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1 – 10 of over 2000
Book part
Publication date: 18 November 2022

Paresh Wankhade, Geoffrey Heath and Peter Murphy

This chapter identifies the serious issue of the mental health and wellbeing of English paramedics working in the emergency ambulance service. It identifies the case of…

Abstract

Purpose

This chapter identifies the serious issue of the mental health and wellbeing of English paramedics working in the emergency ambulance service. It identifies the case of the extant top-down performance measurement regime and the absence of indicators of wellbeing in ambulance performance reporting. The impact of such measures on frontline staff and the implications for their motivation and commitment are also documented. More decentralised, open and discursive approaches to performance management in the public sector are advocated as key methods for re-imagining ambulance and wider public services in a global context.

Design/Method

Drawing on relevant literature, the chapter provides the context of the English ambulance service and the challenges it faces with reference to the New Public Management (NPM) and New Public Governance (NPG). Key issues concerning performance metrics and staff wellbeing and welfare are then identified and discussed. The notions of communicative rationality, deliberative democracy and agonistic pluralism are introduced as a framework for analysing the state of both wellbeing and resilience and the performance regime within the English ambulance service. The chapter relates these themes to the re-imagining of public services internationally, proposing a more participative and discursive approach.

Findings

It is desirable for the evaluation of public services to include the wellbeing of the healthcare provider, as well as the public service recipient. Additionally, there is a case for greater participative and dialogic engagement to address the intertwined relationship of ambulance staff wellbeing and the performance management regime of the service. The process should be revised, therefore, to take into account the wellbeing of ambulance staff as an integral and intrinsic part of the delivery of the service, and it is recommended that deliberative methods of participation are deployed in reimagining ambulance services and public services more generally.

Originality

The challenges facing ambulance services and, more generally, health services globally continue to proliferate and intensify. They are exacerbated by foreseeable contextual challenges such as the demographic profile of patients and service users and budgetary cuts. Traditional and more recent NPM approaches are proving inadequate for this challenge and appear unsustainable in practice. The lack of acknowledgement of welfare indicators in the performance metrics make them unfit for purpose. Our suggested discursive approach would help to re-imagine the service by improving its sustainability and resilience in parallel with the improved wellbeing and personal resilience of the people who provide the service.

Details

Reimagining Public Sector Management
Type: Book
ISBN: 978-1-80262-022-1

Keywords

Article
Publication date: 27 November 2019

Mike Brady

Telephone triage or hear and treat (H&T) describes the process of UK ambulance services nurses and paramedics undertaking enhanced telephone assessments of patients to…

Abstract

Purpose

Telephone triage or hear and treat (H&T) describes the process of UK ambulance services nurses and paramedics undertaking enhanced telephone assessments of patients to determine the most appropriate response, which can sometimes result in no ambulance being sent. Given, however, that 999 is not considered an advice service, it may be reasonable to assert that the expectation of those calling 999 is always an immediate ambulance response. This may not always be realised and may affect patient experience. The purpose of this paper is to ascertain the following: to what extent are the views of UK ambulance telephone triage service users being gathered? In answering this research question, this review also aims to explore the findings to determine service users’ expectations of ambulance telephone triage and the possibility that these expectations are influenced by the UK media. The findings of which could be used to inform the need and nature of future research.

Design/methodology/approach

Phase one consisted of a computerised literature search of online databases CINAHL, Pubmed, Science Direct, Cochrane library, Web of Science and UK government-funded databases. Phase two consisted of searches of all UK ambulance services websites and the submission of freedom of information requests. Phase three consisted of a computerised literature search of the ProQuest international news-stream database.

Findings

A total of 78 results were identified and after further screening 34 results were excluded, leaving 44 for final review. The extent to which users experience of ambulance service telephone triage are being gathered is low; and often limited to one off pieces of non-peer reviewed work. Patients felt overall that they were treated with respect, dignity and care. However, being listened to, reducing anxiety and a need for prompt assurances remain important to those whose overriding expectation is that an ambulance should attend every time a 999 call is made. There appears to be a balanced media portrayal of H&T with the UK media. However, unrealistic public expectations represent a significant barrier to providing sustainable care that users consider to be of high quality.

Research limitations/implications

Some user experiences may have been gathered in more broad research exercises which explored various aspects of 999 ambulance service experience. This was not included if it could not be clearly differentiated as being related to H&T and thus may have resulted in data being omitted. It was not possible to systematically search social media platforms (such as facebook or twitter) for any media results related to this search strategy; only traditional print and online media platforms. This also may have resulted in data being omitted. The inclusion of non-peer reviewed research results and grey literature represents a possible limitation to the conclusions drawn within this review. The concept of Insider Research Bias cannot be ignored within this review. The author himself practices in telephone triage within a UK ambulance service; however, this insider bias is mitigated by the clearly articulated systematic methodology and use of the Critical Appraisal Skills framework. In a similar vein, reviews of this nature are also often conducted as part of a team, to reduce bias, increase objectivity and ensure the validity of findings. This review was a sole effort, and while this is not uncommon, there were no cross checks by peers of the search terms, strategy, paper selection, exclusion criteria or data extraction. This lack of peer critique is considered a possible limitation in mitigating selection and reviewer bias.

Practical implications

The results of this review would suggest a need to increase the amount of research and patient feedback gathered from those being assessed and managed by ambulance service telephone triage within the UK. Ambulance services could hold regular monthly small-scale qualitative interviews with patients and families to ascertain their views, perceptions and anxieties which can then provide an up-to-date understanding of user expectations and the health educational needs of local communities. Patient feedback received directly to ambulance services or via the Patient Advice and Liaison Service could be retrospectively analysed by researchers to determine key themes of positive practice or negative patient experience. Such feedback can be tracked through time and be used as a pre and post community intervention measure, to determine any changes. Moving forward, nationally standardised research frameworks should be adopted to provide more easily collated local and national data, which can monitor improvement strategies and provide a comparison between services to aid the sharing of best practice principles.

Originality/value

There is no other piece of work published which has reviewed the data in this area of clinical practice within the UK.

Details

International Journal of Emergency Services, vol. 9 no. 2
Type: Research Article
ISSN: 2047-0894

Keywords

Article
Publication date: 7 November 2016

Paresh Wankhade

There is a growing academic interest in the examination and exploration of work intensification in a wide range of healthcare settings. The purpose of this paper is to…

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Abstract

Purpose

There is a growing academic interest in the examination and exploration of work intensification in a wide range of healthcare settings. The purpose of this paper is to explore the differing staff perceptions in emergency ambulance services in the UK. It provides evidence on the challenges for the paramedic professionalisation agenda and managing operational demands and work intensity in emotionally challenging circumstances, with significant implications for patient safety.

Design/methodology/approach

Drawing on the evidence from an empirical study in a large National Health Service ambulance trust in England, this paper examines the challenges and differing staff perceptions of the changing scope and practice of ambulance personnel in the UK. Amidst the progress on the professionalisation of the paramedic agenda, individual trusts are facing challenges in form of staff attitudes towards meeting performance targets, coupled with rising demand, fear of loss of contracts and private competition.

Findings

Research findings highlight differing perceptions from various sub-cultural groups and lack of clarity over the core values which are reinforced by cultural and management differences. Need for greater management to explore the relationship between high sickness levels and implications for patient safety including the need for policy and research attention follows from this study. The implications of work intensity on gender equality within the ambulance settings are also discussed.

Research limitations/implications

Ambulance services around the world are witnessing a strain on their operational budgets with increasing demand for their services. Study evidence support inconclusive evidence for patent safety despite the growing specialist paramedic roles. Organisational implications of high staff sickness rates have been largely overlooked in the management literature. This study makes an original contribution while building upon the earlier conceptions of work intensification.

Practical implications

The study findings have significant implications for the ambulance services for better understanding of the staff perceptions on work intensity and implications for patient safety, high sickness absence rates amidst increasing ambulance demand. Study findings will help prepare the organisational policies and design appropriate response.

Social implications

Societal understanding about the organisational implications of the work intensity in an important emergency response service will encourage further debate and discussion.

Originality/value

This study makes an original contribution by providing insights into the intra-organisational dynamics in an unusual organisational setting of the emergency ambulance services. Study findings have implications for further research inquiry into staff illness, patient safety and gender issues in ambulance services. Evidence cited in the paper has further relevance to ambulance services globally.

Details

International Journal of Emergency Services, vol. 5 no. 2
Type: Research Article
ISSN: 2047-0894

Keywords

Article
Publication date: 29 September 2020

Andy Newton

Review of major policy paper in relation to the ambulance service [in England] efficiency and productivity with reference to observed “unacceptable variation”.

Abstract

Purpose

Review of major policy paper in relation to the ambulance service [in England] efficiency and productivity with reference to observed “unacceptable variation”.

Design/methodology/approach

Critical review of ambulance service/EMS policy approach in England.

Findings

Lord Carter’s review describes failings in performance of UK ambulance service/EMS. However, the identified failings are essentially a repetition of many almost identical similar findings. There is a tendency of policy in respect of the ambulance service in England, as exemplified by Lord Carter’s report to consider analysis of the problem a more significant task that actually addressing the shortcoming defined.

Research limitations/implications

This viewpoint comment piece is produced as a viewpoint with all the attendant limitations implied in this approach. However, it has been produced from an informed position.

Practical implications

Challenge to current UK ambulance policy. Previous repetitious finding need to be addressed definitively.

Social implications

The efficiency of UK ambulance services/EMS is seriously impaired, and indeed these findings have been acknowledge previously. However, little by way of active remediation has been attempted. The current approach as exemplified in Lord Carter's recent review appears to ensure that analysis of the long- standing problems that exist is sufficient and possible preferable to active remediation and improvement.

Originality/value

No previous critical review of this type has been attempted (as it would be career-limiting).

Details

International Journal of Emergency Services, vol. 10 no. 1
Type: Research Article
ISSN: 2047-0894

Keywords

Article
Publication date: 2 July 2020

Inger Johanne Pettersen, Kari Nyland and Geraldine Robbins

The purpose of this paper is to study the links between contextual changes, contract arrangements and resultant problems when changes in outsourcing regulatory…

Abstract

Purpose

The purpose of this paper is to study the links between contextual changes, contract arrangements and resultant problems when changes in outsourcing regulatory requirements are applied to complex pre-hospital services previously characterized by relational contracting.

Design/methodology/approach

The study deployed a qualitative design based on interviews with key informants and extensive studies of documents. It is a longitudinal study of a procurement process taking place in a regional health authority covering the period 2006 to 2017.

Findings

A complex and longitudinal public procurement process where pre-hospital (ambulance) services are transformed from relational and outsourced governance to more formal arrangements based on legal and transactional controls, is described in detail. After several years, the process collapsed due to challenges following public scrutiny, legal actions and administrative staff resignations. The public body lacked procurement competencies and the learning process following the regulations was lengthy. In the end, the services were in-sourced.

Research limitations/implications

This study is based on one case and it should, therefore, not be generalized without limitations.

Practical implications

One practical implication of this study is that transactional contracts are not optimal when core and complex services are produced in inter-organizational settings. In public sector health-care contexts, the role of informal and social controls based on relational exchanges are particularly applicable.

Social implications

Acute health-care services essential to citizens’ security and health imply high asset specificity, frequency and uncertainty. Such transactions should according to theory be produced in-house because of high agency costs in the procurement process.

Originality/value

The paper contributes to the understanding of how the public procurement process can itself be complex, as managerial challenges and solutions vary along several dimensions and are contingent upon external factors. In particular, the study increases knowledge of why the design and implementation of outsourcing models may create problems that impede and obstruct control in a particular public sector context.

Details

Journal of Public Procurement, vol. 20 no. 4
Type: Research Article
ISSN: 1535-0118

Keywords

Article
Publication date: 4 September 2019

Peter Murphy, Paresh Wankhade and Katarzyna Lakoma

The organisational and service delivery landscape of the emergency services in the UK has been rapidly changing and is facing further change in the foreseeable future. The…

Abstract

Purpose

The organisational and service delivery landscape of the emergency services in the UK has been rapidly changing and is facing further change in the foreseeable future. The purpose of this paper is to examine recent and ongoing organisational changes in the policy development, service delivery and regulatory landscape of the emergency services, in order to capture the overall picture and potential opportunities for improvement or further investigation.

Design/methodology/approach

This general review utilises the characteristics of the three domains of a national framework, namely, policy development, service delivery and public assurance, and uses these characteristics as lenses to examine the three main blue light emergency services of police, fire and ambulances.

Findings

What emerges in the organisational landscape and conceptual maps for the police and even more so for the Fire and Rescue Service, is the immaturity of many of the organisations in the policy and the public assurance domains while the service delivery organisations have remained relatively stable. In the relatively neglected ambulance services, we find the NHS’s recent Ambulance Response Programme has considerable potential to improve parts of all three domains.

Research limitations/implications

The review is limited to the UK and primarily focussed on England.

Practical implications

The review identifies opportunities for improvement, potential improvement and further research.

Originality/value

Although the National Audit Office has attempted in the past to provide organisational landscape reviews of individual emergency services, this contemporary comparative review of all three services using a common model is unique. It provides considerable new insights for policy makers, service delivers and regulators.

Details

International Journal of Emergency Services, vol. 9 no. 1
Type: Research Article
ISSN: 2047-0894

Keywords

Article
Publication date: 14 March 2017

Sreekanth V.K. and Ram Babu Roy

The purpose of this paper is to apply agent-based modeling and simulation concepts in evaluating different approaches to solve ambulance-dispatching decision problems…

Abstract

Purpose

The purpose of this paper is to apply agent-based modeling and simulation concepts in evaluating different approaches to solve ambulance-dispatching decision problems under bounded rationality. The paper investigates the effect of over-responding, i.e. dispatching ambulances even for doubtful high-risk patients, on the performance of equity constrained emergency medical services.

Design/methodology/approach

Agent-based modeling and simulation was used to evaluate two different dispatching policies: first, a policy based on maximum reward, and second, a policy based on the Markov decision process formulation. Four equity constraints were used: two from the patients’ side and two from the providers’ side.

Findings

The Markov decision process formulation, solved using value iteration method, performed better than the maximum reward method in terms of number of patients served. As the equity constraints conflict with each other, at most three equity constraints could be enforced at a time. The study revealed that it is safe to over-respond if there is uncertainty in the risk level of the patients.

Research limitations/implications

Further research is required to understand the implications of under-responding, where doubtful high-risk patients are denied an ambulance service.

Practical implications

The need for good triage system is apparent as over-responding badly affects the operational budget. The model can be used for evaluating various dispatching policy decisions.

Social implications

Emergency medical services have to ensure efficient and equitable provision of services, from the perception of both patients and service providers.

Originality/value

The paper applies agent-based modeling to equity constrained emergency medical services and highlights findings that are not reported in the existing literature.

Details

Team Performance Management: An International Journal, vol. 23 no. 1/2
Type: Research Article
ISSN: 1352-7592

Keywords

Article
Publication date: 1 May 1995

Kathryn M. Young and Cary L. Cooper

The Occupational Stress Indicator (OSI) was used to investigate jobstress in an ambulance service in the north‐west of England. Sevendifferent aspects of the stress‐strain…

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Abstract

The Occupational Stress Indicator (OSI) was used to investigate job stress in an ambulance service in the north‐west of England. Seven different aspects of the stress‐strain relationship were assessed and the findings compared with those from the fire service. Ambulance service employees were found to be experiencing major stress outcomes of low job satisfaction and poor mental and physical health. Fire service employees revealed significantly poorer physical health. Assesses the sources of job stress, type A behaviour, locus of control and coping styles and discusses them in the light of change in the public services.

Details

Journal of Managerial Psychology, vol. 10 no. 3
Type: Research Article
ISSN: 0268-3946

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Article
Publication date: 7 August 2017

Mike Brady

Complaints are an integral element of the quality control and clinical governance process of UK ambulance services, and form a valid and reliable way of identifying areas…

Abstract

Purpose

Complaints are an integral element of the quality control and clinical governance process of UK ambulance services, and form a valid and reliable way of identifying areas of practice that require improvement. The purpose of this paper is to assess to what extent such complaints and their possible causes are researched; to identify any possible areas of practice requiring further investigation.

Design/methodology/approach

A computerised literature search was conducted using the online databases Science Direct, Cochrane library, and Web of Science, as well as specific searches of the Journal of Paramedic Practice and the International Journal of Paramedic Practice database. Online databases were searched for peer-reviewed full research articles between January 2012 and May 2016.

Findings

A total of 125 papers were identified and after further screening 90 articles were excluded. Additional screening using the critical appraisal skills programme (2014) criterions excluded a further 21 papers, leaving 14 studies for inclusion within the review.

Originality/value

This review found no specific research focussing on any causes of complaints made to UK ambulance services. Moreover, no research was identified specifically investigating the top three cited themes of complaints made in the last three years. More research is required both in researching those themes of complaints already known but also determining any other possible causes of complaints made. This review has evidenced that studies investigating response times improvement strategies, ambulance staff attitudes, and educational assessments of errors, all have findings which are meaningful and valid to determining the possible causes of complaints and possible improvement strategies. Ambulance services, commissioners, practitioners, and clinical academics should endeavour to research and share causes of complaints made to improve the quality of patient care.

Details

International Journal of Emergency Services, vol. 6 no. 2
Type: Research Article
ISSN: 2047-0894

Keywords

Article
Publication date: 27 April 2022

Alan Slater

Mass casualty incidents are characterised by an immediate, unforeseen and unquantifiable surge in demand for ambulance services which soon becomes apparent and will exceed…

Abstract

Purpose

Mass casualty incidents are characterised by an immediate, unforeseen and unquantifiable surge in demand for ambulance services which soon becomes apparent and will exceed any “local” resources available. Casualties require the correct treatment, promptly, at an appropriate resource without incurring any further harm. In the absence of firm operational guidelines, this paper provides templates for ambulance commanders both at call centre and on-site to approach the management of mass casualty incidents.

Design/methodology/approach

Desk research indicated that there were both guidelines on how various elements of the emergency services should work together plus academic papers on techniques to adopt in mass casualty situations. Standing orders or written protocols for ambulance commanders, however, provide little or no specific guidance or an outline plan upon how they should command in a mass casualty situation. Following analysis of relevant public enquiry reports and discussions with ambulance commanders and using the materials from desk research, a four-stage approach was devised for testing using retrospective analysis from field and desktop exercises.

Findings

To have confidence, each commander needs simple digital real-time templates from which they understand their role and how the overall plan defines priorities with the greatest need. A plan should cover call-centre and on-site operations including a basic operational checklist from start to finish; resource structure and inter-relationships; sources and availability of resources plus information and control procedures to impose limited quality control procedures.

Originality/value

The design and implementation of digital templates to provide minute-by-minute visibility to all commanders which have not been recorded before. Such templates give commanders confidence to determine, locate and call forward relevant resources to attend casualties in order of priority of need. Time-lapsed records are useful not just in the minute-by-minute decision processes but also for critical organisational learning and in any post-event review by either a coroner or lawyers at a public enquiry.

Details

International Journal of Emergency Services, vol. 11 no. 2
Type: Research Article
ISSN: 2047-0894

Keywords

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