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The London Ambulance Service Case

The London Ambulance Service Case. The Manual System. 999 call to BT Call switched to LAS call takers Record details & map reference onto a form Send form by conveyor belt to allocator Allocate ambulance based on availability & location Pass form to despatcher

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The London Ambulance Service Case

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  1. The London Ambulance Service Case

  2. The Manual System • 999 call to BT • Call switched to LAS call takers • Record details & map reference onto a form • Send form by conveyor belt to allocator • Allocate ambulance based on availability & location • Pass form to despatcher • Ring station or radio ambulance

  3. LAS Computer Aided Despatch:LASCAD Project • Automate or support: • Call taking & gazeteer • Tracking of vehicles • Allocation & mobilization of resources to incidents • Ambulance resource management • Provision of management information

  4. LASCAD 1980s-1992 • 1986 IAL project scrapped in 1990 at a cost of £7.5m & moved to litigation • 1989/1990 ambulance strike; new CEO John Wilby appointed • 1991 Systems Options £1.1m bid accepted • 1992 trials failed • Oct. 1992 implementation collapsed in chaos • headlines of 30 deaths; Wilby resigns; public inquiry ordered

  5. LASCAD 1993-4 • 1993 Page Report • Total management failure; chairman resigns • Continue with CAD – probably take 4 years • Needs total ownership by management & staff; controllers & crews • 1994 LAS board scrapped; RHA takes over; new CEO & IT Director • 1994 – improvements in IT infrastructure • 1994 – Nasima Begum dies (53 minute wait) • Another inquiry

  6. LASCAD 1995-2003 • 1995 - Wells Report • Continuing management weakness • Poor staff training; high absences; poor shift changeover; lack of technology • 1995 on – gradual implementation of sub-systems • 1996 – received NHS trust status • 1997 – BCS award • 2003 – still implementing sub-systems

  7. Technology Problems • Changes in ambulance design • Introduction of fixed bulkhead • Privacy vs. safety • LASCAD • Over-ambitious • Bought cheap - unreliable, inefficient (Windows 3.0), • Not properly tested & debugged; poor training • Awful project management • => ‘inevitable’ disaster

  8. Public Sector Managerialism • Cost-efficiency paradigm • Importance of technology & targets • Constant reorganisation • 1991 53 managers laid off – 800 years of experience walked • Culture changes from military to managerial • Change in evaluation targets • Increased responsibility to call takers – prioritising calls • Frequent changes in senior managers

  9. Industrial Relations, Power & Status • Ambulances seen as low status service • Legacy of 1989-90 strike • Autonomy & behaviour of crews • Sabotage in 1992? • Changed status of call takers • London is different • Mixed resistance & enthusiasm for change • Constant feeling of anxiety

  10. LAS Improvisation • Need to improvise in a very complex situation • Numerous stakeholder groups; All snapping at each other; vulnerability of senior management • Introduce IS little by little • LAS Golden Circle – development method • Only those within the circle could participate • Failure to confront the crews • Fear of sabotage; continuing industrial relations problems

  11. Quotes • “… there is nothing more difficult to arrange, more doubtful of success & more dangerous … than initiating change” Machiavelli • “A strike is a social phenomenon of enormous complexity… never susceptible to complete description, let alone complete explanation” Gouldner

  12. Conclusion: Need for Understanding • Long & complex story • IT is often a small part • Human cost rather than financial • The story continues …. • Recognition of the importance of: • The changing business, organisational & social context • Multiple stories; People, moods & cultures • Fitzgerald & Russo article • 1992 vs. 1996 – a bit too black & white? • Understanding is constrained by the frame of reference of manager/researcher

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