Search results

The purpose of this paper is to explore English and Finnish paramedic perceptions of the healthcare blame culture, its relationship to complaints, the use of defensive practice and if this impacts on paramedic practice and clinical care.

Participants were recruited from English and Finnish ambulance services that have similar organisational and professional scopes of practice. The aim was to gain insight into the similarities and differences between the countries regarding the existence of a blame culture in paramedic practice. Semi-structured focus groups and interviews involving 20 English and Finnish paramedics were undertaken. Qualitative perceptions concerning the reality of a blame culture in paramedic practice and its impact on professional roles were sought.

Three major themes that were identified in the thematic analysis included: blame culture and its influences; the impact of complaints against paramedics; and the use of defensive practice within their roles. These data themes were similar for both groups of participants. The majority of participants thought the healthcare blame culture to be widespread and believed that this was likely to directly influence paramedics’ working practices.

Whilst the impact of blame culture and complaints on the medical profession has previously been examined, this study makes an important contribution by exploring the factors that impact on paramedics’ lives and their practice, within two European countries. The inappropriate use of social media by some members of the public in both countries was a disturbing issue for many participants and was identified as an area for further research.

Paramedics became nationally registered in 2018 in Australia. Prior to this, there was no central regulation of the profession with reliance on organisational regulation through employers. As paramedics expanded their scope, role and range of employers, especially outside statutory agencies, there was increasing need to engage in professional regulation. Regulation is more than a legal and bureaucratic framework. The purpose of the paper states that the way paramedics interact with their new regulatory environment impacts and is influenced by the professionalisation of the discipline. Regulation also redefines their positionality within the profession.

Two mixed-method surveys were undertaken. A pre-registration survey occurred in the month prior to regulation commencing (N = 419) followed by the second survey 31 months later (N = 407). This paper reports the analysis of qualitative data from the post-registration survey and provides comparison to the pre-registration survey which has been previously reported. Analysis was undertaken using interpretive phenomenological analysis (IPA).

Themes from the pre-registration survey continued however became more nuanced. Participants broadly supported registration and saw it as empowering to the profession. Some supported registration but were disappointed by its outcome, others rejected registration and saw it as divisive and oppressive.

Paramedics are beginning to come to terms with increasing professionalisation, of which regulation is one component. Changes can be seen in professional identity and engagement with professional practice; however, this is nascent and is deserving of additional research to track the profession as it continues to evolve.

Since 2018, Australian paramedics have been regulated under the National Registration and Accreditation Scheme (NRAS) for health practitioners. Established professions have been regulated in Australia for some time, so there is limited knowledge of their entry to regulation. However, as paramedicine has not been previously centrally regulated, this provides a unique case study to explore the transition to regulated practice.

Australian paramedics undertook two surveys: pre- and post-introduction of registration. The first survey was in the month leading up to the commencement of registration (N = 419), and the second survey took place 31 months after registration (N = 407). This paper presents the results of statistical analyses of the post-registration survey including comparisons to the pre-registration survey.

Although support for regulation has increased over time, there remains strong dissent consistent with 2018 levels. After 31 months of regulation, respondents reported increasing knowledge of the scheme and greater ease of navigation. The impacts of regulation are more nuanced and less polarised than in the first survey. Identity is again canvassed, and results suggest a shift from employment status and qualifications as key elements of identity to a community of practice and registration.

Paramedics' experiences and understanding of the rationale for registration are developing. Further support is needed to assist with the emerging professional identity and behaviours. Regulation is one of many occupational factors influencing professional identity and professionalism. Exploring the experience of regulation potentially assists regulators in better supporting practitioners and helps better understand professional evolution.

The purpose is to expand our understanding of different organizational group interactions in crises and extend the Competing Values Framework of organizational culture into three first responder groups – firefighters, police and emergency medical technicians. Because unique organizational culture is a critical element in the success or failure of any organization, when organizations combine during crisis, failure often results. The authors examined the cultures of first responders in a crisis to determine whether differences in cultural type might explain some failures.

Using the Competing Values Framework for organizational culture, the authors examined literature on the three first responder cultures. The literature is available on the failure of these organizations to work together in crisis, but little on the deep organizational reasons for these failures.

In view of the different challenges each profession faces and ways they organize to address those challenges, self-directed coordination of these three distinct groups may be optimal, rather than an overall system of command and control. This can be visualized when the authors examine the three cultures using the Competing Values Framework. The authors discuss specific reasons for problems in crisis coordination and give suggestions on coping with three or more different cultures.

This is a literature review and conceptual paper. A meta-analysis of incidences would be helpful.

When disparate organizations work together, culture may interfere with cooperation and coordination. Taking organizational culture into account will enable operations with less friction. In this paper, the authors explain why.

Lack of cooperation and coordination among firefighters, police and EMTs could create loss of life or property. Understanding potential cultural differences will help the disparate groups work together better.

The authors examine organizational culture differences in detail as a reason for the failures of coordination of first responders in crisis. In addition, the authors extend the Competing Values Framework to these essential groups of first responders. The authors are the first to propose a taxonomy of culture for these three groups, based on the Competing Values Framework.

The purpose of this paper is to explore the organisational cultures of two different parts of the emergency service, the police and the ambulance service.

Semi-structured interviews with 45 police officers and ambulance staff sought to understand more about the relationships between these two distinctly different professions who work together closely and regularly in often very difficult situations.

Interviews with police officers and ambulance staff revealed the strong and harmonious working relationship between the two professions and an existence of both shared organisational characteristics and shared cultural characteristics. These cultural characteristics, identified as both explicit and tacit in nature provide the “glue” which not only binds each organisation together but which appears to cement a longer term, tangible link between the police and ambulance services.

This paper reveals a new dimension within cultural analyses of occupational groups by considering the shared cultural characteristics of two groups within the emergency services, police officers and ambulance staff. This potential for cultural boundary crossing is explored in detail.

The purpose of this paper is to explore the nature of humour within two different organisations, policing and ambulance work, which are linked by their focus on emergency work.

Semi structured interviews with 45 police officers and ambulance staff sought to understand more about the relationships between these two distinctly different professions who work together closely and regularly in often very difficult situations.

Interviews with police officers and ambulance staff revealed that humour is a key component in the working relationship of police officers and ambulance staff. The humour of superiority and the humour of exclusion are used to both cope with the demands of their work, reinforce group values and to strengthen the shared bonds between the two occupations.

Humour has been studied within organisations but this paper reveals that humour also functions across occupational divides. Police officers and ambulance staff draw from a mutually acceptable but culturally defined joke‐book in the course of their work. The informal forces of humour appear, ironically, to provide a means of enhanced interoperability between the two organisations but at the expense of other agencies involved within the emergency service field.

Violence against paramedics is a complex – but underreported – problem. Extant research suggests organizational culture may play a role in sustaining cultural norms that downplay the significance and limit reporting. The purpose of this paper is to qualitatively explore paramedics’ experience with violence, with particular emphasis on understanding how organizational culture contributes to under-reporting.

The authors surveyed paramedics from a single, large, urban service in Ontario, Canada, asking participants to describe their experiences with violence, including whether – and why or why not – the incidents were reported. Within a constructivist epistemology, we used inductive thematic analysis with successive rounds of coding to identify and then define features of organizational culture that limit reporting.

A total of 196 (33% of eligible) paramedics completed the survey. Fully 98% of participants disclosed having experienced some form of violence; however, only a minority (40%) reported the incidents to management, or the police (21%). The authors defined a framework within which a lack of support from management, and consequences for offenders, implicitly positions the ability of paramedics to “brush off” violent encounters as an expected professional competency. Disclosing emotional or psychological distress in response to violent encounters invited questions as to whether the individual is personally suited to paramedic work.

While the extant research has indicated that underreporting is a problem, the findings shed light on why – a critical first step in addressing what has been described as a serious public health problem.

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.

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.

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.

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.

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.

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

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.

The purpose of this paper is to describe and analyse two approaches to paramedic service clinical governance and quality management from the perspective of two groups of paramedics and paramedic managers working in North America.

A case study approach was utilised to describe and analyse paramedic service medical direction in North America and contrast this with the professional self-governance and clinical governance systems operating in other high-income countries. Researchers interviewed participants at two remote North American sites, then completed transcription and thematic analysis.

Participants identified three themes: first, resourcing, regulatory frameworks and fragmentation; second, independent practice facilitators and barriers; and third, paramedic roles and professionalisation. Those trained outside North America tended to identify self-regulation and clinical governance as the preferred approach to quality management. Few participants had considered paramedicine becoming a self-regulating health profession.

In North America, the “medical direction” model is the dominant approach employed to ensure optimal patient outcomes in paramedic service delivery. In contrast, other comparable countries employ paramedic self-regulatory systems combined with clinical governance to achieve the same ends. This is one of two studies to examine medical direction from the perspective of paramedics and paramedic managers.

This paper aims to present the current state of evidence regarding the mental health literacy of paramedics and student paramedics and whether mental health literacy affects the care that paramedics provide to their patients with mental illness.

Embase, PubMed, Medline and Google Scholar were searched for recent (2010–2020) English language published articles using the key phrases paramedic AND/OR ambulance AND mental health AND mental health literacy. Additional searches of the reference lists of included articles were undertaken. A descriptive thematic analysis was used to arrive at a narrative synthesis of the study findings.

The emergency medical services system has taken a primary role in the care of patients with mental illness but has limited capacity for non-emergency psychosocial situations. Negative and judgemental attitudes amongst paramedics towards patients with mental illness is a significant issue and remains a barrier to patients seeking medical care for mental illness. Improved care provision and patient engagement might result from specific education aimed to better enhance paramedics’ mental health literacy.

This literature review provides insights into the current practice of mental health training for Australian undergraduate paramedic science students and the implications for patient care. Recommendations for educational strategies are provided.