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Ambulance Services: Leadership and Management Perspectives

Authors:
Professor Paresh Wankhade at Edge Hill University
Professor Paresh Wankhade
Kevin Mackway-Jones at Manchester Metropolitan University
Kevin Mackway-Jones
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Abstract

This volume provides fresh insights and management understanding of the changing role of the ambulance services against the backdrop of massive cuts in health budgets around the world and the changing context of pre-hospital care within the wider healthcare networks. The challenges of funding, training and cultural transformation are now felt globally. The need to learn and adapt from suitable models of ambulance service delivery have never been greater. The book offers critical insights into the theory and practice of strategic and operational management of ambulance services and the leadership needs for the service. One of the highlight of this volume is to bring together scholarship using experts- academics, practitioners and professionals in the field, to each of the chosen topics. The chapters are based in the practical experiences of the authors and are written in a way that is accessible and suitable for a range of audiences. We are confident that this book will cater to a wider audience to inform policy and practice, both in the UK and internationally.
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P. Wankhade, K. Mackway-Jones (Eds.)
Ambulance Services
Leadership and Management Perspectives
▶Firstauthoritative guide to ambulance service management
▶Addresses key concepts such as risk management, leadership
development and organizational culture
▶In times ofausterity and cuts in public service budgets, tells how to
do "more for less" while protecting public from increased risk
This volume provides fresh insights and management understanding of the changing role
of the ambulance services against the backdrop of massive cuts in health budgets around
the world and the changing context of pre-hospital care within the wider healthcare
networks. The challenges of funding, training and cultural transformation are now
felt globally. The book offers critical insights into the theory and practice of strategic
and operational management of ambulance services and the leadership needs for the
service. One of the highlight of this volume is to bring together scholarship using experts-
academics, practitioners and professionals in the field, to each of the chosen topics.
The chapters are based in the practical experiences of the authors and are written in a
way that is accessible and suitable for a range of audiences. We are confident that this
book will cater to a wider audience to inform policy and practice, both in the UK and
internationally.
Paresh Wankhade is Professor of Leadership and Management at Edge Hill University,
UK
Kevin Mackway-Jones is the Medical Director at North West Ambulance Service NHS
Trust, UK
“This unique and valuable publication, charts the history and development of the
ambulance service in England over the last hundred years or so. The role of this key
emergency service has always been important, and arguably never more so than today.
The contributing authors have not only provided the reader with gr
eat insights into where the service has come from and the leadership challenges it has,
and continues to face; it also gives examples of how the future could look as our journey
of transformation continues.”
Peter Bradley CBE, MBA (and author of Taking Healthcare to the Patient 2005), Chief
Executive Officer.

Chapters (16)

Introduction: Understanding the Management of Ambulance Services
Full-text available
Chapter
  • Oct 2015
  • Ambulance Services: Leadership and Management Perspectives
  • pp.3-16
This chapter sets the scene for the second of the three-volume edited series on the leadership and management perspectives in the three main blue light emergency services (police, ambulance and the fire and rescue services). It provides the rationale behind this volume and its relevance to a wide audience of students, academics, practitioners, professionals including management practitioners who may be interested to study about the ambulance services. The chapter first sets the changing context of ambulance delivery drawing the evidence from the UK. The chapter then details the aims of this book and provides a brief summary of each of the chapters and the plan of this volume. One of the highlights of the volume is the assembly of experts from academia, serving and former ambulance leaders, staff and practitioners, both in the UK and abroad, giving an international perspective on the future of ambulance services. The chapter also makes reference to the challenge of covering all the possible management themes in a single volume, but the editors remain confident that the chosen topics will provide a rounded understanding and critical insights into the leadership and management in the ambulance services.
Historical Perspectives in the Ambulance Service
Chapter
  • Sep 2015
  • Ambulance Services
  • pp.17-28
For most of human history, the care of the wounded in war or the sick and injured in the community was not of great concern to generals or those in civil authority. Exceptions existed, but these did not lead to a general movement towards the provision of ambulance services on the battlefield or the street. Then in 1792, a surgeon in the Napoleonic army designed the first threefold system of good military ambulance practice, treating the wounded in situ, speedily transporting them from the place of conflict and providing a safe facility for aftercare. In 1866, a doctor in New York organised the first civil ambulance service which was summoned by telegraph, thereby completing the four features upon which modern ambulance services are based: dedicated teams, standby vehicles, reception hospitals and electronic communication. After slow and uncertain beginnings, ambulances began to save increasing numbers of lives using ingenuity and technological innovation.
A Strategy for Managing Quality in Ambulance Services
Chapter
  • Sep 2015
  • Ambulance Services
  • pp.31-42
The practice of risk management and corporate governance relates to all aspects of an organisation’s business and activities. The current focus within the health service is primarily around improving quality by putting the patient first and protecting them from harm and developing a culture of transparency and openness (for instance, the National Health Service (NHS) Outcome Framework). The measurement of quality within ambulance services has also been traditionally limited to operational activities and presents significant challenges due to the unique environment they operate within, in comparison to other types of healthcare providers. Ambulance services across England use the Clinical Performance Indicator Care Bundle to measure and monitor the quality of care given to patients. Reviewing the current state of development of ambulance quality indicators, the authors conclude that the care received by patients in the pre-hospital arena could be measured and monitored using the Clinical Leadership Education Accountability and Responsibility (CLEAR) framework.
Management of Emergency Demand
Chapter
  • Sep 2015
  • Ambulance Services
  • pp.43-50
Is it time to consider remodelling the ambulance service? This is a question that emanates from the nature of competing requirements of public expectation and rising emergency demand, all against the backdrop of a reducing health sector finances and significant changes to the healthcare system itself. The increase in demand for ambulance services is being seen everywhere—possibly driven by a combination of an ageing population beset by multiple illnesses combined with urbanisation and fragmentation of communities. This has resulted in ambulance services struggling to meet the exacting response standards expected for potential emergencies irrespective of demographics or geography, whilst also providing an acceptable service to less urgent but nonetheless individually concerning health concerns.
Ethical Commissioning of Emergency Ambulance Services
Chapter
  • Sep 2015
  • Ambulance Services
  • pp.51-61
Urgent and emergency ambulance services are a critical part of the pre-hospital infrastructure and are held in high regard with service users and the public. These services are working in a challenging climate where decisions on priority setting have to be made within an ethically acceptable framework. Commissioners of ambulance services need to ensure that services that are in place are effective (do good) and that decisions on priority setting are fair. For ambulance services, the principles of ethical commissioning will not always reach a conclusion on priority setting, and a triangulated approach that also includes clinicians, service users and the public in decision-making will ensure that a decision is fair, and the process for decision-making is open and transparent resulting in a more ethically robust decision that has greater legitimacy.
Organisational and Professional Cultures: An Ambulance Perspective
Chapter
  • Oct 2015
  • Ambulance Services: Leadership and Management Perspectives
  • pp.65-80
This chapter concerns the place of culture in ambulance services. There are issues around organisational cultures and subcultures and the ways these are cross-cut by professional cultures. It is difficult to define culture adequately, and the ways in which it affects behaviour are obscure. In the case of ambulance services, for instance, does it make sense to refer to a single culture within, let alone across, organisations? Similarly, cultures may not be transformed as easily as sometimes suggested. Nevertheless, governments increasingly seek to move the focus in the National Health Service (NHS) from changing structures and systems towards changing cultures, raising a number of interesting questions. What happens when attempts to change organisational cultures encounter professional cultures, which support power and status based on professional standing? This is particularly relevant given the changing role of ambulance paramedics, which is an international phenomenon. In analysing these issues, Schein’s identification of pluralistic dimensions of culture has been used. We conclude that ambulance organisations have multiple cultures, some of which counter change. This complexity adds to the difficulties of delivering effective reforms
Leadership and System Thinking in the Modern Ambulance Service
Chapter
  • Sep 2015
  • Ambulance Services
  • pp.81-93
Ambulance services remain locked in an eighteenth century mind-set that reinforces a traditional emergency care and transport-focused mode of operation, which is insufficiently attuned to the changing and more heterogeneous actualities of demand of the modern world. An effective response to current rising pressures will require clear doctrine and revised concept of operation that is far more reflective of contemporary epidemiological realities and the changing role of the ambulance service and paramedics. Effecting the necessary organisational and professional changes will require both a high order of leadership and the recognition that there is a fundamental relationship between leadership and the design of the system in which leadership is being practiced.
Ambulance Service Modernisation
Chapter
  • Sep 2015
  • Ambulance Services
  • pp.95-106
This chapter starts by setting the scene regarding the challenges the ambulance service are currently facing. The authors then go on to discuss the ways in which the ambulance services have responded to these challenges and what methods have been adopted to improve patient care whilst also creating efficiencies.
Interoperability and Multiagency Cooperation
Chapter
  • Sep 2015
  • Ambulance Services
  • pp.107-117
The UK emergency services have worked together for many years, but at repeated major incidents they have settled back into silo working. A major programme to train commanders to work differently and understand each others’ issues started in 2013 with the aim to improve communication and understanding of how the different emergency services work, what resources they have and the rules and regulations that govern how the different services respond to a major incident.
Responding to Diversity and Delivering Equality in Prehospital Care: Statutory Responsibilities, Best Practice and Recommendations
Chapter
  • Sep 2015
  • Ambulance Services
  • pp.119-133
Population and workforce diversity in the National Health Service (NHS) together with legislation and national guidance has led to equality becoming an increasingly important issue for patients, service users and staff. Ambulance services, as public sector organisations, are bound by The Equality Act 2010 and as NHS organisations are actively encouraged to implement the Equality Delivery System (EDS) and its successor EDS2, providing the local strategic context to understand and address system inequalities. This chapter examines current challenges for ambulance services in relation to equality and why this matters. It goes on to explore how services are responding to diversity, how they should embed this through engagement with both patients and staff and how they should understand the effects of these activities through more effective data monitoring.
Dealing with the Austerity Challenge
Chapter
  • Sep 2015
  • Ambulance Services
  • pp.135-145
This chapter describes the difficult financial position the National Health Service (NHS) faces and how this directly affects the ambulance service. It discusses the changing demographics and attitude of the UK and the impact of these on the ambulance service. The authors go on to discuss the innovative ideas and changes ambulance services have had to make to meet the ever-increasing demand placed upon them. Finally, the question is raised regarding the possible need for changes in commissioning.
The Ambulance Service of the Future
Chapter
  • Sep 2015
  • Ambulance Services
  • pp.149-156
The future of ambulance services raises important issues about the nature of prehospital care and the changing societal–cultural context. Talking of future service delivery models of engagement must involve an open and honest debate about the true nature, purpose and role of the ambulance services. There are two core functions of the ambulance services currently—a means of supported transport of patients in the community and a responsive and professional outreaching emergency diagnosis and management service. Some form of reactive service, able to respond immediately to the perception of a health emergency, will always be required. We foresee that while these functions will still be integral in the future prehospital care models, what is likely to change is the means of delivery and the professionals that deliver the service. But this transformational journey for the ambulance services to be a fit-for-purpose organisation for the twenty-first century is going to be evolutionary rather than by revolution or jettisoning what we currently have. It essentially centres on 3Ss—structure, skills and science.
Future Perspectives for the UK Ambulance Services: Evolution Rather than Revolution
Full-text available
Chapter
  • Oct 2015
  • Ambulance Services: Leadership and Management Perspectives
  • pp.157-162
The future of ambulance services raises important issues about the nature of prehospital care and the changing societal–cultural context. Talking of future service delivery models of engagement must involve an open and honest debate about the true nature, purpose and role of the ambulance services. There are two core functions of the ambulance services currently—a means of supported transport of patients in the community and a responsive and professional outreaching emergency diagnosis and management service. Some form of reactive service, able to respond immediately to the perception of a health emergency, will always be required. We foresee that while these functions will still be integral in the future prehospital care models, what is likely to change is the means of delivery and the professionals that deliver the service. But this transformational journey for the ambulance services to be a fit-for purpose organisation for the twenty-first century is going to be evolutionary rather than by revolution or jettisoning what we currently have. It essentially centres on 3Ss—structure, skills and science.
International Perspectives: Australian Ambulance Services in 2020
Chapter
  • Sep 2015
  • Ambulance Services
  • pp.163-174
Prehospital care in Australia is slowly evolving, from the current traditional paradigm of protocol-driven care delivered by vocationally trained providers to safe clinical care based on the evidence of improved patient outcomes, dispensed by tertiary educated, registered practitioners. This fundamental change in system-wide practice is hampered by the various challenges of vast geographical distance, fiscal constraint, paucity of robust data and a lack of political will and understanding of the critical importance of evidence-based policy.
International Perspectives: South African Ambulance Services in 2020
Chapter
  • Sep 2015
  • Ambulance Services
  • pp.175-183
Prior to 1980, ambulance services in South Africa were almost solely rendered by public sector emergency services. Levels of care and associated training differed between regions and provinces. There was little or no recognition for emergency care providers as independent healthcare professionals. Consequently, working on an ambulance was often seen as an “unwanted” add-on or adjunct to a more formally recognised primary role of municipal traffic officer, firefighter or civil defence volunteer. The lack of professional recognition and standing was in part as a result of an absence of formal higher education qualifications in emergency medical care at that time. Emergency care training which did occur was in-service and largely “skills based,” taking the form of short courses which ranged from only a few weeks to months. Post 1994, service delivery failures of an under-resourced public sector resulted in the emergence and rapid expansion of private ambulance services. Since the mid-nineties we have seen the South African emergency care profession begin to professionalise. The professionalization of ambulance services has been characterised by a gradual movement away from the historical “doctor-driven” technician system of the 1980s toward a separate self-regulated autonomous stand-alone profession. Emergency care practitioners now able to register and function as independent clinicians / practitioners and the historical short-course training system is in the process of being phased out in favour of formal 1-, 2- and 4-year higher education qualifications. Consequently, in South Africa the responsibility for clinical decision-making, interrogation, critique and development of prehospital medical protocol and direction is now largely driven and owned by South African paramedics themselves.
International Perspectives: Finnish Ambulance Services in 2020
Chapter
  • Sep 2015
  • Ambulance Services
  • pp.185-189
Emergency medical services and paramedic practice has developed rapidly in the past decades in Finland and in Europe. Demographic change in Europe means that more changes are needed to keep up with the growing demand for social and health services. Education has moved to universities, and with higher education, paramedic profession has developed to be an important part of emergency medicine. New technology makes it possible to transfer information from the field directly to emergency department and specialized MD. That makes decision-making process safer and more accurate. When patients are treated at home, they get better service and money, and time is saved. Advanced skill set demands high-quality continuing education system and good basic educational system. There is a demand for master’s level education, Ph.D. and research in the paramedic science to improve the overall quality of emergency medical services and quality of care in Finland.
... Education requirements are low and are typically obtained in a technical institution rather than through higher education, resulting in a patient care model reliant on medical protocols, physician consultation and high hospital conveyance rates (Leggio et al., 2019;Pozner et al., 2004). Integration into the wider health system is often minimal, with these systems typically identified as part of the public safety realm rather than health care (Wankhade and Mackway-Jones, 2015). These systems can often be a standalone paramedic system or integrated into a fire department or hospital-based ambulance system. ...
... The directive model of paramedicine appears fragmented in its approach to transforming into a fully recognised profession. Medical direction has a strong hold over paramedicine in North America, where paramedics and paramedic leaders have limited power or agency to change a system that is embedded in the legal structures and accreditation requirements of state legislatures (Wankhade and Mackway-Jones, 2015). This contrasts with the situation in other high-income countries operating within the Anglo-American paramedic system, where professional self-regulatory boards and clinical governance systems support the growth of an independent paramedicine profession with its own unique body of knowledge (Wankhade and Mackway-Jones, 2015;O'Meara et al., 2018a). ...
... Medical direction has a strong hold over paramedicine in North America, where paramedics and paramedic leaders have limited power or agency to change a system that is embedded in the legal structures and accreditation requirements of state legislatures (Wankhade and Mackway-Jones, 2015). This contrasts with the situation in other high-income countries operating within the Anglo-American paramedic system, where professional self-regulatory boards and clinical governance systems support the growth of an independent paramedicine profession with its own unique body of knowledge (Wankhade and Mackway-Jones, 2015;O'Meara et al., 2018a). ...
Exploring the structure and characteristics of the Anglo-American paramedic system in developed countries: a scoping review
Article
  • Dec 2021
Purpose This study aims to map and examine the existing evidence to provide an overview of what is known about the structure and characteristics of the Anglo-American paramedic system in developed countries. Design/methodology/approach The review includes results examining the structure and characteristics of the Anglo-American paramedic system in English-speaking developed countries. Databases, including Embase, MEDLINE, Web of Science, EBSCOhost, CINAHL, Google Scholar and Epistemonikos, were searched from the inception of the databases. A grey literature search strategy was conducted to identify non-indexed relevant literature along with forward and backward searching of citations and references of included studies. Two reviewers undertook title and abstract screening, followed by full-text screening. Finally, data extraction was performed using a customised instrument. Included studies were summarised using narrative synthesis structured around broad themes exploring the structure and characteristics of the Anglo-American paramedic system. Findings The synthesis of information shows that varying models (or subsystems) exist within the Anglo-American paramedic system. The use of metaphorical models based on philosophical underpinnings are used to describe two novel subsystems within the Anglo-American paramedic system. These are the professionally autonomous and directive paramedic systems, with the directive model being further categorised into the rescue and hospital-managed submodels. Originality/value This study is the first of its kind to explore the modern subcategorisation of the Anglo-American paramedic system using a realist lens as the basis for its approach.
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... With funding pressures, and rising political and consumer demands, the need to learn and adapt from innovative models of paramedic service delivery from across the globe has never been greater (32). Widespread problems with policy implementation, funding cuts, poorly integrated services across institutional settings, and few examples of successful multi-disciplinary teams have resulted in professional and consumer dissatisfaction with health service delivery (27). ...
... Even though paramedic services, given their 'command and control' organisational cultures, might be reluctant to view and engage the public as stakeholders in strategic decisions, the empowerment of patients to have a voice in how care is delivered is an important part of building trust and public acceptance throughout decision-making processes (32). As strategic objectives and key activities change throughout the process of time and innovation, stakeholders should be a dynamic concept, who may change or not be identified until the organisation's objectives are clearly defined (23). ...
Community Paramedicine through Multiple Stakeholder Lenses Using a Modified Soft Systems Methodology
Article
  • Jun 2020
p> Introduction Community paramedicine (CP) is an emerging model of care which expands paramedic scopes of practice to collaboratively support primary healthcare delivery in underserviced and disadvantaged communities. CP is a patient-centred holistic approach focussed on improving health outcomes, with success heavily reliant on integrative partnerships. This research aimed to identify key stakeholder perspectives about the value of CP in rural Australia. Methods A workshop was conducted using a modified soft system methodology (SSM) that asked participants to consider the value of CP from the perspective of five key stakeholder groups. The 50 participants consisted of paramedics and volunteer ambulance officers, paramedic service executives, paramedic educators, Medicare Local representatives and a general practitioner. Participants were randomly allocated to five stakeholder groups: paramedic profession; Minister for Health and Ageing; consumers, chief executive and executive management team of an ambulance service; and healthcare professionals. The application of SSM placed the five groups into three broad categories of stakeholders: customers, actors, and owners. ‘Customers’ in this context are patients, families and carers. ‘Actors’ are paramedics and volunteer ambulance officers, and ambulance service executives. The ‘owners’ are the Office of the Minister and those with the power to facilitate or block initiatives. Participants were allocated 15 minutes to brainstorm the question: “What can a community paramedic do for you to improve rural health provision?” Group views were verbally shared with all workshop participants and video recorded for analysis. Results The ‘customers’ asked about CP from patient, family and carer perspectives, and were highly engaged with questions about how, when and where CP could operate. The paramedic and volunteer ambulance officer group of ‘actors’ battled to move beyond their emergency response mindset to articulate a clear CP vision. The executive management team responded from a strategic and risk management perspective focussing on patient safety and corporate image. They identified the need to form stakeholder partnerships. The ‘owners’ representing the Office of the Minister focussed on the holistic and wellness benefits of CP. The health professional group anticipated the CP role could provide collaborative care and support doctors. Conclusions The findings suggest many participants had a limited understanding of CP, which creates a barrier for implementation. Key benefits identified included a reduction in financial and physical burdens on the rural healthcare sector and improved outcomes for consumers. Active participation of stakeholders in the process of introducing CP programs, where people are comfortable questioning current practices and encouraged to explore new concepts and innovations, would enable a shared understanding of program aims and expectations. For paramedic services to expand service delivery models in rural Australia community participation and engagement with stakeholders is essential. They and paramedics must be willing to embrace meaningful and collaborative partnerships with patients, broader health networks, social services, politicians and researchers, and be prepared to step away from their traditional ‘command and control’ culture to co-design innovative paramedic models. SSM was a worthwhile approach to stakeholder engagement that has the potential to improve implementation of community paramedic programs through improved inclusion and the valuing of stakeholder perspectives. </p
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... [15,28] Integration into the wider health system is often minimal, with the system typically identified as part of the public safety realm rather than health care. [38] Services operating within this system can often be a stand-alone paramedic service or integrated into a fire department or hospital-based ambulance service. ...
Shaping the future design of paramedicine: A knowledge to action framework to support paramedic system modernization
Article
  • Mar 2023
Background: Over the past two decades, the demands placed on modern paramedic systems has changed. Paramedic services can no longer continue to operate on a traditional response model where more ambulances are deployed to meet the rising demand of patients calling for their health needs. Recent research has explored system design in paramedicine and its relationship with organizational performance. Two subsequent paramedic systems have been identified with one, the Professionally Autonomous paramedic system, being linked to higher performance. Yet, how to operationalize this model for system modernization continues to be a gap in practice. Objective: To provide health leaders and policy makers with a framework from which to drive paramedic system modernization. Methods: This study uses the Knowledge to Action framework to develop an implementation plan for systems that seek to modernize their service delivery model toward that of a Professionally Autonomous paramedic system. Results: A detailed plan of the steps required to undertake system transformation are outlined. Whilst this framework outlines the components required for system modernization, it does not propose an in-depth outline of each of the steps required to achieve each component. Rather, end users are encouraged to develop individual implementation plans tailored to the local context using the comprehensive tools outlined within. Conclusion: This knowledge to action framework provides health leaders and policy makers with a uniform roadmap for paramedic system modernization intended to improve health (clinical) outcomes as well as health system outcomes through the Professional Autonomous paramedicine model.
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... The medical director is responsible for patient care activities performed by paramedics, takes responsibility for their appropriateness, and ensures that these activities are within the scope of practice and operational expectations [23]. This model, known as medical direction in paramedicine, continues to have a strong hold over the profession, particularly in the US and Canada, where paramedics and paramedic leaders have limited power or agency to change a system that is embedded in the legal structures and accreditation requirements of state legislatures [24]. A notion supported by recent literature showing that systems in the US and Canada are more closely aligned with public safety rather than healthcare and public health, resulting in a care delivery model that is more linear and less focused on developing an approach to care that connects patients with the right care, the first time [22,25]. ...
From stretcher bearer to practitioner: A brief narrative review of the history of the Anglo-American paramedic system
Article
  • Jun 2022
Background This narrative review presents a brief chronological history of the Anglo-American paramedic system, combining decades of stories from across ambulance services in western, English-speaking developed countries Methods Databases, including Embase, MEDLINE, Web of Science, CINAHL and Google Scholar were searched from the inception of the databases. A grey literature search strategy was conducted to identify non-indexed relevant literature along with forwards and backwards searching of citations and references of included studies. Two reviewers undertook title and abstract screening, followed by full-text screening. Included studies were summarised using narrative synthesis structured around the exploration of the history of the Anglo-American paramedic system. Results The research team structured the narrative in chronological order and used metaphorical models based on philosophical underpinnings to describe in detail each era of paramedicine. The narrative explores several key milestones including, industrial orientation, scope of practice, innovation, education and training, regulation as well as significant clinical and technological advancements in the delivery of traditional and non-traditional paramedic care to patients. Conclusions Paramedicine, like other allied health professions, has successfully navigated the pathway toward professionalisation in a considerably short period of time. From its noble beginnings as stretcher bearers in times of war, the profession has looked outwards to emulate the success of our healthcare colleagues in establishing its own unique body of knowledge supported by strong clinical governance, national registration, professional regulatory boards, self-regulation, and a move towards higher education supported by the development of entry-to-practice degrees. Whilst the profession has achieved many great milestones, their application across multiple jurisdictions within the Anglo-American paramedic system remains inconsistent, and more research is needed to explore why this is.
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... Tidigare forskning om ledarskapets betydelse inom ambulansverksamheter har i olika internationella studier fokuserat på skilda perspektiv som exempelvis etiska aspekter (Al Halbusi et al, 2021), relationsskapande och service (Baird & Boak, 2016;Bajnok et al, 2012) och betydelsen av feedback och lärandeaspekter (Cannon & Witherspoon, 2005;Lee & Martebo, 2009). Olika aspekter som befrämjar ett effektivt ledarskap har även belysts i tidigare studier (Waugh & Streib, 2006;May & Norbury, 2007;Cummings et al, 2008;Grimm, 2010;Wong et al, 2010;Taylor, 2011;Taylor, 2012;Giltinane, 2013;Larsson & Hyllengren, 2013;Nordby, 2015;Newton & Harris, 2015;Wankhade & Mackway-Jones, 2015;Phung et al, 2016;O´Meara et al, 2017). Studier har även fokuserat på organisationernas betydelse för ambulansverksamheter och ambulanspersonal (Harrison, 2019;Samad & Memon, 2021;Stewart et al, 2021). ...
Prehospitala arkitekter. Verksamhetsansvariga om förebyggande arbete, ambulanssäkerhet och ambulanskörning – en Websurvey 2021-2022
Research
Full-text available
  • Mar 2022
Forskningsrapporten Prehospitala arkitekter handlar om verksamhetsansvariga inom ambulanssjukvården i Sverige och hur de själva uppfattar och upplever sitt eget ledarskap, förebyggande arbete och om sådana förhållanden som berör ambulanskörningen i praktiken. Prehospitala arkitekter har erfarenheter av ambulansverksamheter i såväl offentlig som privat regi. Deras röster och reflektioner är mycket viktiga att ta del av för att vi ska kunna få en ökad förståelse för hur ambulansverksamheten ser ut i dag men även hur de Prehospitala arkitekterna tänker och reflekterar om framtiden. I sina ledarroller som Prehospitala arkitekter har de verksamhetsansvariga inom ambulanssjukvården en viktig uppgift att se verksamheten ur ett helhetsperspektiv. Föreliggande rapport handlar därför om patientsäkerhet, arbetsmiljö och trafiksäkerhet. Områdena kan nämligen inte betraktas isolerade från varandra. Huvudfokus i rapporten är det skadeförebyggande arbetet och vilka förutsättningar och villkor som befrämjar respektive försvårar möjligheterna för ambulanspersonalen (ambulanssjuksköterskor och ambulanssjukvårdare) att utvecklas till förare av ambulansfordon och utryckningsförare. Rapporten redovisar resultatet från en Websurvey 2021-2022, riktad specifikt till verksamhetsansvariga inom ambulanssjukvården. Hur reflekterar dagens Prehospitala arkitekter om det förebyggande arbetet, intern trafiksäkerhet, Nollvisionen och säkra ambulanstransporter? Vad har de att uttrycka om den lokala och nationella ambulanssäkerheten? Totalt 32 verksamhetsansvariga från olika regioner i Sverige delar med sig av sina erfarenheter och sin kunskap inom området. Rapporten kan därför ses som Prehospitala arkitekternas eget lärande och deras reflektioner om ambulanssäkerhet i förfluten tid, nutid och framtid.
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... In the US and Canada, there are two common management and leadership features found within government and private paramedic systems: the medically directed paramedic system, in which a physician acts in both a clinical and supervisory role (4); and the fire-based paramedic system, which involves a firebased operational leadership structure combined with physician medical direction (4,5). Although the fire-based paramedic system can be considered a subset of the medically directed paramedic system, it is important to recognise that many physician-directed paramedic systems are not a part of a firebased reporting structure, and so two separate classifications are required. ...
The Structure and Characteristics of Anglo-American Paramedic Systems in Developed Countries: A Scoping Review Protocol
Article
Full-text available
  • Apr 2020
p> Introduction Paramedicine has undergone significant change in the past two decades. While the Anglo-American paramedic system continues to grow there appears to be a dearth of published literature regarding modern categorisation of this evolving paramedic system. The objective of this scoping review is to examine and map the existing evidence to provide an overview of the characteristics and structural similarities and differences of Anglo-American paramedic systems in English-speaking developed countries. Methods Databases, including Embase, MEDLINE, Web of Science, EBSCOhost, CINAHL, Google Scholar and Epistemonikos, will be searched from inception. A grey literature search strategy has also been developed to identify non-indexed relevant literature. Citations and references of included studies will also be searched. Two reviewers will undertake title and abstract screening, followed by full text screening. Data extraction will be conducted using a customised instrument. Inclusion criteria: results examining management, leadership or governance in paramedicine related to the Anglo-American paramedic model in English-speaking developed countries will be included in the review. Included studies will be summarised using narrative synthesis structured around themes of management, leadership and governance in paramedicine.</p
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From frontline to forefront: paramedics as healthcare leaders within the NHS
Article
  • Sep 2024
The NHS in the UK faces numerous challenges, including increasing demand for services, financial constraints and the need for effective leadership. Paramedics are exceptional healthcare leaders within the NHS in the UK, possessing unique skill sets and experiences that make them invaluable in leadership roles. Their clinical expertise, decisive decision-making abilities, and adaptability, honed in challenging frontline environments, are crucial assets in healthcare leadership. Transformational and situational leadership theories align seamlessly with paramedic practice, showcasing their ability to inspire teams and effectively navigate diverse healthcare scenarios. Evidence demonstrates paramedics' significant positive impact on patient care, organisational performance, and healthcare innovation when in leadership positions. Despite their capabilities, challenges persist, including historical professional hierarchies and underrepresentation of certain groups in leadership. A new framework for developing paramedic leaders addresses these issues, emphasising targeted training, interprofessional collaboration, and inclusive practices. Recommendations include implementing comprehensive leadership development programmes, enhancing incident scene management training, and addressing psychological factors affecting leadership effectiveness. By fully recognising and nurturing paramedic leadership, the NHS can leverage their unique perspectives to create a more resilient, efficient, and patient-centred healthcare system to meet current and future challenges.
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A conceptual framework for the exploration of the relationship between systems of paramedicine and system performance
Article
  • Oct 2022
Background: Over the past 60 years since its inception, the Anglo-American Paramedic System has continued to grow and evolve. While brief and fragmented accounts of the differences between systems have been noted in the literature, until recently there has been a paucity of research that explores and identifies sub-models of paramedicine within the Anglo-American Paramedic System. Objectives: This article describes a conceptual framework that sets a roadmap for defining and comparing two newly identified sub-models of the Anglo-American Paramedic System. Methods: A conceptual framework for the exploration of these novel sub-models was developed on the basis of the work completed by Donabedian as well as Turncock and Handler. These two sub-models worked to develop a model for quality assessment and performance measurement in the public health system. Results: The conceptual framework consists of six components that are strongly related to each other: system design, macro context, mission and purpose, structure, service delivery models and quality outcome measures. While this framework relates specifically to two novel paramedic systems known as the Professionally Autonomous an Directive paramedic systems, it can be used to measure any integrated health model. Conclusion: The conceptual framework described in this paper provides a stepwise roadmap for the definition and comparison of the newly identified paramedic systems to better inform future research that defines and compares paramedic system design and performance.
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Using Travel Times for Optimization Numbers of Medical Rescue Service Points—Case Study from Slovakia
Article
Full-text available
  • Dec 2020
Health care and protection is one of the fundamental human rights, which apply to all people of the world. Life and health threats can occur at any place and time, both at times of peace and security and at times of emergencies of any kind. In many cases, provision of urgent medical care creates a time strain. Emergency medical care in the Slovak Republic is provided by a medical rescue service, including mobile emergency care and ambulances, with or without a doctor. The present article deals with the purpose and role of medical rescue service with an emphasis on mobile emergency care provision by ambulances. The following part defines selected factors affecting medical rescue service station locations and numbers of ambulances. Emphasis is laid on an analysis of theoretical assumptions for optimization of the number of medical rescue service stations and ambulances used by them for the purpose of securing care of life and health of the population and addressing emergencies within selected territorial units in the Self-Governing Region of Žilina. The proposed optimization of the number of medical rescue service stations in municipalities is addressed theoretically as a location issue. The resulting theoretical variant of the proposed new distribution of medical rescue service ambulance stations is a mathematical consideration of assurance of emergency medical care provision within 15 min from each event reporting. The mathematical algorithm used for the proposal of medical rescue service ambulance station distribution is applicable in different regions and countries with a defined time to provision of first aid and emergency medical care.
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The strategic and operational landscape of emergency services in the UK
Article
  • Aug 2019
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.
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