Ambulance Services (eBook)

Paresh Wankhade is the Professor of Leadership and Management at Edge Hill University Business School. He has a PhD in Ambulance Performance & Culture Change Management from the University of Liverpool, UK. He is the founder Editor of International Journal of Emergency Services (an Emerald group Publication) and is recognised as an expert in the field of emergency management. He has chaired special tracks on leadership and management of emergency services at major international conferences including the annual European Academy of Management (EURAM) Conference; British Academy of Management Conference and Public Administration Committee (PAC) Conference. His research and publications focus on analyses of strategic leadership, organisational culture, organisational change and interoperability within the emergency services. His publications have contributed to inform debates around interoperability of public services and challenges faced by individual organisations. His latest book on Social Capital, Sociability and Community Development explores these issues including the state of the pre-hospital care in eight selected case-study countries (UK, USA, China, India, Bangladesh, Japan, Netherlands and South Africa) around the world.Edge Hill University, Ormskirk, United Kingdom Kevin Mackway-Jones was appointed Consultant at Manchester Royal Infirmary in 1993 and became Professor in 2001. He has published widely on the practice and theory of Emergency Medicine, both books (Advanced Paediatric Life Support, Major Incident Medical Management and Support, Emergency Triage amongst others) and academic papers. His main research interests are diagnostic strategies, psychosocial care and major incident management. As well as consulting at Manchester Royal Infirmary and the Royal Manchester Children’s Hospital he is also Executive Medical Director of the North West Ambulance Service, Civilian Consultant Advisor to the British Army, and Head of the North Western School of Emergency Medicine. He developed and is webmaster for www.bestbets.org and the St Emlyn’s Virtual Hospital through which he runs an MSc in Emergency Medicine. He was editor in chief of the Emergency Medicine Journal from 2005 – 2013.North West Ambulance Service NHS Trust, Bolton, United Kingdom

Preface 5
Acknowledgements 6
Contents 7
About the editors 9
Contributors 10
Part I 12
Context and Background 12
Chapter-1 13
Introduction: Understanding the Management of Ambulance Services 13
Context and Background 13
Realty and Perception 15
Aims and Plan of This Book 17
Limitations of the Current Project 23
Future Research Agenda 23
Bibliography 24
Chapter-2 27
Historical Perspectives in the Ambulance Service 27
Introduction 27
The Wounded in Battle 27
Sick and Injured in the Streets 29
Twentieth-Century Ambulance Services: Military and Civilian 32
The State of Ambulances in the UK National Health Service 34
The Role of Air Ambulances 35
Conclusion 36
Bibliography 37
Part II 39
Providing Emergency Care 39
Chapter-3 40
A Strategy for Managing Quality in Ambulance Services 40
Introduction and Background 40
Management of Quality and Risk in Ambulance Services 41
How Is Clinical Quality Measured and Monitored? 42
National Ambulance Service Audit Programmes 42
Clinical Performance Indicator Care Bundles 43
Quality Improvement in the Pre-hospital Arena 45
Blueprint to Quality Improvement 46
Clinical: Leadership at Local Level 46
Leadership: There Is Never Enough Feedback 46
Education: Plan to Improve 48
Accountability and Responsibility: At Individual Level 48
Conclusion: Quality Improvement—The Next Phase 49
References 49
Chapter-4 52
Management of Emergency Demand 52
Introduction 52
Evidence 53
Analysis and Discussion 55
Conclusion 58
References 58
Chapter-5 60
Ethical Commissioning of Emergency Ambulance Services 60
Introduction 60
Ethical Ambulance Commissioning 61
Ensuring Ethical Priority Setting and Resource Allocation 62
Ensure Fair Decision-Making: Involving Clinicians, Patients and the Public 66
Conclusion 69
Bibliography 69
Part III 71
Context of Emergency Care 71
Chapter-6 72
Organisational and Professional Cultures: An Ambulance Perspective 72
Role of Occupational Cultures and Organisational Behaviour 74
Professional Cultures 76
Changing the Culture in the Ambulance Service 77
Extending Roles and Skills of Ambulance Personnel 78
A New Beginning? 79
Classification of Ambulance Culture 81
Conclusion 82
Bibliography 83
Chapter-7 88
Leadership and System Thinking in the Modern Ambulance Service 88
Introduction 88
A Challenging Leadership Environment 89
Ambulance Services and the Need to ‘Shift Left’ 91
Transforming Ambulance Services Before It Is Too Late 92
A Changing NHS Model 95
Conclusion 97
References 97
Chapter-8 101
Ambulance Service Modernisation 101
Introduction and Background 101
Organisational Development 102
Workforce Planning 103
Succession Planning 103
Improving Clinical Care and Outcomes for Patients 104
Critical Care 104
Primary Care 105
Paramedic Education and Development 106
Need for Information, Demand and Performance Mapping 106
Results 108
Cost Effectiveness 108
Urgent Care: The Future 109
Operating Model 110
Experience and Expertise in Ambulance Services 111
Conclusion 111
References 112
Chapter-9 113
Interoperability and Multiagency Cooperation 113
Introduction 113
The Need to Change 115
Joint Emergency Services Interoperability Programme 115
Principles for Joint Working 116
Co-location 117
Communication 117
Coordination 117
Joint Understanding of Risk 118
Shared Situational Awareness 118
The Joint Decision Model 118
Interoperability Outside the UK 121
Role and Contribution of the National Ambulance Resilience Unit 121
Conclusions 122
Appendix 1 122
Bibliography 123
Chapter-10 124
Responding to Diversity and Delivering Equality in Prehospital Care: Statutory Responsibilities, Best Practice and Recommendations 124
Introduction 124
Why Does Identifying Diversity and Ensuring Equality Matter? 125
Access to Services 125
Treatment 126
Outcomes 126
Workforce Discrimination 127
The Equality Act 2010 and the PSED 127
Equality and Diversity in the NHS 129
The Equality Delivery System (EDS) 129
Implementing and Embedding the EDS 130
The Evolution to EDS2 131
Good Practice in the NHS 131
Progress Towards Identifying Diversity and Achieving Equality in the Ambulance Service 132
Case Studies 132
Continuing Issues with the EDS and EDS2 134
Recommendations 135
Conclusion 135
References 136
Chapter-11 139
Dealing with the Austerity Challenge 139
Introduction 139
Changes in Attitude and Demographics 140
Is Austerity the Catalyst for Innovation? 142
Using Resources to Maximum Efficiency 142
Aligning Hospital and Pre-hospital Specialist Care 143
Prioritising and Developing Rigorous Processes 144
Strategy for Prevention 144
Lack of Control Over Internal and External Factors 145
Value of the Ambulance Services 146
Does Commissioning Need to Change? 146
Conclusions 147
Bibliography 148
Part IV 150
Looking to the Future 150
Chapter-12 151
The Ambulance Service of the Future 151
Context and Background: The Case for Change 151
Specialist Centres for Emergency Care 153
Implications for Ambulance Services 154
The Digital Patient Record and Integration with the Wider Health Economy 155
Conclusion 157
References 158
Chapter-13 159
Future Perspectives for the UK Ambulance Services: Evolution Rather than Revolution 159
Context and Background 159
References 162
Chapter-14 164
International Perspectives: Australian Ambulance Services in 2020 164
Introduction 164
State of Australian Ambulance Services 165
Australian Ambulance Services in 2020 167
Ambulance Services as the Prehospital Element of the Health Service 167
Paramedic Registration 167
E-learning and the Education Revolution 168
Clinical Reasoning 169
Extended Care Paramedic Models 170
Human Factors and Error 170
Cardiopulmonary Resuscitation Quality 171
Simulation 172
Data 173
Conclusion 173
References 173
Chapter-15 176
International Perspectives: South African Ambulance Services in 2020 176
Introduction: Development of Emergency Medical Services in South Africa 176
South African Emergency Medical Services 177
Education and Training for South Africa Emergency Medical Service 178
More Recent Developments 180
South African Emergency Medical Service 2020: Future Challenges 181
Conclusion 183
References 183
Chapter-16 185
International Perspectives: Finnish Ambulance Services in 2020 185
Short History of Ambulance Service in Finland 185
Educational Standards in Paramedic Practice (Finland and European Perspective) 186
Quality Factors and Risk Management 187
Future of Ambulance Services: Continuing Education and Professional Development 188
References 189
Index 190