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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.

This paper compares the impact of leadership behaviours on the discretionary power, and well-being, and affective commitment of police officers from Italy and the United Kingdom (UK). In contrast to Italy, UK is an example of a core-New Public Management (NPM) country that has implemented reforms, in turn, changing the management and administration of public organizations. Consequently, it is expected that there will be significant differences in the behaviour of police officers. In particular, the paper examines the antecedents and outcomes of police officers' well-being.

The study involves collecting and analysing survey data using Structural Equation Modelling from 220 Italian and 238 UK police officers.

There was a significant path from Leadership to Discretionary Power to Employee Well-being to Affective Commitment – at least for the Italian sample. The UK sample does not have a significant link between leadership and discretionary power. Discretionary power was similarly low for both groups as was affective commitment. Authentic leadership and discretionary power explained approximately a third of their well-being, particularly discretionary power. Together, directly and indirectly (mediated by well-being), they explained at least a third of police officers' commitment to their organization. Well-being appears to be the key to ensuring effective police officers.

The limitation of this paper includes the use of cross-sectional data (Podsakoff et al., 2003). However, a common latent factor (CLF) was included, and several items that were explained by common method variance were controlled, as per George and Pandey's recommendations (2017). Additionally, a Harmon's single factor test was applied to the data.

The UK police officers have significantly lower commitment compared with the Italian police officers (non-commitment), and both Italian and UK police officers have less discretionary power and well-being compared with police from the United States of America (USA) police officers and other street-level bureaucrats (SLBs). The findings suggest that the present police leadership behaviours erode rather than supports police officers' discretionary power and well-being, leading to a low organizational commitment. Leadership training will better prepare managers to ensure the well-being of police officers working under conditions of work intensification.

The UK police officers have significantly lower commitment compared with the Italian police officers (non-commitment), and both Italian and UK police officers have less discretionary power and well-being compared with US police officers and other SLBs. The findings show that the police leadership erodes rather than supports police officers' discretionary power and well-being, leading to low organizational commitment. Leadership models that enhance employee well-being rather than efficiency targets must be a priority if police are to be prepared to cope effectively with emergencies and pandemics.