Paresh Wankhade

Performance measurement and the UK emergency ambulance service: Unintended consequences of the ambulance response time targets

Purpose – The purpose of this paper is to assess the performance measurement in the UK NHS ambulance service documenting various unintended consequences of the current performance framework and to suggest a future research agenda.Design/methodology/approach – The paper reviews the literature on ambulance performance targets and documents several unintended consequences of the current performance system through an in‐depth case study analysis based on interviews with Trust staff and policy experts along with observation of performance review meetings in the chosen Trust. Ethical approval for the study was obtained from a local NHS research ethics committee.Findings – Significant unintended consequences of the ambulance performance targets based on response times have been systematically documented, which are likely to put the target under spotlight, especially that of the eight‐minute response. The current policy focus to reform the eight‐minute target by making it more stringent has the potential of jeopa...

Bridging the theory and practice gap in emergency services research: a case for a new journal

Purpose – The purpose of this paper is to provide the rationale underpinning this new journal in addressing the apparent gap and fragmented nature of the emergency services research, to introduce the papers in this inaugural issue and encourage readers and potential contributors to support the International Journal of Emergency Services (IJES).Design/methodology/approach – The paper introduces the new journal, and its intention to challenge the current “silo approach” which isolates the academic and practitioner community. It also outlines the editorial intentions for the journal, linking the theme and selected papers for the inaugural issue to the future editorial direction of the journal.Findings – Emergency function resides with a host of agencies including the three “blue light” services (police, fire and ambulance). IJES is an opportunity to publish up‐to‐date and original research contributions for the benefit of scholars, policy makers and practitioners in these areas, including the interface of po...

The negative consequences of culture change management: Evidence from a UK NHS ambulance service

Purpose – The purpose of this paper is to analyse the culture change management programme in one UK NHS ambulance service, documenting various perverse consequences of the change management and suggest further research implications. Design/methodology/approach – The paper reviews the literature on “culture” and “culture change” and identifies several perverse consequences of a culture change management programme through an in-depth case study analysis, based on interviews with trust staff and policy experts along with non-participant observation. Study was given ethical approval by the local NHS research ethics committee. Findings – Significant negative consequences of the culture change management programme in the ambulance service are systematically documented. The paper argues that any worthwhile study of organisational culture change management must take into account the perverse consequences of such a process and its overall impact on employees. Research limitations/implications – These findings come...

The Big Society in a Time of Crisis – the Impact on Public Health

At the time of writing, the UK is in a “double-dip” recession with the economy flatlining. The Government is set for a new round of benefit cuts. The cuts introduced to the public sector when the coalition government came to power in May 2010 are already beginning to bite. This “age of austerity” and general gloom was lifted briefly in summer 2012 by the undoubted success of the London Olympics and Paralympics; however, the sense of crisis within the nation runs deep. This article explores the extent to which the concept of the “Big Society” can alleviate the impact of the crisis on public health. The authors explore the thinking behind the concept of “Big Society” tracing related ideas back to Victorian times. We further examine this issue, citing evidence about the impact of cuts on the National Health Services ambulance service and how social capital offers a way forward. While acknowledging that there is merit in the Big Societys call for voluntary sector support, beyond the support provided by the State, the authors argue that the reality of the Big Society is nonetheless flawed. If anything, the call should be for a “Little Society” of voluntarism at a local level, where meaningful voluntary action can help ameliorate the inevitable forecast decline in state support.

Working with language: a refocused research agenda for cultural leadership studies

This article critically reviews existing contributions from the field of cultural leadership studies with a view to highlighting the conceptual and methodological limitations of the dominant etic, cross-cultural approach in leadership studies and illuminating implications of the relative dominance and unreflective use of the English language as the academic and business lingua franca within this field. It subsequently outlines the negative implications of overlooking cultural and linguistic multiplicity for our understanding of culturally sensitive leadership practices. In drawing on lessons from this critical review and the emergent fields of emic, non-positivist cultural leadership studies, this analysis argues that the field of cultural leadership studies requires an alternative research agenda focussed on language multiplicity that enables the field to move towards emic, qualitative research that helps to empower individual cultural voices and explore cultural intra- and interrelationships, tensions and paradoxes embedded in leadership processes. The article concludes by offering suggestions on methodological approaches for emic cultural leadership studies that are centred on the exploration of language as a cultural voice.

Global Perspectives on Volunteerism: Analysing the role of the State, Society and Social Capital

Purpose – The purpose of this paper is to examine the concept of volunteerism in three different case countries, namely, that of USA, UK and China while highlighting the role of the state, society and social capital. Design/methodology/approach – The paper reviews the extant literature on the volunteering traditions in the chosen case study countries highlighting the idiosyncrasies while analysing implications for future research. Findings – The paper highlights the role of the state, society and social capital in the chosen countries, each deriving its origins from the specific traditions in those countries. Research limitations/implications – This paper provides a conceptual review focusing on the key literature in the field. The authors have examined various academic texts and published materials. Practical implications – This paper provided an update critically discussion on the concept of volunteerism in three different case countries. Social implications – This paper is highly relevant to academics ...

Regional Variations in Emergency Service Performance: Does Social Capital Matter?

Andrews R. and Wankhade P. Regional variations in emergency service performance: does social capital matter?, Regional Studies. The relationship between social capital and the performance of public organizations is currently at the top of the UK policy agenda and elsewhere. This paper examines whether social capital is associated with improved regional emergency service performance by exploring its relationship with the achievements of ambulance trusts in England. Drawing on a six-year panel dataset, ambulance response times are modelled using an index of social capital, incorporating measures of community organizational life, political efficacy and social trust, in the regions served by National Health Service (NHS) ambulance trusts. Theoretical and practical implications are discussed.

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.

Staff perceptions and changing role of pre-hospital profession in the UK ambulance services: an exploratory study

Purpose 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. Design/methodology/approach 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. Findings 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. Research limitations/implications 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. Practical implications 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. Social implications Societal understanding about the organisational implications of the work intensity in an important emergency response service will encourage further debate and discussion. Originality/value 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.

Introduction: Understanding the Management of Ambulance Services

This chapter sets the scene for the first of a three volume edited series on the leadership and management perspectives in the three main blue light emergency services (Police, Ambulance and the Fire & Rescue Services). It provides the rationale behind this volume and its relevance to a wide audience of students, academics, practitioners, professionals including the management practitioners in police forces. The chapter first sets the changing context of policing 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 police officers & staff and police practitioners both in the UK and abroad, giving an international perspective on the future of policing. 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 of police services.