ASHBEAMS Standards The Why and How

ASHBEAMS has written comprehensive standards that are applicable to all aeromedical providers. The organization recognizes that the methods used to meet these standards may vary with the type of provider or the level of care delivered.

The development, review, and revision of ASHBEAMS standards is the responsi- bility of the Standards Committee. All standards recommended by this commit- tee must be reviewed and approved by the board of directors as well as by a majority of the membership. Compliance with these standards is mandated for provider membership in ASHBEAMS. This ongoing process of revising the stan- dards could not be accomplished without the contributions of many aeromedical professionals.

The standards are intended to be used as criteria when an aeromedical service is developed, operated, or evaluated. They are goal oriented and may be used by members in their original form or they may be individualized for use in a partic- ular institution or by a particular provider.

Most providers find ASHBEAMS stan- dards empirical to the evaluation process. They are, in fact, the criteria used to measure performance. They describe the conditions necessary to achieve and ensure the quality of patient care and safety of the crew and patient. Of course, the ultimate test of the usefulness of these standards is the extent to which achieve- ment of the standards results in quality. While quality achievement is sometimes difficult to measure, the standards can be useful as a basis for studying the condi- tions manipulated by a program to affect quality.

To be useful, the standards must have certain characteristics: 1. They must be valid. 2. They must relate to the quality of care or service provided. 3. They must be written to encourage excellence, reflecting a state of the art or

Patrica Rice Yancy, RN, MS, is currently the secretary~treasurer for ASHBEAMS and an educator and consultant in matters of aeromedical and emergency services with St. Vincent Medical Center in Toledo, Ohio.

standard of care. 4. They must be achievable. 5. Compliance with said standards must be measurable.

The development of these standards has been an ongoing process. A standard is established because there is an identi- fiable need to measure or enhance the quality of care or service. Innovations in a technique, advancements in technology, expansion of the knowledge base and changes from regulatory agencies, or demands by consumers for accountabil- ity can bring about the need to revise or develop a standard. Cost considerations are an integral part of the standards devel- opment process.

Input for each standard is solicited from all available resources. The agencies concerned with the promnlgation of sim- ilar standards and regulation of said and similar services are sent drafts and revised standards requesting comment and input, as well as enforcement. Indi- vidual health and aviation professionals are encouraged to comment on proposed standards through their respective delegations.

To assist the members and proposed members to understand the standards and their application, interpretation of the standards is provided. The interpretations are intended to make the conditions of compliance more easily recognizable. The words must and shouM are used to assist in the interpretations. There is, therefore, room for substantial overall com- pliance [should] and, where necessary, absolute compliance [must].

These word interpretations allow for a program's alternative innovations. The burden of proof in these matters falls to the provider who must assure ASH- BEAMS that the desired goal has been attained. The interpretations are to serve as a guide for aeromedical providers to organize and operate effectively, not to establish any type of restriction in the offering of aeromedical service and allow for variations in the delivery of care by qualified aeromedical practitioners. While the ASHBEAMS standards com- mittee is both consultative and educational, it is currently not evaluative.

Change is a phenomenon that occurs continuously in all living systems. Plan- ning change is a conscious, deliberate,

and collaborative effort to improve opera- tions. Planned changed has purpose and a goal, which is improvement of the system through alteration. Participative decision making occurs. No one person plans the change; rather, all those who will be affected by the change are actively involved in planning it.

Those in a position to effect change must be knowledgeable about the phenomenon of change to flmction effec- tively. The position requires involvement in assessment and evaluation and an understanding of the many factors in- volved in group dynamics.

The process of planning change is a three-fold process of evaluation that includes: • the establishment of criteria or a foun- dation upon which judgment can be made; • the collection of data igroviding evi- dence to be used in the process; and, finally, * comparison of the data collected to the established standard and making a judg- ment on its continued appropriateness or the need for change.

All the while, the evaluators must stay objective - there is no place for subjectivity.

Accountability to one's profession includes a willingness to judge one's pro- fessional peers and a conscientious development of the ability to judge. A profession must have standards and a code of ethics to which members must adhere. The only Way that standards can be developed, revised, and applied is through judgment of the members in the profession. Judging professional peers, and being judged by them, is truly being accountable to the profession. Please ascertain your leadership and assist us in this endeavor.

Bibliography Bennis, WG, Benne, KD, Chin, R: The Planning of Change. New York: Holt, ]Rinehart and Winston, Inc., 1969. Bernhard, LA, Walsh, M: Leadership: The Key to Professionalization of Nursing. New York: McGraw- Hill, 1981. Klaus, KE, Bailey, JT: Power and Influence in Health Care. St. Louis: C. V. Mosby Company, 1977. Kraezel, JM: Organizations, Environments, Rela- tionships. Nursing Resources, Inc., 1980. Rothman, J, Erlich, JL, Teresa, JG: Changing Orga- nizations and Community Programs. Beverly Hills: Sage Publications, 1981.

30 NOVEMBER/DECEMBER 1986 & M J