrangement between the project and taxi company as the service provider. The manual is based on the medical run transport services developed by the Transport Options Project (TOPS) funded by Home and Community Care (HACC), auspiced by Queensland

Council of Social Service Inc. (QCOSS). The service provider the TOPS project chose is the Yellow Cab Company based at Woolloongabba.

This medical transport model

is a partnership between

the Project

the Service Provider

and the Consumer

TOPS have been funded by HACC as an indirect transport model. The project area covers over 80 suburbs in Brisbane South (south of the Brisbane River) within the Brisbane City Council boundaries. A map of the project area is included in Appendix 1. See also the chapter on HACC statistics on Brisbane South included in this document. The Project does not own a vehicle – the Project brokers to bus and taxi companies to provide services for eligible consumers.

TOPS received initial funding in 1998 as a HACC agency to provide transport to eligible consumers in Brisbane South. During 1997 a research project was undertaken by

QCOSS to survey transport needs for HACC eligible consumers. QCOSS then applied for funds and the TOPS project came into being. The project initially worked as an information source, gathering transport information on public transport services, information on transport schemes and subsidies, shopping and community transport services. The Project produced Transport Bulletins and Fact Sheets in English and other languages to increase consumer awareness of these transport options.

TOPS produced in collaboration with the HACC project for Brisbane North – Transport Access (TAP), auspiced by St Johns Ambulance the Transport Options and Access

(4)

Guide (TOAG) in 2001. Queensland Transport assisted with formatting and production of the 2001 edition. Printing funds for this edition were provided by the Department of Veteran Affairs. The booklet contained detailed information on transport options across Brisbane and was made available to consumers, groups, agencies, hospitals etc. The booklet assisted consumers to access transport information and to use the transport resources that were available to them. This booklet was updated and reprinted in 2004.

TOPS has worked with a community development methodology from the beginning of the project. The Flexiride, an accessible community shopping bus for the people of Wynnum, Manly and Lota was developed in 2000. This service is still in operation today and uses a brokerage method of delivery via a bus company providing a low floor

accessible bus with a TOPS staff person, acting as bus escort, to transport people to shopping centres in and around the area. A manual was prepared to share this

development named “How to develop a Flexiride Service”. Evaluations of the Flexiride service have occurred annually and now biannually. The manual and evaluation booklets are available from the Transport Options Project.

The TOPS project has always shared with the community the development of transport services and encourages you to read on the following pages, the model developed for a

brokered medical transport service.

Work commenced on the inaugural medical transport service, the Inala Hospital Flyer, in 2002 to gain funding and the first passenger was transported in November 2003. The Inala Hospital Flyer was renamed in April 2004 - the South West Brisbane Medical Transport Run. (see the chapter on Development of the Inala Hospital Flyer)

Brief Description of the Medical Transport Service

A pre booked, group ride medical transport service, brokered to a taxi

company as the Service Provider, using a selection of vehicles in the fleet of

the taxi company.

Eligible consumers receive door to door transport from their home to one of

the designated destinations of the medical transport service.

The service operates Monday to Friday from 7am to 4pm with a set fare and

run schedule.

(5)

1.1 Consumer market – Medical Transport Service

• Consumers who are willing to share ride a vehicle to a set destination

• Consumers who reside in the geographic area of the Medical Run

• Consumers who can no longer drive a car

• Consumers who cannot safely use public transport

• Consumers who are able to independently or with the aid of a carer

access the transport service

• Consumers who are ineligible to be transported to medical

appointments by Queensland Ambulance non urgent patient transport

• Consumers who do not hold a Gold Card from the Department of

(6)

2. Background to the Development of the Medical

Service.

From the commencement of the TOPS project in 1998 - consumers, agencies and medical professionals requested assistance from the project with transport for their clients to medical appointments. These questions were handled in a number of ways –

1. If the consumer was able to use public transport they were given the necessary contacts to ascertain the timing of these services. Sometimes it would be

necessary for consumers to catch two buses or a train and a bus to gain access to their medical appointment. TransInfo became a very important contact for people using public transport. Operators were able to advise the bus number, bus stop etc. to enable access.

2. Some people were able to drive themselves to their medical appointments but had difficulty locating available parking, or were unable to walk from the car park to the hospital. Most major hospitals now have car parks or drop off zones available for these purposes. The Princess Alexandra (PA) hospital has a courtesy bus to assist people using the car park and public hospital to gain entry to the main hospital. Some private hospitals have a courtesy bus which will pick up people from various locations.

3. Other people were able to make contact with a friend or relative to drive them to the appointment and contribute by paying the parking fee.

4. Some people had Taxi Subsidy Scheme vouchers but were unaware how to use them or had exhausted their supply. The project developed a Fact Sheet to assist members of this scheme and would mail this information out to them.

5. Other people had Taxi Subsidy Scheme vouchers but could not afford the shortfall. The project would then assess people and provide assistance if necessary via project taxi vouchers. This approach worked well for a ‘one off’ medical appointment but became expensive for ongoing medical appointments and very labour intensive to manage within the available funding.

6. Some people were eligible to use the Queensland Ambulance Service non urgent patient transport and were referred to this organisation.

(7)

7. Some people held a Gold Card and were eligible to use the DVA patient transport.

8. Spouses of people with a Gold Card had difficulty when visiting their spouse in hospital. The RSL has now developed courtesy buses which work in a number of locations within the Brisbane metropolitan area to provide access for visitors.

9. Other HACC funded Agencies received many requests from their HACC clients for medical transport to destinations. A trial of TOPS funded taxi vouchers commenced in 1999 with 10 agencies holding quantities of vouchers and allocating these as the need occurred with their HACC clients.

Each agency entered into a Memorandum of Understanding with the TOPS project regarding the use of these vouchers. This program was very successful and the agencies involved became extremely important as key stakeholders in developing the medical transport runs. (A manual is available on this program titled “How to develop a dollar limited taxi voucher scheme” available from TOPS).

In Summary

There were an increasing number of people that were unable to access any of the above options. Project funding to meet the ongoing need of the TOPS funded taxi vouchers was not sufficient or economically viable. A new method of transportation had to be devised to meet this identified market niche of the transport system.

The Project commenced logging the suburb where people lived and the medical destination they were trying to access to build a picture of the transport need.

Over time this information was fed into HACC quarterly meetings, surveys and planning meetings. The logged information from consumers and the input from agencies were valuable in developing this medical transport service.

Funding was secured from the Gambling Machine Benefit Fund to commence the Inala Hospital Flyer trial and from HACC using NSV funding to commence the Bayside Medical Run trial.

(8)

2.1 Development of the Inala Hospital Flyer

(This service is now known as South West Brisbane Medical Transport)

In the first instance (April 2003) the Inala Hospital Flyer was developed using a similar model to the successful Flexiride shopping service the project had developed in 2000.

• A bus company (National Bus Service now Veolia Transport Brisbane) which

provided the chartered bus for the Flexiride was approached to partner the project with a weekly accessible bus to service an identified area of consumers at Inala and Acacia Ridge using some door to door pick ups and some set pick up points.

• The bus would transport consumers to the major south side hospitals and dental

clinics. The destinations of Wickham Terrace specialists and north side hospitals by negotiation.

• Bookings would be taken from consumers by the bus company for the service.

• A volunteer escort would be on the bus to assist people with access.

• A fare of $10 per trip was established – this was later reduced to $5 per trip.

Funding was applied for a trial of this model from the Gambling Community Benefit Fund in December 2002. The application was successful and in May 2003 the service commenced.

Whilst some enquiries were received from consumers in regard to this service, no

bookings were ever taken. In July 2003 after meetings with the community collaboration group and consumers it was decided to reduce the fare to $5.00 per trip. The service was advertised in local papers but again enquiries were received but no firm bookings. In August 2003 the TOPS project was restructured and relocated to a central location within the region at Woolloongabba.

In October 2003 a meeting of stakeholders was convened to discuss the situation and possible options. From this meeting a proposal was put forward to trial a pre booked, door to door, group ride taxi service using sedans, operating Monday to Friday. An initial fare of $2.00 per person per trip and carers would travel at half fare was proposed. The service was to operate from 7am to 4pm,Monday to Friday, with four forward journeys and four return journeys each day.

(9)

Why didn’t the initial model work –

• The service only operated one day a week (Thursdays) and people had medical

appointments Monday to Friday.

• It was difficult for people to change their given appointment times to a Thursday

because different clinics work on specific days at specific times.

• The service offered was not flexible enough – there was a morning forward run

and an afternoon return run.

• An accessible bus was not the right vehicle for the service.

• A medical service is completely different to a shopping service where people go

on a weekly or fortnightly basis to attend to their shopping needs. There is no consistency with medical appointments.

What happened next –

A meeting was convened (October 2003) of key stakeholders to discuss a revamped service for the Inala Hospital flyer -

• the area of need – suburbs were suggested to commence the service.

• medical destinations were provided.

• What was available in the community for medical transport was listed.

• The kind of vehicle to use for this purpose. It was noted that the DVA transport

model worked well with both taxi companies providing silver service or business class vehicles for this purpose.

• Frequency of service – it was agreed a Monday to Friday service would better

meet the need.

• Timing – a number of forward runs and return runs were proposed each day.

• Fare – as the previous fares of $10 and $5 per trip were unsuccessful - $2 per trip

(10)

• Bookings – a deadline of 12 noon on the day prior to travel was suggested.

• Funding – an amount from the Gaming Machine Benefit Fund remained and a

small amount of HACC funding was also provided.

• Eligibility – both HACC and non HACC consumers would be transported. Non

HACC consumers would pay a higher fare.

• It was agreed that the revised project should commence in late November and that

all stakeholders would promote the service to their clients and refer clients to TOPS.

How was this revised service model developed ?

The project had five weeks to revise the operation of the Inala Hospital Flyer and redevelop the service, using the input from the meeting with Stakeholders. Some of the key issues completed were –

• TOPS staff were recruited and trained to undertake the registration process with

consumers and the development work for the service. Staff visited the destinations to gain access needs and spoke with key people involved in the major hospital transit lounges to work out safe ways to drop off and pick up consumers.

• Negotiations took place with the Service Provider to establish the new model of

service

• Consumer assessment tools were developed

• All interested parties were emailed on a regular basis (newsletter) to keep

everyone up to date on progress

• One of the destinations, Wickham Terrace specialists, had limited vehicle access

to the area. TOPS staff spent significant time talking with each of the medical areas, providing information on the service and sourcing access points for consumers. This area has limited access points and is logistically challenging. Registrations of consumers commenced a week prior to the new service commencing on Monday 24th November, 2003.

Within two days of the new service commencing trips were being made by consumers using this new model.

(11)

Stakeholder review

In February 2004 the Project convened a meeting of stakeholders to discuss the progress of the Inala Hospital Flyer. From this meeting the following changes were made to the service –

• The geographic pick up area was expanded

• An extra daily forward and return journey was added to the service

• The name of the service was changed from the Inala Hospital Flyer to South West Brisbane Medical Transport. The new name better reflected the area serviced.

• The fare was increased from $2 per person per trip to $4 per person per trip for

HACC eligible consumers and $10 per person per trip for non HACC passengers. These changes came into effect in April 2004.

A Consumer Review was undertaken during March/April 2004. The report from this review was tabled at a key stakeholder meeting in November 2004.

(12)

3. Outline of the Medical Transport Service

A group ride service

Consumers travel with other consumers to set medical destinations. In a sedan this would allow three or four consumers to travel in one trip to a destination/s or in a multi taxi up to six consumers to travel. The number of consumers travelling can make the trip more economical.

Example - four consumers travelling with a total fare for the trip of $40.00. Each

consumer may pay $5.00 per trip; amount collected by driver $20.00 leaving the shortfall for the trip at $20.00. This shortfall is paid by the project. $20.00, divided between four consumers – the project would fund this trip at $5.00 for each of the four consumers.

Door to door service

Consumers are picked up from their home address and given assistance where needed into the vehicle. Special arrangements can be made via the consumer template (registration card) to assist with mobility issues. Consumers are transported to the booked destination with other consumers and carers.

On the return journey the driver will arrive at the Transit Lounge / medical centre reception area to escort the consumer to the vehicle. Consumers with wheelie walkers, and walking aids are transported. Consumers being admitted to hospital can take one suitcase with them on the forward journey. These items need to be indicated when booking the service with the service provider to allow for space allocation, e.g. a station wagon instead of a sedan may need to be used depending on the size of a walking aid.

Geographic pick up area for service

Each service has a particular geographic area – by suburb. This is arranged so that the most economic route for a group ride situation can be implemented, taking into account the medical appointment time, the time for cross suburb pick ups from the service base, before undertaking the journey to the destination. The Service Provider takes into consideration these points when allocating vehicles for consumers.

Suburbs along the main roadway are added into the service. For example the suburbs of Wynnum, Manly and Lota form the base of the Bayside Medical service. The suburbs adjacent to the roadway used to access the destinations (Wynnum Road) are added into the service (Tingalpa, Cannon Hill, Morningside, and Norman Park etc.).

(13)

Set destinations

Each service has a number of designated medical destinations that the service accesses. These destinations are initially set by discussion with consumers, HACC agencies, medical centres and health professionals prior to the service being formulated. Destinations are reviewed by regular agency and consumer surveys of the service.

Within some major hospitals there can be a number of different buildings consumers need to access. For example – PA Hospital at Buranda has a number of different clinics within the complex. Arrangements were made with the help of PA staff for consumers to be transported by using the service road within the complex to the building for the clinic they were attending. This was particularly important for consumers with limited mobility, as the complex is located on a hill. Likewise the Mater Hospital has an Adult Hospital, Children’s Hospital, Private Hospital and Medical Centre. Each of these facilities has an access point for consumers as some locations are not within walking distance of the main drop off point, the Adult Hospital.

Service operation times

Each service will have set operational times. All of the medical run services developed by TOPS operate Monday to Friday between 7am to 4pm. The number of forward and return journeys each day is decided firstly by available funding and secondly by taking into consideration turnaround time at hospital appointments.

When initially developing the runs, Project staff will need to discuss appointment times with consumers, agencies, hospitals and health care professionals in regard to the turnaround of patients. Some clinics may have a 30 minute turnaround, with other areas it may be up to two hours. Some patients may be referred on to two to three clinics on the one day, and then have to pick up medication from the pharmacy. No two consumers will be the same, so a generalisation has to be made from the given information.

Project staff will need to meet with each destination to discuss with the different clinics their hours of operation and frequency to develop the transport service to meet the particular needs of the area being developed.

The funding you have for the transport service is also an important consideration. You may only have enough funding to accomplish two forward trips and two return trips per day for a particular service. Timing will therefore be extremely important. You will need to discuss in detail with the medical destinations the days and appointment times they allocate to patients for the various clinics operating from each destination.

(14)

Fares

Each consumer pays a fare to the driver on entry to the vehicle.

Carers and children under five accompanying the consumer pay half fare.

Example - Consumer pays $5.00 per trip – accompanying carer pays $2.50 per trip. Only one carer is usually allowed to accompany the consumer. Fare given by the consumer to driver for consumer and carer is $7.50 per trip. The support of a carer is particularly important as consumers age, are visually or hearing impaired, need an interpreter or just need some support when meeting with a doctor.

Each service has a prepared brochure which is given to all consumers detailing how the service operates. Fares are reasonably priced and are usually around the $5.00 per trip for a long haul journey and $2.50 for a local trip. Fares are payable to the driver after

entering the vehicle.

If consumers are using the transport service on a daily basis for a period of time, they are able to contact agency staff to discuss fares applicable.

Vehicles used

Sedans, station wagons, maxi taxis (accessible vehicles) and multi taxis are used. An agreement was made with the Service Provider for the use of Silver Service vehicles when available as the first transport priority. This option was suggested to provide consumers with the best possible transport service to meet their needs. Drivers are trained to respond to consumer needs and assist with the stowage of walking aids.

Name of the service

It is important for the name of the transport service to reflect the area that the service will cover. This is an ideal opportunity for the key stakeholders and consumers to take some ownership of the run and put some names forward for consideration. If you will be developing more than one medical transport service take time to consider the name – something short and the start of the name is usually used for the abbreviation on the registration card. For example, with the Bayside Medical run, registration numbers commence with BM.

If you are developing a local and a long haul medical transport service – No 1 usually becomes the long haul and No 2 the local service. Registration covers both services so the one registration number covers both services for the consumer.

(15)

4. Processes used to develop the Medical Transport

Service

Establishing the need for the service

This can be done by –

Logging the calls you receive from consumers requesting this service by developing a form with the following information

• suburb/area

• local or long haul service • destinations required • name and address of caller

Commence working collaboratively with agencies to provide assistance with transport for clients to medical appointments.

• Regular discussions with agencies in relation to their consumer needs and log

this information for funding submissions

• Collect trip information from agencies / consumers, in relation to destinations

and frequency

• Establish a project funded taxi voucher system to gauge the actual need for a

scheduled service.

Identifying the area for the medical transport service to be developed

• From the information logged from consumer requests, agency and community

group feedback take a map of the area and highlight the suburbs identified.

• The base of the service or starting point needs to extend no more than 10

kilometres across.

• Good cross suburb access between the base suburbs is important and if this is

not the case the base may need to be decreased in size.

• Mark the requested destinations on the map with a different highlight colour

and establish the corridor road routes that would be used to access these points, from the identified suburbs.

• With this information, it is then possible to add to the base suburbs the

suburbs that can be accessed along the corridor road routes to the destinations.

• At this stage it is advisable to have a meeting with your selected Service

Provider and discuss the proposed area to be serviced and routes to be used.

• The Service Provider will be able to indicate if there are any particular peak

times in this area, i.e. work, school, shopping etc. so that you can then make some decisions in relation to frequency of the service, hourly, two hourly etc. The cheapest time to travel is off peak but you need to weigh up the timing of the appointment times as well. Most services have a forward trip commencing

(16)

at 7am for an 8am appointment. The last return trip is normally 4pm as after that you are in peak time for travel.

• For economy it is wise to develop services within the lower flag fall

timeframe.

• Once you have established the best way to develop the service, it will be

timely to meet with the Key stakeholders, agencies, consumers etc.

Development of local and long haul services

You may decide to develop a local transport service to local doctors, allied heath practitioners and carers groups with the separate development of a long haul service to major hospital and medical centre destinations. (Runs 1 and 2) The establishment of each of these services will meet most consumer medical needs and enable the consumer to remain independent.

The local transport service will need to be more time responsive, as the consumer will be visiting a doctor, dentist, optometrist etc. Forward and Return journeys on the hour have proven to be useful for local services.

With the long haul transport service, in the case of the Bayside Medical run, the base suburbs are often 20-25 kilometres away from the destinations. It is important not to offer too many frequencies, firstly because of the cost of the trips and secondly the fact that you need to group ride to keep the trip cost economical.

When commencing the medical run services it will take some time for the consumer pool to develop to have good group ride numbers. It maybe six months into the service before you see good groupings in sedans occurring. The next level of economy will be with the use of multi vehicles (if the Service Provider has these in the fleet)

As an example let us look at what the current Bayside Medical service offers –

Run No 1 – long haul to five major destinations operates Monday to Friday providing six scheduled forward journey times each day and six scheduled return journeys each day. This run has been established since February 2004. Initially the service commenced with four forward and four return runs each day. Over time and with growth funding the frequencies have been able to be increased.

Run No 2 – local medical destinations (includes doctors, allied health professionals, specialists, optometrists, dentists, X-rays, therapy pool) - operates Monday to Friday providing seven forward journeys each day and seven return journeys each day.

(17)

Meeting with Stakeholders, community groups and interested individuals

These are the people who will help you to mould the service into being. They are usually local people who currently work with medical transport for their own clients. The larger agencies may have taken part in a Project funded taxi voucher scheme. These are valuable organisations, as they have their fingers on the pulse and you can check the outline of the service with them. (See outline in this manual)

• Once you have partially established the best way to develop the service, it will be

timely to meet with the Key stakeholders, agencies, consumers etc.

• For this meeting you will have prepared an outline of the proposed service and

you will need input from the attendees in regard to –

name of the service

fares for the service

days of operation

times of travel both forward and return, make a suggestion for a start and a finish and fill in what trips would be left with the available funding

confirm the destinations

eligibility

booking arrangements

promotion by the project and how the key stakeholders can help with this

who should receive enquiries, this probably needs to be the project developing the medical transport service

(18)

4.1 Appointment of a Service Provider

As the TOPS project services the Brisbane south area, discussion took place with both Brisbane taxi companies to negotiate a suitable service provider and the part each partner would play. A decision on the service provider was made in relation to

• the fleet of the taxi company,

• the willingness of the taxi company to partner with TOPS to embark on this

new service, and

• the ability of the taxi company to provide information to meet HACC, MDS

(Minimum Data Set) and project requirements.

Responsibilities of the Service Provider

Initial discussions need to occur with the selected Service Provider in relation to “how the service will work”. Preliminary discussion on the actual service need to include –

• suburbs to be serviced • routes to be used • vehicles to be used • availability of vehicles • collection of fares

Each partner will need to take responsibility for certain processes. The Service Provider will normally undertake the following –

• booking processes • allocation of vehicles • driver training

• communication centre staff training • invoicing of shortfall

• daily run summaries

• template for consumers (registration card) • weekly trip information – consumer / cost

(19)

Cost negotiations with the Service Provider

The project needs to negotiate with the Service Provider the cost of the service to be provided –

• rate per km

• flag fall applicable

• surcharge for different vehicles • administration fee

It is important to note for the budget of the Project that taxi fares increase annually and this is usually negotiated between the State Taxi Council and the State Government. The Taxi Council makes a recommendation to the State Government Department of Transport for an increase and this can be in the kilometre rate and / or the flag fall (applicable in Queensland).

This increase usually occurs toward the end of a calendar year, however with the current increase in fuel costs, increases may occur at other times. The Service Provider will usually insert a clause in the Memorandum of Understanding, as below –

“Subject to a fare increase being granted by Queensland Transport, Service Provider

reserves the right to pass on that increase to the project.”

Important note

Consumers with State Government Taxi Subsidy Scheme vouchers cannot use these vouchers on a contracted Medical Run Service. 10 percent of the current members of the medical runs managed by TOPS hold taxi subsidy scheme (TSS) vouchers.

Feedback from TSS members indicates they use their taxi subsidy vouchers for booking a standard taxi service, when the frequency of the medical run does not suit their needs. Please refer to the eligibility of the Taxi Subsidy Scheme, as this feedback reflects their limited mobility/medical condition. Their medical conditions may also allow these people to access the Queensland Ambulance Service non urgent patient transport. Unfortunately QAS does not transport people with walking aids and carers.

(20)

Preparation of the Memorandum of Understanding

A Memorandum of Understanding between the Project and the Service Provider is then prepared for the period of the trial. This document contains information on –

• Name of the service • Objectives and Principals • Outline of service

• Geographic area to be serviced • set medical destinations

• frequency of service • booking arrangements

• fares for HACC, non HACC, children under 5 and carers • responsibilities of each party

The document is reviewed –

• before the end of the trial period;

• depending on circumstances, a new document may be prepared for a further

six months or negotiated time frame;

• once established, on a yearly basis to tie in with funding.

Meetings with the Service provider and Project worker

Once the service has been developed with the Service Provider a regular meeting time needs to be set to address issues. In the first month of the service – meetings may take place on a weekly or fortnightly basis. The meetings may then move to monthly, quarterly and then six monthly basis.

Items that need to be discussed are –

• Consumer feedback • Consumer usage

• Cost of the service to budget • Service Provider feedback • Vehicle allocation

(21)

4.2 Developmental Responsibilities of the Project

Budget Development

• Develop a Budget for the Medical Transport Service to include –

• trip shortfall costs

• printing of marketing material and consumer information

• mailing costs for consumer information (approximately $1 per consumer kit) • mailing costs for medical centres, agencies, groups, hospitals etc. (who do not

have email or are unable to provide large quantities of brochures for their clients)

• telephone costs covering initial contact to medical centres etc. plus cost of

confirming transport to each consumer on a daily basis

• staffing needs

Marketing material development

• Develop a three fold Brochure on the service covering the following topics –

• where will it pick up ? • where does it go ? • how much will it cost ? • what days, what times ?

• what’s so special about this service ? • how to book ?

• Project details

Select a colour for each medical run and establish all cards, brochures, marketing materials in this colour, so that consumers can easily identify the service. A landscape layout was found to be the most informative design for the brochure. Organise printing of sufficient copies for promotional and marketing work, as well as consumer information. It will be necessary to provide large quantities of service brochures to all destination points.

(22)

Consumer registration

• Develop a Registration process for consumers to use the service –

• assessment tools for registration to meet funding guidelines • Passenger Registration form (see below)

• member registration card, credit card size (Appendix 2)

• develop a consumer welcome letter and consumer information kit (see below) • Passenger information sheet (see below)

• training for staff on registration process

Ideas on how to develop the above tools -

• Passenger Registration form (Appendix 4) to provide information to the Service

Provider to establish the consumer template. This form is part of the consumer registration process. This form is faxed to the Service Provider on completion of the consumer assessment and provides the following consumer details –

• Medical Service to be used • Name

• Address • Phone contact

• questions in regard to mobility • Where can you sit in the vehicle? • Are you visually or hearing impaired? • Other information

• A tick box for assessment as HACC eligible or non HACC eligible.

This information is passed onto the Service Provider (client’s consent is given for this), and the client’s registration is processed and number generated. The

registration number is forwarded back to the project.

• Registration card – membership card providing the consumer with –

• their own individual number, which contains their special needs to use the

service (information originally faxed to the service provider for their template). This is the number the consumer quotes when making a booking for the service.

• name of the service

• booking number for the service provider

(23)

• Passenger Information sheet – giving the consumer detailed information on

‘how to use the service’ and Tips for using the service. (Appendix 3)

• How to book your forward journey • How to book return journey • Consumer responsibility • Tips for users of this service • Project information

• Taxi feedback form – a basic form developed for the consumer to provide

positive and negative feedback on the journeys to the project for discussion with the service provider. (Appendix 5)

• Letter to the consumer confirming membership of the medical transport service.

This letter forms part of the information mailed to each consumer and explains the use of the service to the consumer. Included with this letter is the consumer registration card, Taxi feedback form, Passenger information sheet, Client Handbook and HACC program services for the suburb the consumer resides within. This information required a C5 envelope and incurred a $1.00 mailing cost per consumer.

(24)

4.3 Consumer partnership

Registration by the consumer

The consumer can contact the Project by phone to register to use the medical transport service which covers their suburb.

The consumer may have found out about the service from one of the following –

• HACC agency that provides services into the home • Friend or neighbour who has used the service • Picked up a brochure from one of the destinations

The consumer will be asked some questions –

• do you drive a car ?

• can you use public transport ?

• how do you normally get to medical appointments ? • the suburb you live in ?

• Where do you need to access for appointments?

From the answers to these questions the staff person will then commence the assessment or refer the consumer to a more appropriate transport option.

Project Registration of consumers to use the medical transport services

Each consumer is assessed to be able to use the service for registration purposes. The service is for consumers who can no longer drive and cannot safely use public transport. The registration process can take up to 15 minutes and at completion the consumer will be advised if they are eligible. Registration needs to take place at least three days prior to the use of the service. This time allows for the template to be completed by the service provider and the mailing out of the registration card, user procedures etc. to the consumer by the agency.

Each registration card has its own number, which is relative to the needs of the consumer.

For example –

• can only be transported in a maxi taxi,

• driver to assist from front door of house to vehicle • entry to driveway is via easement at no 22.

• takes a wheelie walker / walking stick

(25)

Consumers must take their registration cards (similar size to a credit card) with them to all medical appointments when using the transport service. This allows the correct identification of the consumer and provides medical staff with information to book the return journey. (see sample card – appendix 2).

Each consumer will receive a letter of membership, associated HACC guidelines and a Passenger Information sheet to assist their use of the transport service. It is important for the consumer to personally register, so that they personally understand how to use the transport service. Registration staff have the knowledge to explain the procedure to use the service to consumers.

Assessment tools have been developed by agency staff to meet the needs of the transport service. Registration staff receive training to undertake the assessments and provide feedback to the project on this process.

Bookings are made by the consumer

After registration is completed, consumers will receive, within three days of their assessment, a registration card and information pack to enable the consumer to independently use the medical transport service.

Consumers are able to book their medical transport with the service provider, once they have a confirmed medical appointment at a destination included in their service. Consumers provide –

• Their registration card number • The date and time of appointment • The destination they wish to attend

Bookings close at 12 noon the business day before their appointment. For example, a consumer’s appointment is on Wednesday at 9am, booking must be made by 12 noon Tuesday. Appointment Monday 8am, booking must be made by 12 noon Friday. Only the forward journeys are pre booked.

Return bookings are made from the medical destination, when the consumer is ready to leave and are booked with the service provider for the next available scheduled run time on their service.

Medical staff will take the consumers registration card and provide the following details to the service provider –

• The name of the medical service to be accessed • Members card number

(26)

The operator will advise the caller of the next schedule service that is available and the caller will inform the consumer of the time and where to wait.

Example – medical staff ring the service provider at 2.30pm the next available run for the service requested is 3pm – the consumer is then booked on this service.

The last schedule return journey for all services is 4pm – bookings for the last service have a cut off time of 3.30pm. Consumers are advised that the 4pm run is the last service for the day and after this time they will have to make their own transport arrangements. This cut off time is needed by the service provider to ensure that all consumers are booked on and adequate time is allowed to schedule the service. Likewise, all other return times have a 15 minute cut off prior for the same reason.

In some cases hospitals may have a Transit Lounge. Negotiations are entered into with staff of the Transit Lounges to assist with the return bookings for consumers. Transit Lounges are used by Ambulance services, community transport agencies and volunteer groups as a safe ‘waiting area’ for transport services. In other situations, the receptionist at a medical centre may make the return booking and the consumer will wait in their reception area for the driver to arrive.

Some of the larger hospitals such as the PA and Mater hospitals, have a number of buildings on their complex that consumers access. Consumers, when booking their forward journey, indicate the destination and the building they want to access. The main building houses the Transit Lounge but there is a known ‘pick up’ point on the complex service road for each of the buildings needing to be accessed.

Consumers can also use the service one way. They may have a friend or relative who is willing to take them or pick them up from the medical destination and may only use the service for the journey they are unable to arrange transport for.

Transport confirmation by the Project to the consumer on the afternoon

prior to service.

The service provider emails the Project by approximately 2pm with the bookings for the next day. A staff member of the agency will then confirm transport with each

consumer, checking destination, number of passengers and timing information. This confirmation of service gives certainty to the driver of a confirmed ‘pick up’ and allows the service provider to group consumers in the most economical/geographical manner. Drivers will always inform base if no pick up occurs and the agency is then advised. The agency will then make contact with the consumer. The majority of consumers live alone, so this is an important checking mechanism.

(27)

If consumers are unavailable when the staff person calls to confirm transport, a message is left with the information and the project number to call if this information is incorrect. Telstra customers currently have the use of an answering service (101) at no charge. Staff discuss with the consumer at registration a process to leave messages if the phone is unattended.

Consumer knowledge

Membership of the service signifies that the consumer –

• Understands procedures

• Has taken responsibility when making bookings for the transport service. On

each occasion when making a booking, the name of the service and the membership number must be quoted.

• Advises changes to the project if details regarding mobility change, the

consumer moves to a new address, receives a new telephone number, etc. the consumer needs to advise these changes immediately to the PROJECT, so that the registration card can reflect current details. (This information to the consumer is contained in the Passenger Information sheet – Tips for users)

Example

Mrs Jones lives at 22 Smart Street, Happytown.

It is two months since Mrs Jones has used the medical service and during this time has moved to a new address at 54 Smith Street, Smartown.

This new address is actually out of the service area of the medical run Mrs Jones has membership of.

However the new address is covered by another medical service the project manages. The information in this case can be transferable and a new card for the service that covers the new address will be provided and medical run information mailed.

The run destinations and schedule may differ between the two services and staff will need to explain these differences to the consumer.

If Mrs Jones doesn’t advise the project of the changes, the car will go to the address on the membership card. There is a checking point here that the project uses when

confirming daily pick up times, the project staff member will confirm the address for pick up.

Project staff may also pick up on a different address that the Service Provider has

indicated for ‘pick up’ of the consumer on the daily run sheet – the consumer has advised the Service Provider but not the Project. Project staff will then follow this up with the consumer.

(28)

Safe place for keeping Project information

Information on the project and the HACC guidelines and service listing information need to be kept in a safe place for future reference by the consumer.

Participation in surveys and reviews

Consumer reviews are conducted regularly by mail, so that all changes are kept current. Consumers will receive a reply paid envelope with the survey or review forms.

Completed surveys or reviews are then posted by the consumer to the project.

*Consumers that are visually impaired are contacted by phone and the staff person will make a time with the consumer for the survey or review to be conducted.

*Consumers that have language difficulties are contacted by phone and an arrangement made with a support person to assist.

*During the initial assessment for membership of the Medical Transport Service, staff will identify ‘special needs’ of consumers

(29)

4.4 Promotion and Marketing

•

Promotion of the service is undertaken via

–

• presentations at HACC meetings

• presentations to community groups and organisations

• emails to Key stakeholders, agencies, politicians, community health centres

(a regular newsletter was developed to keep everyone informed of progress)

• staff training sessions at hospitals

• distribution of marketing materials

• QCOSS email news or other local/agency newsletters.

• Introductory letters and brochures are mailed and personally

distributed to –

• medical practitioners

• allied health professionals

• community health centres

• HACC agencies

• community and church groups in the service area

(Local distribution of the marketing material by TOPS staff gained valuable feedback from services and facilities, plus ongoing contact.)

•

Destinations are visited by a staff member to

-

• gain access information,

• explain the booking process and gain feedback on their willingness to assist

consumers with bookings

(30)

5. Evaluation and Review of the Medical Transport

Service.

After a service has been developed and has been running for six months – two reviews need to be conducted –

1. a Consumer Review, and

2. a Meeting of the Key Stakeholders (after the results of the Consumer Review are available)

Meetings with the Service Provider will have occurred, firstly on a fortnightly basis, then monthly, then on a “needs’ basis. A regular quarterly and then six monthly meeting should then be programmed into diaries. These meetings will have addressed issues as they have been raised and can usually be categorised into –

• issues relating to Consumer knowledge of the service

• issues relating to Service Provider vehicle allocation

• issues relating to driver knowledge and processes.

The Consumer Review is conducted at the end of the first six months of consumer usage. Reviews have been conducted by mail enclosing a reply paid return envelope and this has been found to achieve a 65 percent success rate. Contact is made by Project staff on a one to one basis, with consumers who are vision impaired and non English speaking.

The form used is designed to be user friendly with a simple tick box method. (Appendix 6 ) Questions are asked of consumers as below –

• Age of consumer

• Use of service – no of times

• The following questions are gauged on a satisfaction level with:

o Registration o Project assistance

(31)

o Driver assistance o Destinations used o Frequency times o Response of vehicle o Fare o Booking system o Service as a whole

• Suggestions for improvements to the service

Information gained from the Consumer Survey is then included when meeting with the key stakeholders.

At the Meeting of the Key Stakeholders, the project needs to provide details on -

• Level of consumer use

• Number of consumers in the passenger pool

• Usage by destination

• Cost of the service to date

• Distribution of the brochure and marketing material

Feedback from the different parties involved is also extremely important –

• From consumers, using the results of the Consumer Survey

• Ask for this from each of the agencies and groups present. If there is no

representative present, follow up with an email or letter.

• From the Service Provider – using input from the regular meetings

(32)

A discussion may also occur on items raised from the above feedback and some of these could be –

• Name of the service

• Fare review

• Destination review

• Frequency of service review

• Geographic area review

The Project needs to take on board information from the Consumer Survey and Key Stakeholders Meeting and it may be necessary to revamp the service to meet the newly presented needs. If this is the case, a timeline will then be entered into by the Project to make these changes. This could mean an updated brochure needs to be produced and distributed to operate from a certain date.

Before any of these changes are made, the Project will also need to meet with the Service Provider to discuss how these changes will be implemented.

(33)

5.1 Consumer Reviews

The project incurs costs for the administration of the medical transport services apart from the direct trip costs for each of these services. Administration costs relate to –

• Initial registration process

• Ongoing transport confirmation to consumers • Changes with consumer needs

• Ongoing troubleshooting and monitoring with the service provider • Meetings with the Key Stakeholders

• Periodic evaluation of consumers • HACC data entry requirements

The project will plan to undertake consumer reviews on a regular basis, as required by their funding agreement. Each consumer has a file of information and as changes occur this information is altered and the necessary changes made with the Service Provider. The consumer files are kept as per the funding agreement.

The timelines for Consumer Reviews are dependent on –

• the number of services the project manages

• the availability of project staff to undertake this task

• the amount of time to complete the task and the costs incurred

These reviews are built into the ‘Annual Plan’ for the project and usually occur within 18 to 24 month periods.

Initially tools are developed by staff to undertake the reviews. A mailing out process using a reply paid envelope has been used and this process has been found to be effective. Some of the tools used are –

• Client Review Form – used to gauge use of service and other needs.

• Client Details checklist – used to check client’s details and mobility needs.

Follow up is required to consumers not returning the mailed information within the set period of time.

(34)

Some of the reasons for no response are –

• the consumer has moved into a residential care facility

• the consumer has passed away (Project staff now check funeral notices on a

daily basis to keep these records current)

• the consumer has gone to live with a relative or friend

(35)

6. Strengths and Weaknesses of the Model.

Strengths

• An economical use of HACC funding to maintain the well being of

eligible consumers

• Consumers can independently book and use the service with the

assistance of the registration card, when they have a confirmed

medical appointment.

• Consumers can choose to take a carer with them (carer pays half fare).

A large number of consumers choose to have an accompanying carer

on long haul runs – 30 percent of consumers are accompanied.

• Consumers are able to take walking aids and wheelchairs with them.

• No bookings for a scheduled run time – no cost incurred

Weaknesses

• The model is a partnership between the Service Provider and Project

to meet the needs of the consumer. All partnerships need continual

work. Commitment by key people to ongoing maintenance of the

service is critical to the success of the model.

• Consumer changes – address, move into residential care or onto care

packages – are not always advised by the consumer, these items need

to be included in the review tools.

• Individual Taxi Subsidy scheme vouchers cannot be used with the

(36)

6.1 What was learnt

The model can be used by people with special needs

• Visually impaired consumers are identified and receive information in large

print. Their support services provide telephone programming and large print assistance to help with their independent use of the transport service.

• Hearing impaired consumers are identified and use the TTY services to make

bookings to access the service. Alternatively, a SMS system for bookings and confirmations can be utilised.

• People from CALD backgrounds are able to use the service independently and

/ or with the help of a support person.

• People with limited mobility in wheelchairs or wheelie walkers are able to use

the service independently or with the help of a carer.

Consumer information on ‘how to use the service’ must be user friendly

• The consumer kit now comes in a plastic sleeve with a label “read this

information before using” to provide consumers with instructions to use the service. Most early feedback relates to a lack of consumer knowledge with the key processes of using the registration card to make forward and return bookings. [As with most people, we read the instructions after we have failed].

Seating allocation

To assist the Service Provider with allocation of seating within a vehicle and to fill the vehicle to maximum capacity, the Project chose to identify the needs of each consumer in regard to seating using the Passenger Registration form.

Front Seat position

There is only one front seat in vehicles and it is important that this seat is

allocated correctly. The front seat is usually the only seat that can be adjusted to height, leg room etc. Some of the priorities for this seating could be

severe arthritis

hip conditions

(37)

As some of these conditions are short term, it is important that any conditions given during the initial consumer registration assessment are highlighted when the consumer review is conducted.

If you do allocate a ‘priority’ front seat for a consumer, it is important to discuss with the consumer that the service is a group ride service and where possible their ‘priority’ will be delivered.

Back seat

Consumers are asked “how comfortable they would be travelling with

one or

two travel companions in the back seat”. This is a sensitive way to identify the number of passengers who can travel comfortably in the back seat. Some

consumers will also have difficulty travelling in the middle seat in the back (their mobility may not allow them to move to this position).

Encourage consumer feedback

• The use of the taxi feedback form provides both positive and negative

feedback from the consumer. It can also be used anonymously by the consumer. The positive feedback is given to the service provider and often passed onto the actual driver involved. Negative feedback is addressed in a short period of time and allows the model to learn from the issue.

Establish good links with the key people at destinations

–

• Immediate feedback when something has gone wrong is extremely important.

The coordinators of the hospital transit lounges advise the project if the vehicle is more than 30 minutes later than the quoted pickup time. This allows the project to contact the Service Provider – ascertain why the vehicle hasn’t arrived – and respond to the transit lounge coordinator. The consumer feels valued when they know the reason for the delay.

Address issues when they occur and learn from the experience

–

• Confusion for consumers with the location of the transit lounge at one of the

hospitals when the Inala Hospital flyer was first developed was a vital issue. When the hospital installed signage directing people to this area, the problem vanished.

• Drivers call the names of each consumer for the trip and consumers pay the

(38)

passengers allocated to his vehicle on board. Previously confusion had occurred with similar names and when more than one transport service was using the same destination point at the run schedule time. Consumers are always anxious to return home.

Use dark and light shades of one colour to denote a particular medical

service.

Keep the use of the main colour consistent when developing the registration card and all marketing materials. Each run needs to be colour specific – try using the primary colours first.

• Example – Bayside medical run uses the colour blue – light blue for run no 2

brochure and a darker blue for run no 1 brochure and the registration card. The registration card provides coverage for the local consumers of both runs.

• The use of colour makes it easy when speaking with a consumer. They may

not know the exact name of the medical run but they will remember the colour of their card.

• Colour helps confirm the runs for the drivers – if the consumer cannot

communicate but shows their card, identification happens.

Don’t take block bookings

• Whilst it may make sense to take a block booking when consumers are

undergoing a treatment process on a daily basis, this doesn’t always work. Initially the block appointment times were provided by the medical centre to the project. Unfortunately these times changed frequently and made more work and created confusion for the consumer, as well as the Service Provider.

• In discussions with the medical centre it was found there were other ways a

consumer could be advised of the next day’s appointment, which allowed the consumer to make the daily booking by the close of booking time.

• The only block booking system that works is one where the consumer is using

the service on a weekly basis on the same day and at the same time every week for the forward and return journeys. Basically, all details of the trips are consistent.

(39)

Points to remember when initially developing the geographic area of the

service

• Don’t make the base suburbs too wide. Make sure there is sufficient access

for cross suburb pick up.

• Identify the main corridor roads to the major destinations

• Add the suburbs along these corridors into the run

• Discuss your proposed service base and routes with your Service Provider to

gain feedback and confirmation.

Non HACC consumers

Often a HACC eligible consumer will ask if their spouse or partner can use this service, as a consumer. The spouse/partner may not meet the eligibility criteria for the service. They are able to travel if they are willing to pay the fare as a non HACC consumer (this is usually set at twice the HACC eligible fee, on a cost recovery basis).

You may also have other individuals that do not meet the criteria for the service. As they do not have any other transport options, they may be willing to travel as a non HACC consumer, at the appointed fare.

During the consumer review you will need to have a question about ‘mobility’. This area can change and a ‘non HACC consumer’ can become a ‘HACC consumer’.

Passenger Pool

The Project has identified that economical ‘group rides’ start to occur when the active passenger pool of any service is between 400 and 500 consumers.

(40)

7. HACC Regional Profile of South Brisbane

Planning Region 2006

The area the TOPS project covers in Brisbane South, is within the HACC South Brisbane Planning Region. The Local Planning Areas (LPA’s) of Coorparoo, Inala, Mt Gravatt and Wynnum are included in the TOPS project area. The Local Planning Area of Redlands is serviced by a separate community transport organisation.

So that you can make some comparison with the Project area, the following information has been included from statistics contained in the HACC, South Brisbane Planning Region – Regional Profile 2006 document.

• “The South Brisbane Planning Region covers Local Government areas of Redland

Shire and the Brisbane Suburbs. The borders of the Region are the Brisbane River, Moreton Bay, Southern Bay Islands, Cleveland and Wacol. The Health Districts covered are the Bayside, Princess Alexandra Hospital, Mater Hospital and QEII Hospital and Health Service District.”

• “The residential area contains a mix of high density and low density living in

inner city, suburban, rural and island environments. Some older suburbs are undergoing both renewal, and rapid development. New areas are undergoing rapid growth, including canal developments and small block and gated housing estates. There is a significant increase in the homeless population and a decrease in the number of low cost housing options in the Brisbane inner Southside area.”

• “Approximately 16.5 percent of the State’s total population resides in the South

Brisbane Planning Region.”

• “16.32 percent of the total State wide HACC Target Population (HTP) resides in

the South Brisbane HACC Planning Region.”

• “For 2006, the HTP is estimated at 65,305 persons. The population is relatively

evenly distributed across all LPAs with the exception of Wynnum and Mt Gravatt that have the lowest and highest HTP populations respectively.”

• “Within the next 5 years there will be an estimated additional 8,200 HTP eligible

persons across the Region. The Local Planning Areas expected to experience highest relative growth are Redlands (18 percent) and Wynnum (14 percent). All other LPA’s will experience growth of between eight and 11 percent.

NB – The TOPS project does not cover the Redlands LPA, so information included above referring to Redlands LPA, Moreton Bay Islands, Cleveland is not relative to the TOPS

(41)

8. TOPS Project Information

Transport Options Project

116 Logan Road

Woolloongabba

Telephone –07 3891 1755

Fax – 07 3891 3266

Email: [email protected]

Postal address – PO Box 1709 Coorparoo DC QLD 4151

8.1 Staffing

The project has a Coordinator (full time), Project Worker (part time) and two

Administration Intake Officers (job share).

(42)

8.2 Sharing Information with others

The TOPS project has always been willing to share information with others.

Discussions with organisations about the development of the medical transport services can be time consuming and repetitive for staff of the Project. The Project has decided because of the interest in these services to prepare this manual so that other individuals and organisations can read about the processes and outcomes of the brokerage model. After the establishment of the South West Brisbane Medical Transport, the project was approached by the Community Transport Solutions Unit of Queensland Transport for feedback on these developed services. The feedback was used by the Unit to develop a trial named the “Mt Gravatt Hospital Flyer”. This trial took place from April 2005 to June 2006. Queensland Transport undertook a number of trials at this time as part of a cross-agency project co-funded by the Queensland Ambulance Service and Queensland Health.

(43)

8.3 Current TOPS Medical Transport Services

The TOPS project has expanded the medical transport services and seven runs now operate in the project area.

• South West Brisbane Medical Transport Run 1

A long haul run covering the suburbs of Acacia Ridge, Algester, Annerley, Archerfield, Coopers Plains, Doolandella, Durack, Fairfield, Forest Lake, Inala, Moorooka, Pallara, Parkinson, Richlands, Rocklea, Salisbury, Tarragindi, Willawong, Yeerongpilly and Yeronga. Destinations are the major Southside hospitals, dental clinics, Wickham Terrace specialists, hydrotherapy units and allied health centres.

• South West Brisbane Medical Transport Run 2

A local run covering the suburbs of Doolandella, Durack, Forest Lake, Inala and Richlands to medical destinations within the suburbs listed.

Current Passenger Pool on South West Medical = 450 (as at July 2006)

• Bayside Medical Run 1

A long haul run covering the suburbs of Balmoral, Cannon Hill, Hemmant, Hawthorne, Lota, Morningside, Manly, Manly West, Murarrie, Norman Park, Tingalpa, Wynnum, Wynnum West and Wynnum North. Destinations are the major Southside hospitals and medical centres.

• Bayside Medical Run 2

A local run covering the suburbs of Hemmant, Lota, Manly, Manly West, Tingalpa, Wakerley, Wynnum, Wynnum West and Wynnum North to local medical destinations within the listed suburbs.

Current Passenger Pool on Bayside Medical = 700 (as at July 2006)

• Centenary & Oxley Reach Medical Run 1

A local run covering the suburbs of Chelmer, Corinda, Darra, Graceville, Jamboree Heights, Jindalee, Middle Park, Mt Ommaney, Oxley, Riverhills, Sherwood, Sinnamon Park, Seventeen Mile Rocks, Sumner, Tennyson, Westlake and Wacol. Destinations are Medical, allied health, hydrotherapy, carer and social support groups within the

How to develop a Medical Transport Service