James Radcliffe

Performance Measurement and the English Ambulance Service

Performance indicators used in the ambulance service in England are one-dimensional and do not reflect the widening role of the ambulance paramedic. The development of a broader range of indicators is thus to be encouraged. As well as highlighting the consequences of simplistic indicators, this case study has important implications for our understanding of the New Public Management (NPM).

Exploring the utility of current performance measures for changing roles and practices of ambulance paramedics

This article explores the relationship between the changing roles of ambulance paramedics, the causes of increasing call outs in the UK and in other countries and the need for improvements in process and outcome measures to reflect these changes. It also reflects on the application of ‘Lean’ techniques to the modernization of ambulance services, although with some scepticism. Moreover, it is contended that changing roles have moved far in advance of existing performance measures, contributing to misunderstandings between healthcare professionals and service users.

Ambulance calls and cancellations: policy and implementation issues

Purpose – The purpose of this paper is to explore the issues around the considerable increase in emergency calls experienced by a large county ambulance trust and implications for the implementation of government policy in relation to the English National Health Service Ambulance Service.Design/methodology/approach – The paper involves a literature review and the analysis of the ambulance service data based on emergency call outs, and discussions with senior ambulance and health authority personnel.Findings – Increased calls were mainly explained by a large increase in cancellations, especially after the vehicle had arrived at the scene. The term “cancellation” is potentially misleading and may carry connotations of wasted resources. There was little evidence of inappropriate calls and no single cause of cancellations or any simple solution. Instead, a wide range of actions were included, many of which seem potentially worthwhile. However, the way the data are presented disguises their diversity and poten...

Organisational and Professional Cultures: An Ambulance Perspective

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.

Cultural change and perpetuation in organisations: Evidence from an English Emergency Ambulance Service

ABSTRACT Transforming cultures rather than changing structures is a favourite prescription for reforming health care organisations. We explore the relationship between cultures, performance measures, and organisational change by analysing the cultural characteristics of an English ambulance trust to understand how organisational culture is perpetuated. Internal and external factors that impact on culture change programmes, such as historical legacy and sub-cultural dynamics, are identified. The role and identity of ambulance personnel, the conflict between professional culture and managerial objectives, and the role of performance measurement were found to be significant issues which promoted resistance to enforced change and impeded planned management action.

Performance Management in the Public Sector: The Case of the English Ambulance Service

This chapter examines performance measurement within the public sector, with particular reference to the English ambulance service. Recent experience concerned the perverse incentives inherent in using single dimension performance measures. However, performance evaluation now better reflects the changing role of ambulance paramedics, which stresses clinical activity rather than simply the speedy transportation of patients to hospital. Analysis of these developments is placed within the context of theory derived from New Public Management and New Public Governance. The topic is significant for the academic study of management control in organizations and also to policy makers, managers and public sector professionals.

Ecological Pressure Groups

Turning from those groups attached to the established parliamentary parties and the electoral system, the next to consider are those pressure groups active on environmental issues but which have no party political link. The range of such organizations is very wide and so the choice of groups discussed below is a small section of the total number in existence. Some of the groups have emerged in response to the environmental crisis and are associated with the radical concept of ecology. Other groups discussed include ecological research groups and recent developments surrounding the anti-roads lobby and their association with life-style changes.

The Green Party and Party Politics in the UK

The purpose of this chapter and the next is to examine the ideology and the methods of a number of organizations who may be said to comprise part of a community or movement whose concern is centred upon environmental issues. The material was gathered between 1978 and 1998, and includes publications, interviews with members and items published on the Internet. The views expressed, except where these come from pamphlets and other publications, are the personal views of those interviewed.

Ecology and International Summitry

The processes by which the environmental crisis is debated at the international level between governments, state actors and non-governmental organizations is now an extremely complex one. The range and diversity of organizations involved is only matched by the range and complexity of the issues under discussion. As a consequence this chapter can only scratch at the surface of the issues and does not propose to be a comprehensive analysis of all the activities that can be placedunder the heading of international summits and conferences on the environment.

Centralism versus Decentralism

The previous chapter centred around the relationship of technology to social structure, the nature of economic growth and the questioning of their role within a finite world. The result was to see that society had to take account of both these factors and control their substance in order to achieve a desirable future. In essence the demand of ecologists is that humanity must actively participate in the directing of the technological and economic development of his/her future rather than reacting to circumstances or ‘muddling through’. This entails the creation of an ecological society, and means we must enquire into the structure of such a society, in particular its political structure; for if decisions are to be taken about technological developments and the nature and distribution of resources, we are in the realm of politics. This requires that we ask who makes the decisions and how they are to be enforced. Within the ecological debate this centres upon thecentralist–decentralist division.