Organizacija, Volume 48 Research papers Number 4, November 2015 DOI: 10.1515/orga-2015-0021 The Impact of Demographic Changes on the Organization of Emergency Medical Services: the Case of Slovenia Tatjana Kitic Jaklič1, Jure Kovač2 1General Medical Practice Activities of the Gorenjska Region, Kranj, Community Health Centre, Gosposvetska ulica 10, 4000 Kranj, Slovenia tkitic@gmail.com 2University of Maribor, Faculty of Organizational Sciences, Kidričeva cesta 55a, 4000 Kranj, Slovenia jure.kovac@fov.uni-mb.si Background and Purpose: The modern environment requires that organizations (profit and non-profit) continually harmonize their organizational models with changes in their respective environments and with their own visions and strategies for further development. The organizational structure of Emergency Medical Services (hereinafter EMS) is currently a very topical issue in Slovenia, given that a project to establish a new organization of EMS is currently underway at the national level. By examining the case of one region in Slovenia, this article presents an analysis of factors that impact on the number and types of EMS activities and depicts a forecast of future trends for the requirement of EMS. The analysis presents the initial phase of a strategic planning process for the mentioned activity and consequently, a starting point for the formation of an organizational EMS model. Methodology: This article presents an analysis of factors that impact on the formulation of an EMS model on the basis of research carried out for one geographical region of Slovenia. For the previous period, data was collected from 2002 to 2014. The software tool used for the analysis was STATA 13.0. For the purpose of forecasting a five-year period trend we used statistical package RStudio and Hyndman's Forecast package given that this package contains algorithms for forecasting univariate time series including exponential smoothing using automated spatial models and ARIMA modelling. Results: The research has confirmed a correlation between social/environmental factors and the rate of increase in the demand for EMS. A population's age structure has been identified as the key social factor that increases the need for EMS. On the basis of this finding, this article presents a model for forecasting growth trends in the scope of EMS activities. Conclusion: The research study has identified some important elements that are imperative to take into consideration when formulating an EMS network at the prehospital level. Population ageing has emerged as a key social factor. In the accordance with forecasted trends, an increase in the burden placed on EMS activities may also be anticipated in the future. Keywords: strategic planning, foresight, trends, emergency medical services (EMS), organizational model 1 Introduction Healthcare systems across the world face major challenges, with all developed countries being subject to a list of unfavourable external trends that include demographic changes, incredibly rapid technological development, rising user demand for healthcare services and rising health-related costs in the context of the global financial crisis (Walshe and Smith, 2011, pg. 3). In addition to these factors, a number of trends that reflect the socio-economic situation in our society should also be highlighted. These include globalization, which has a decisive impact on the Received: July 16, 2015; revised: August 28, 2015; accepted: October 2, 2015 247 Organizacija, Volume 48 Research papers Number 4, November 2015 international migration of populations in different parts of the world, global financial and geopolitical upheavals, various crisis situations due both to natural disasters as well as various political and other social conflicts, urbanization and environmental degradation (Rodriguez-Garcia, 2001; Ramani et al., 2008, pp. 16 - 18; Bufon, 2014, pp. 9 - 32). The above described problems and challenges faced by healthcare institutions are therefore not new. Since the 1980s, there has taken place an intensive debate on the issue of how to increase the efficiency of various public enterprises and other non-profit organizations in a rapidly changing environment. The primary goal of providers as well as others involved in the healthcare system is to improve the services that are on offer to patients. The most important value is understood to be a positive treatment outcome, which we also strive to achieve through the provision of financial sustainability. Solutions to improve the efficiency of healthcare institutions began being sought in management theories and management best practices of for-profit organizations. Due to an increase in the efficiency and quality of service provision, the introduction of modern management methods has become a necessity (Kowalczyk, 2002; Berwick et al., 2008; Hedegaard and Ahl, 2012; Kuhlmann and von Knor-ring, 2014). An integral component of healthcare includes emergency medical services (hereinafter 'EMS'). This is a public service that performs medical treatment for suddenly sick or injured individuals and is an integral component of the public healthcare network at the primary (prehospital) and secondary levels of health care. Over the past twenty years, researchers from most developed countries report on coming to terms with trends that reflect an increase in the number of EMS treatments performed, particularly as a consequence of negative demographic trends, epidemio-logical and social changes (Fischer et al., 2000; Cabrera et al., 2011). From this perspective, it is therefore necessary to understand current trends towards the reorganization of the EMS system, which we are also witness to in our environment. The modern and carefully constructed EMS system, particularly at the primary level, is without doubt a condition for better treatment outcomes and lower healthcare costs in the continuing care provided by all other levels of the healthcare system. This paper focuses on an analysis of the impact of social factors in the number and type of required EMS treatments by examining the case of one Slovenian region, which also represents the starting phase for the strategic planning of an EMS organizational model. The analysis was carried out for the Gorenjska region in such a way as to further enable the transfer of the model to the national level. The aim of the research is to formulate a proposal for the creation of an EMS organizational model that will enable the efficient use of human and other resources and that will also enable the achievement of efficient and effective health care from the perspective of the health care industry, health care providers and patients. The primary goal of this research is to predict trends for the next five-year period with the help of extrapolation methods and to determine the impact of demographic population changes as regards the provision of EMS activities. 2 Theoretical Background 2.1 Strategic Planning in Healthcare The greatest problem faced by managers today is that they must be able to foresee the future development of their own organization within the complex environment in which it operates and on the basis of understanding specific trends and the development of related factors. In the framework of strategic management (or strategic planning), various instruments, methods, techniques and approaches for managing an increasingly more complex environment have recently been developed (Varkey and Bennet, 2010; Rodríguez Perera and Peiró, 2012). The purpose of strategic planning is to encourage organizations towards strategic thinking, working and learning (Bryson, 2004, pg. 27). A strategic approach places an emphasis on analysis over own resources and trends within the environment. On the basis of this mutual analysis, long-term directions for the successful development of an organization are shaped by a strategic approach (Hitt et al., 2009; Robbins and Coulter, 2009; Daft, 2010; Bleicher, 2011). The process of strategic planning is made up of several interrelated steps or phases (Bryson, 2004; Varkey and Bennet, 2010; Rodríguez Perera and Peiró, 2012). According to Bryson, the process of strategic planning can be demonstrated more clearly and comprehensively by the following ten steps (Bryson, 2004, pp. 32-34): Step 1 - Initiate and agree on a strategic planning process, Step 2 - Identify organizational mandates, Step 3 - Clarify organizational mission and values, Step 4 - Assess the external and internal environments to identify strengths, weaknesses, opportunities and threats, Step 5 - Identify strategic issues faced by the organization, Step 6 - Formulate strategies to manage the issues, Step 7 - Review and adopt the strategies or strategic plan, Step 8 - Establish an effective organizational vision, Step 9 - Develop an effective implementation process, Step 10 - Reassess strategies and the strategic planning process. Because these steps do not necessarily or exclusively follow linearly, it is more correct to speak of "a cycle of strategic changes". Within this framework, a plan is used for all public and non-profit organizations and may also be used for the institution as a whole, as well as for its individual components. Because a depiction of the analysis of social/environmental factors in the number and type of EMS treatments 248 Organizacija, Volume 48 Research papers Number 4, November 2015 is the main purpose of this article, we shall focus exclusively on the fourth step of this cycle. The greatest value of this step lies in obtaining information that is of central meaning for the survival and growth of the organization. This step provides insight into the organization as a whole in relation to its internal/external environment, which should prevent its vulnerability in relation to any potential subsequent negative effects that may emerge from its surroundings. Fundamentally, this step is about obtaining information on the strengths and weaknesses of organizations, which may easily be related to the opportunities and challenges faced by an organization (Bryson, 2004, pg. 124). Identifying opportunities and challenges enables the shaping of a vision and perceptions of the organization in future. According to Bryson, the influence of the external environment may be divided into three different categories: (i) influence on forces and trends, (ii) key resource controllers and (iii) influence of competitive and collaborative forces (Bryson, 2004, pg. 32). Among all environmental factors that influence on the strategic planning of the development of EMS, those identified as key factors include demographic trends as well as some socio-economic and geographical characteristics of the external environment (Rodriguez-Garcia, 2001; Matter-Walstra et al, 2006; Guidelines on EMS, 2008; Bufon, 2014, pg. 266; Verdel, 2015, pgs. 21 - 22). 2.2 Organization of Emergency Medical Services in the Gorenjska Region At the primary level of healthcare service provision, EMS is organized in such a way as to ensure its continuous operation during a time of emergency services, as well as during regular clinical activities or as a special unit in accordance with the criteria and grid set forth in the EMS Guidelines (Official Gazette RS, no. 106/2008). In shaping the network of units of prehospital EMS, a series of professionally justified criteria needs to be taken into consideration so that under normal circumstances accessibility to EMS is enabled for most inhabitants in the shortest possible time or within acceptable time limits. In so doing, the following criteria must be taken into account: the number of inhabitants; the proportion of persons aged over 65; geographical conditions and territorial distance; level of threat due to accidents, traffic and similar; development of transportation links; distance to hospitals; response team for carrying out EMS; frequency of events within a particular area (Official Gazette RS, no. 106/2008). Other factors also impact on the provision of a wider range of EMS services. Tourism, for example, plays a role due to numerous factors that include: an increase in the number of people (tourists) in a given tourist destination, a higher risk for the onset of various injuries that may result from intense performance of sports and other activities during holiday seasons, the possibility of more rapid transmission of infectious disease (Rodriguez-Garcia, 2001; Matter-Walstra et al, 2006). A number of enterprises may be connected with a higher degree of risk in terms of the probability of the onset of work injury, depending on the type of activity performed. This also applies to agriculture. The literature defines acceptable access time as achieving 90 percent access time within 9 minutes or intervention with the highest degree of urgency within 8 minutes in 75 percent of the time (Wu and Hwang, 2009; O'Keeffe et al., 2011). The Regulation on EMS in Slovenia, a new proposal which was submitted for public discussion in April of this year (the debate was closed one month later) has defined as a still acceptable access time for calls with the highest level or urgency as being 10 minutes in urban areas and 20 minutes in rural areas, where the access time must be reached 80 percent of the time in all emergency interventions. In accordance with the still valid Regulation on EMS, which regulates the conditions, organization and methods of EMS in the Republic of Slovenia, EMS is comprised of doctors and other health workers who are trained in carrying out EMS. At the pre-hospital stage, teams are divided into units A and A2, unit B, unit B-ok, unit C and PHE (prehospital unit). The composition of EMS teams is actually not the only factor for which teams of these services vary, but the scope of their work is also different so that the consequence is variability in the population's access of the population to EMS across different regions of Slovenia. Our research study was carried out for the Gorenjska region. In Gorenjska region, which is one of Slovenia's 12 regions, the General Medical Practice Services of Gorenjska (hereinafter OZG) is responsible for providing EMS for the entire region. This is an institution that carries out health care at the primary level and implements it via the following organizational units (hereinafter OE): OE Health Care Centre (hereinafter ZD) Kranj, OE ZD Škofja Loka, OE ZD Tržič, OE ZD Radovljica, OE ZD Jesenice, OE ZD Bled and OE ZD Bohinj. Table 1 provides data that was obtained in the scope of this research pertaining to socio-geographic and other indicators for units within the Gorenjska region. As evident from the table, growth trends are evident in the Gorenjska region in terms of: the number of inhabitants, population density and the proportion of individuals over the age of 65. The number of overnight tourist stays and the number of companies located in the region is also on the rise. A downward trend is apparent in the number of traffic accidents. In terms of agriculture, there is an evident reduction in the surface area of usable agricultural land. 249 Organizacija, Volume 48 Research papers Number 4, November 2015 Table 1: Data displayed on socio-geographic and other indicators for Gorenjska region (Source: Statistical Office of the Republic of Slovenia, own review). Demographic information is inclusive of 31 December of the current year for the years 2004 to 2008 and 1 July of the current year for the years 2009 to 2012. The number of enterprises includes company activities listed in group C - Kfrom years 2004 to 2007, while after 2008, all enterprises - registered legal or natural persons that displayed revenue during the years of observation or employed person or persons who work and carry out as their main activity one of the activities listed under the Standard Classification System. 2012 204170 95.5 17.1 1658 31411 1670653 15712 2011 203703 95.3 16.7 1831 31411 1640825 16353 2010 203192 95.1 16.6 1820 31411 1584895 16165 2009 202470 94.7 16.6 1579 6 2 3 3 1520376 15510 2008 201779 94.4 16.4 1700 6 2 3 3 1411964 14531 2007 201254 94.2 16.2 2124 6 2 3 3 1479922 10022 2006 199902 93.5 15.9 2096 33573 1394324 9465 2005 199085 93.2 15.5 2110 33402 1460276 8899 2004 198342 93.0 15.2 2713 33402 1488957 8698 Number of inhabitants Population density (per km2) Proportion of population aged over 65 Number of road traffic accidents Utilised agricultural area (ha) Number of tourist overnight stays Number of enterprises Area of ■ 2 2 'm S to o - 21004 2006 20OB 2010 20122004 2)006 200B 2010 2012 -1-:-1--1200 4 20 06 200B 2010 2012 Year Figure 2: Graphical representations of rising proportions of elderly populations in the Gorenjska region (significance of numbers in the title graphic: 1 - ZD Kranj, 2 - ZD Škofja Loka, 3 - ZD Tržič, 4 - ZD Radovljica, 5 - ZD Bled, 6 - ZD Bohinj, 7 - ZD Jesenice) 255 Organizacija, Volume 48 Research papers Number 4, November 2015 Table 3: Display of proportion of individual EMS treatments performed by OE in Gorenjska, 2008 to 2013 inclusive (hi-quad-rant=9547.928; p<0.001) Organizational Unit No. of Emergency Interventions (%) No. of Home Visits (%) No. of Outpatient Examinations (%) ZD Kranj 6736 (4.1) 8623 (5.2) 150169 (90.7) ZD Škofja Loka 3086 (4.4) 2589 (3.7) 64779 (91.9) ZD Tržič 1814 (5.1) 2274 (6.3) 31728 (88.6) ZD Radovljica 1757 (4.4) 4693 (11.6) 33858 (84.0) ZD Bled 3309 (9.7) 1729 (5.1) 29143 (85.3) ZD Bohinj 578 (6.2) 1786 (19.3) 6891 (74.5) ZD Jesenice 3049 (4.3) 7674 (10.8) 60218 (84.9) EMS provision) - the variable that we wish to control. The share of explained variance (coefficient of determination) measures over 90 percent in EMS provision in all cases. The statistically significant t test indicated that the proportion of the population aged 65 and over impacts upon the number of home visits. Even binary variables for regions have a statistically significant impact on the clarification of dependent variables, while the F statistic indicates that the model fits the data well (F (9.71) =179.93; p=0.000). The proportion of explained variance of the dependent variable which may be attributed to the variation of the independent variable is, at 95.8 percent, very high. 5 Discussion Organizations today work in an extremely dynamic and rapidly changing environment. It is for this reason that they must constantly be aware of and focused on changes in their external environment, all the while monitoring their own internal capacities (Jeffs, 2008, pg. 16). As a result, the external environment and time may reliably be defined as two key factors in the successful operations of all organizations, irrespective of their field of activity (Morden, 2007, pg. 109; Jeffs, 2008, pg. 17). This research confirms what researchers from other parts of the world have already reported - namely, that the number of EMS treatments is on the rise, as is the complexity of administered treatments (Fischer et al., 2000; Cabrera et al., 2011; Mocnik, 2012, pg. 1; Verdel, 2015, pg. 12). The number of EMS treatments is also growing in the Gorenjska region and this trend is expected to continue in the following 5-year period. This fact applies not only to rare exceptions among observed organizational units in Gorenjska, but is common in municipalities throughout the region. Highly unfavourable demographic statistics are prevalent in the municipalities of Kranjska Gora, Bohinj and Bled, as these areas exhibit the highest ageing index in the region (the ageing index indicates the number of people aged 65 and over, per 100 inhabitants under the age of 15). This study has confirmed that the number of home visits is higher in those municipalities. The case of OE ZD Bled has indicated that a larger proportion of treatments is represented by outpatient examinations, although it is possible to attribute this to the fact that Bled is an extremely well developed tourist destination and the number of outpatient examinations strongly correlates with the development of its tourism activities. In their research, Matter-Walstra and colleagues (2006) have proven a higher number of medical cases during the winter season, a factor that was correlated with a higher number of tourist visits at this time. This study has several limitations. Firstly, the study covered a relatively short period of time. Secondly, it has become apparent that the data acquired from different research participants was obtained in a somewhat varied manner, which could result in there being some deviation from the benchmark in future research. It has been determined that complete insight into the number of EMS treatments conducted were not held by some of the providers themselves. This reinforces our conclusion that most healthcare organizations in the region unfortunately have little awareness of their efficiency and effectiveness, a fact that has also been reported by foreign researchers. Bryson, for example, notes that a vast majority of public and non-profit organizations are familiar with an entire host of information with respect to financial flows, but few have information on a clear philosophy, core values, research competencies and organizational culture (Bryson, 2004, pg. 40). 6 Conclusion One of the key elements of the modern healthcare system is an efficient and carefully constructed system of prehos-pital EMS that takes into account social changes. The challenge of modern times is how to maintain the standard and accessibility of healthcare services at their existing level. Many calls for the reorganization of the health care sys- 256 Organizacija, Volume 48 Research papers Number 4, November 2015 tem have been made among the public in recent years. For example, in Slovenia, there has even recently been an extremely controversial establishment of a network of emergency centres aimed at merging EMS prehospitals and hospital emergency divisions. One of the goals in establishing a network of emergency centres that will at some point be reliably positioned in all regions of the country is to improve the quality and efficiency of emergency healthcare conditions. The undertaken analysis is part of more extensive research that aims to develop a proposal for the formation of an EMS organizational model that will enable the efficient use of human and other resources and which will also realize the provision of efficient and effective medical care, from the perspective of the medical field, health care providers and patients. Some important elements that are critical to consider in the formation of EMS at the prehospital level have been identified. This has shown to anticipate the trend in the number and types of EMS treatments in the Gorenjska region. In accordance with the findings of this research, the following recommendations for the process of reorganizing EMS activities in the Gorenjska region are proposed. First, due to the continued provision of 24 hour health care service, the merger of some geographically proximate health care providers is recommended. It would be rational to combine units in terms of total coverage of outpatient examinations and in carrying out home visits, taking also into consideration the establishment of emergency centres. Due to assuring good response from EMS teams, it is at present necessary to retain the current allocation of units carrying out paramedic emergency services, although staff profiles may be adjusted in some areas and for some types of services. Prior to any type of reorganization, we must assure the introduction of a dispatch system and triage system, which has not yet been guaranteed for the Gorenjska region. National policy and Health Ministries face the difficult and important task of determining a formula according to which it will be possible to preserve current access to healthcare services. The public and local communities have a responsibility to understand the reasons for changes in healthcare and to prepare to cooperate in the process of implementing necessary emergency reforms. Finally, managers of healthcare organizations face several challenges, one of which is the reliable development and implementation of a system of monitoring quality, as well as a more efficient response to all changes in the external environment. Strategic planning, the basis of which is to study an organization's surrounding environment, must become a central component in the management of healthcare organizations. This is especially true because organizations do not impact on their external environment. Acknowledgements The authors are extremely grateful to Ms. Jana Suklan for her assistance in the statistical analysis. We are also very grateful to Ms. Mojca Kodric for her assistance in the Slovenian-English translation. Literature Berwick, D.M., Nolan, TW., & Whittington, J. (2008). The triple aim: Care, health, and cost. Health Affairs, 27(3), 759-769, http://dx.doi.org/10.1377/hlthaff.27.3.759 Bleicher, K. (2011). Das Konzept Integriertes Management. Frankfurt am Main: Campus Verlag. Bryson, B. (2004). Strategic Planning for Public and Nonprofit Organizations. San Francisco: Jossey-Bass. Bufon, M. (2014). Družbena geografija sveta: Globalni sistemi in regionalne dinamike [Social geography of the world: The global systems and regional dynamics]. Koper: Univerzitetna založba Annales. Retrieved June, 23, 2015 from http://www. zrs.upr.si Cabrera, E., Taboada, M., Iglesias, M.L., Epelde, F., & Luque, E. (2011). Optimization of healthcare emergency departments by agent-based simulation. Procedia Computer Science, Vol. 4, 1880-1889, http://dx.doi. org/10.1016/j.procs.2011.04.204 Caley, M., & Sidhu, K. (2010). Estimating the future healthcare costs of an aging population in the UK: expansion of morbidity and the need for preventative care. Journal of Public Health, 33(1), 117-122, http:// dx.doi.org/10.1093/pubmed/fdq044 Capon, C. (2008). Understanding Strategic Management. Harlow: Prentice Hall. Daft, LR. (2010). New Era of Management. South-Western, Cengage Learning. Fischer, A.J., O'Halloran, P., Littlejohns, P., Kennedy, A., & Butson, G. (2000). Ambulance Economics. Journal of Public Health Medicine, 22(3), 413-421, http://dx. doi.org/10.1093/pubmed/22.3.413 Hedegaard, J., & Ahl, H. (2013). The gender subtext of new public management-based work practices in Swedish health care. Equality, Diversity and Inclusion: An International Journal, 32(2), 144-156, http:// dx.doi.org/10.1108/02610151311324389 Hitt, M.A., Black, J.S., & Porter, LW. (2009). Management. Upper Saddle River, NJ: Prentice-Hall. Horibata, K., & Takemura, Y. (2015). Inappropriate use of ambulance services by elderly patients with less urgent medical needs. The Tohoku Journal of Experimental Medicine, 235(2), 89-95, http://doi.org/10.1620/ tjem.235.89 Hyndman, RJ. (2015). Forecasting functions for time series and linear models. Retrieved October 1, 2015 from http://cran.r-project.org/web/packages/forecast/ forecast.pdf Jeffs, C. (2008). Strategic management. London: SAGE Pub- 257 Organizacija, Volume 48 Research papers Number 4, November 2015 lications, http://dx.doi.org/10.4135/9781446216446 Kohler, U., & Kreuter, F. (2009). Data Analysis Using Sta- ta. Stata Press, Texas. Kowalczyk, R. (2002). The effect of new public management on intensive care unit staff. The International Journal of Public Sector Management, 15(2), 118-128, http://dx.doi.org/10.1108/09513550210419573 Kuhlmann, E., & von Knorring, M. (2014). Management and medicine: Why we need a new approach to the relationship. Journal of Health Services Re-sesarch and Policy, 19(3), 189-191, http://dx.doi. org/10.1177/1355819614524946 Lünger, B., & Luhan, M. (2010). Strategische Krankenhausmanagement in der Praxis. V: Debatim, J.F., Ekkernkamp, A., & Schulte, B. (Hrsg.) (2010). Krankenhausmanagement. Berlin: Medizinisch Wissenschaftliche Verlagsgesellschaft. Matter-Walstra, K., Widmer, M., & Busato, A. (2006). Seasonal variation in orthopedic health services utilization in Switzerland: The impact of winter sport tourism. BMC Health Services Research, 6: 25, http:// dx.doi.org/10.1186/1472-6963-6-25 Ministry of Health. (2013). Javna mreža primarne zdravstvene dejavnosti v republiki Sloveniji [The public network of primary healthcare activities in the Republic of Slovenia]. Retrieved June 2, 2015 from www.mz.gov. si Morden, T. (2007). Principles of Strategic Management. Ashgate Publishing Limited, Hampshire. Močnik, U. (2012). Analiza čakalnih vrst v dežurni ambulanti zdravstvenega doma [Analysis of emergency department waiting lines in Community Health Centre]. Master's Thesis, Ljubljana: Faculty of Economics. Müller, A.W., & Müller-Stewens, G. (2009). Strategic Foresight. Stuttgart: Schäffer-Poeschel Verlag. Pravilnik o službi nujne medicinske pomoči [Rules on emergency medical services].Pravilnik o službi nujne medicinske pomoči (Uradni list RS, št. 106/08 z dne 11. 11. 2008), Official Gazette RS, no. 106/2008. Ramani, K.V., Mavalankar, D., & Govil, D. (2008). Strategic Issues and Challenges in Health Management. New Delhi: SAGE Publications. Robbins, SP., & Coulter, M. (2009). Management. Upper Saddle River, NJ: Prentice-Hall. Rodriguez-Garcia, R. (2001). The health-development link: Travel as a public health issue. Journal of Community Health, 26(2), 93-112, http://dx.doi. org/10.1023/A:1005225129295 Rodríguez Perera, FP. & Peiró, M. (2012). Strategic Planning in Healthcare Organizations. Rev Esp Cardiol, 65(8), 749-754, http://dx.doi.org/10.1016/;. rec.2012.04.004 Salvi, F., Morichi, V., Grilli, A., Giorgi, R., De Tomma-so, G., & Dessi-Fulgheri, P. (2007). The Elderly in the Emergency Department: A Critical Review of Problems and Solutions. Internal and Emergency Medicine, 2(4), 292-301, http://dx.doi.org/10.1007/s11739-007-0081-3 Šelb-Šemerl, J., Rok-Simon, M., Kelšin, N., & Ivas, N. (2004). Staranje prebivalstva v Sloveniji: demografske spremembe in nekaj posledic za zdravstveno varstvo. Posvet slovenskega zdravniškega društva o problematiki starostnikov in staranja [The Ageing of the Population in Slovenia: Demographic changes and some consequences for Healthcare. Consult of the Slovenian Medical Association on the problems of older people and aging]. Retrieved June 3, 2015 from www.szd.si Varkey, P., & Bennet, KE. (2010). Practical Techniques for Strategic Planning in Health Care Organizations. Physician Executive Journal, 36(2), 46-48. Verdel, D. (2015). Obravnava nenujnegapacienta v ambulanti nujne medicinske pomoči [Treatment of non-urgent patient in the emergency department]. Master's Thesis, Maribor: Faculty of Health Sciences. Walshe, K., & Smith, J. (2011). Healthcare Management. Berkshire: Open University Press. Wo, C.H., & Hwang, P.K. Using a discrete-event simulation to balance ambulance availability and demand in static deployment systems. Academic Emergency Medicine, 16(12), 1359-1366, http://dx.doi.org/10.1111/ j1553-2712.2009.00583.x Tatjana Kitic Jaklič attained her specialization in Family Medicine at the University of Ljubljana. She practices as a family medicine doctor at the Kranj Community Health Centre, Division for General Medical Practice Activities of the Gorenjska Region. Her current research interests encompass organizational methods and techniques for achieving greater efficiency and effectiveness in the field of healthcare. Jure Kovač is a Professor of Organization and Management at Faculty of Organizational Sciences, University of Maribor. His research interests are organization theory, organization design and management development. 2S8 Organizacija, Volume 48 Research papers Number 4, November 2015 Vpliv demografskih sprememb na organiziranost nujne medicinske pomoči - primer Slovenije Uvod in namen: Sodobno okolje zahteva od organizacij (tako profitnih kot neprofitnih) nenehno usklajevanje modela organiziranosti s spremembami v okolju ter lastnim videnjem in strategijo nadaljnjega razvoja. Organiziranost nujne medicinske pomoči (NMP) je v tem trenutku v Sloveniji izredno aktualna tema, saj na nacionalni ravni teče projekt, katerega namen je vzpostavitev nove organiziranosti te službe. V članku bomo prikazali analizo vpliva dejavnikov okolja na področju števila in vrste obravnav v službi NMP ter prikazali napoved trendov za to dejavnost, in sicer na primeru ene od regij v Sloveniji. To predstavlja začetno fazo procesa strateškega načrtovanja omenjene dejavnosti in s tem izhodišče za oblikovanje organizacijskega modela te službe. Metode: V članku je prikazana analiza dejavnikov okolja, ki vplivajo na oblikovanje organizacijskega modela NMP, kar bo opravljeno na primeru ene geografske regije v Sloveniji. Uporabljeni podatki obsegajo časovno obdobje od leta 2002 do 2014. Pri analizi je bilo uporabljeno programsko orodje STATA 13.0. Za namen napovedovanja trenda petletnega obdobja smo uporabili statistični paket RStudio in knjižnico Forecast avtorja Hyndmana, ker knjižnica vsebuje algoritme za napoved univariatnih časovnih vrst vključno z eksponentnim glajenjem s pomočjo prostorskih modelov in avtomatizirano ARIMA modeliranje. Rezultati: Z raziskavo smo potrdili zvezo med dejavniki okolja in stopnjo naraščanja potreb po storitvah službe NMP. Kot ključni dejavnik okolja, ki povečuje potrebo po storitvah NMP, je bila potrjena starostna struktura prebivalstva. Na tej osnovi smo oblikovali model predvidevanja rasti po obsegu dejavnosti NMP. Zaključek: V raziskavi so bili ugotovljeni nekateri pomembni elementi, ki jih je neobhodno potrebno upoštevati pri formiranju mreže službe NMP na predbolnišnični ravni. Staranje prebivalstva se je izkazalo kot ključni dejavnik okolja. Skladno z napovedjo trendov je tudi za prihodnost mogoče pričakovati povečanje obremenitev na področju dejavnosti NMP. Ključne besede: strateško načrtovanje, predvidevanje, trendi, nujna medicinska pomoč, organizacijski model 259