London Ambulance Service NHS Trust (LAS)
As part of the NHS trust the London Ambulance Service has the responsibility to handle all ambulances operations and responding to all urgent and medical situations that are urgent within London. Their services are mostly curated to respond to 111 and 999 phone calls and avail triage and any form of advice to help deal with the case reported effectively (LAS,2002). They are one of the ambulance trusts in England to provide urgent medical services and since it receives direct government funding the services are free. There are no charges to anyone using the service as every citizen in the United Kingdom has the right to the given services. On average the services receive about 2500 calls per day, where 1500 are 999 related phone calls and 1000 are 111 related (Fitzgerald & Russo, 2005) This means that they are responsible to respond effectively to the calls and dispatch ambulances if necessary. This means that the services are expected to work efficiently since they deal with human lives. This is one of the major challenges that the services have faced over the years.
Strategic issues facing LAS.
The challenge they have about the number of people they offer services to is meeting and controlling the demand. The service has received generous contributions from the trust and government directives and this makes their expectations rise with each contribution. They have set targets such as management of 80 percent of their calls within 14 minutes (LAS, 1994a), and this target kept on increasing by the years.
Their performance was also meant to increase such that 50 percent of the ambulances were expected to reach their patients within 8 minutes and for the patients living in urban and rural 98 percent of the ambulances are supposed to reach them within 14 minutes and 19 minutes respectively (Chapman, 1996). The demand for the ambulance services also increased and this meant that to fulfill the services they had to cut costs so that they could sustain their services as the growing demand was not being fully funded. It has led to the challenge of fulfilling every call the service gets with the utmost care needed. The red 1 calls have resulted in being given more priority as the red 2 calls are responded to in more than 8 minutes when they will be upgraded to red 2 calls. This leaves a loophole for patients with cases that can escalate to get worse by the time they get the medical attention that they need.
The whole system is supposed to be dependent on the computer-aided dispatch system in response to the calls being made by patients. This means that a system of high tech is to be used to determine the level of medical priority that is to be given to the different unknown calls the service gets (Clawson, Olola, Heward, Patterson, & Scott) This system is the one responsible for labeling a call as red alert 1 or 2 and this determines the attention the call will be given. The ambulances once dispatched are monitored in the control room via the GPS tracker that is installed inside the ambulance. This is used to estimate the time an ambulance is supposed to reach a certain destination and the patient can be assured if they call again. The response that the receiver of the call gives will determine the information they put in the system which will access the situation and determine if it is critical or not. The patient’s life is determined by these two factors, one is whatever information the computer system receives and the category it will put the patient and two the information put in the system by the staff.
Challenges facing LAS.
The system is computerized means that the system has to be updated, checked for errors if any and the staff have to be fully trained to ensure that they give efficient results. This will impact the services given, the turnaround time for the ambulance crew to respond to other calls, and overall efficient results (Fitzgerald & Russo 2005). The London Ambulance Service has met a lot of challenges in its quest to meet these strategies. One of the issues in controlling their demand is where the ambulances have to take their patients to get the medical attention that they need. The destination for patients changes from one to another which means that the ambulance service is also affected. Patients with stroke, trauma, or ones with heart attacks need special medical care and need to be taken to centers that can attend to their various needs (Clawson, Olola, Heward, Scott, & Patterson, 2007) and not taken to local medical centers. The long rides to the various centers mean that the ambulance crew ends up caught in traffic for long hours out of their jurisdiction and this reduces the efficiency of their services.
This issue on the service staff paramedics and crews also extends to staff retention and hiring. The pressure to meet demand, the trauma that some crew members face during their rounds (Misra, Greenberg, Hutchinson, Brain & Glozier (2009) are a few of the many reasons why the London Ambulance Services have issues with staff retention and hiring. It is impossible to know the trauma potential staff had faced in their previous work and if the incidents would affect their present job. There is also a rise in demand for paramedics in other industries that have less pressure, this takes a toll on the efficiency in responding to the emergency calls since there isn’t enough staff and paramedics to handle the ambulance calls. The paramedics and control room staff also have to be given enough training and monitored closely before they are given the freedom to handle issues on their own. This is important because the staff in the control room have to learn how to decode information carefully and have the expertise to know if a call is urgent and if it can wait for more than eight minutes. This is because their ability to discern critical and less critical calls will determine how the computer will classify the call. Once the call is labeled critical then the frontline staff will be alerted on the case.
Solutions to address the challenges facing LAS.
These issues however can be handled effectively and result in a better system that works efficiently. The staff turnover is seen as a major issue affecting the London Ambulance Service and this is a limiting factor to what they are commissioned to do which is save lives. The challenges can be curbed by investigating the reasons why their service is experiencing high staff turnover and through this data they can come up with ways of handling the issue. Some of the reasons why the staff is let go is because they are considered incompetent in their work by management. The service can not blame the staff on an error that is as a result of a system failure. The London ambulance service computer-aided despatch system (LASCAD) is not perfect and at times it can be faulty (Beynon, 1999). An information system failure has been seen as a human error more than once in the London Ambulance Service, this has led to the staff feeling incompetent even though they did their best t decode the right information from the call. It is not up to the staff to decide to send an ambulance but up to the system, so if the system puts the patient on red alert 2 yet the staff intended to classify them as 1 then they can not do much about it. The issue comes in when the patient ends up losing
their life as a result of being put on hold. The staff would take the blame for the incident and not the system. This is where trauma starts to build up as a result of the guilt that builds up, even the ambulance crew ends up feeling incompetent each time they lose patience as a result of wrongful computer analysis.
When such cases become a norm the employees are bound to report the issue if it is not given any attention that is when some of them start to leave. Even new employees prove hard to keep since they get a dysfunctional working environment that is based on a system that is failing them (Beynon, 1999). The management should come up with a way to solve the issue by coming up with a way of fixing the glitch or implementing a new system to aid the already existing one to work more efficiently. The staff will then rely on the system and not second guess it and try to use their own accord to make choices. It is through this that the employees would feel heard and this will reduce the level of guilt they get when a patient loses their life. Staff also sometimes feel wasted when they get inappropriate calls at the expense of important ones. Once the system is curated to filter out spam calls and important calls then the efficiency and time management of the staff would be greatly increased.
How LAS could practically implement the solution.
The issue of employing staff who have mental issues due to trauma can be solved by critically evaluating candidates for the job before giving them the job. This is best solved by putting the staff to tough situations and monitoring their reactions to the situation. This will enable the management to know the mental status of the candidate and know if they can be employed or not. This can be implemented by putting the tests as part of the interview for the job. This is one way of preventing the candidate from seeing the test as a form of discrimination. If a candidate has a mental health issue then the management should not just let the paramedic go just like that but instead refer the candidate to an institution that can help them get better (Misra, Greenberg, Hutchinson, Brain, & Glozier 2009). Once they recover then they can be employed and this would not be a loss to either party.
If the case is mild the management should find a suitable position for the candidate where the pressure would not be as much as they recover from their previous trauma. The management should also incorporate a good amount of funds to help employees in their work and also reward them in case they achieve major milestones. This will show employees that their interests are considered by management and in case of anything during their rounds they will be well compensated and taken care of. The pressure at work, demand during the job would be seen as a worthy cause since they will get benefits from what they do other than just saving lives. The staff in the control room have to be well trained to ensure that they conduct their jobs with the needed expertise, they will then be able to handle the London ambulance service computer-aided despatch system (LASCAD) and all the pressure that comes with it (Fitzgerald & Russo 2005). Extensive training of all employees that are to be situated at the control rooms will ensure that they have the needed skills, know-how and the needed confidence to take up any distress calls from 999 and 111 patients.
This will reduce any risks that come with staff having a difficult time decoding the information they get from calls and knowing if the call needs important attention or if they can wait and be leveled as red 2 calls. The training should not just be theoretical but also practical in that the candidates can handle calls before they get employed, this will ensure that they have the needed skills to handle calls and in the end they can do it on their own. The training of alm employees on the different areas of the service will ensure that the management can be able to rotate their employees in the various departments. The rotation will ensure that the pressure and demand for the job will be distributed in the company and employees who are in the demanding departments get a break once in a while as others take over.
The management should focus on addressing all departments and the issues that affect the employees in those departments. The Information Technology department should have constant updating of their system, training on the new systems that have been developed, and how they can help the London Ambulance Services. The ambulance staff issues like meal breaks, need for early retirement, insurance, late finishes and operational issues like long working hours with risks involved have to be considered. This will ensure that there is better employee management and less staff turnover which is beneficial as the efficiency of the London Ambulance Service will be increased.
Works cited,
Beynon-Davies, P. (1999). Human error and information systems failure: the case of the London ambulance service computer-aided despatch system project. Interacting with Computers, 11(6), 699-720.
CHAPMAN, R. (1996). Review of Ambulance Performance Standards, Department of Health, July
Clawson, J., Olola, C., Heward, A., Patterson, B., & Scott, G. (2008). The ability of the medical priority dispatch system protocol to predict the acuity of “unknown problem” dispatch response levels. Prehospital Emergency Care, 12(3), 290-296.
Clawson, J., Olola, C. H., Heward, A., Scott, G., & Patterson, B. (2007). Accuracy of emergency medical dispatchers’ subjective ability to identify when higher dispatch levels are warranted over a Medical Priority Dispatch System automated protocol’s recommended coding based on paramedic outcome data. Emergency Medicine Journal, 24(8), 560-563.
Fitzgerald, G., & Russo, N. L. (2005). The turnaround of the London ambulance service computer-aided despatch system (LASCAD). European Journal of Information Systems, 14(3), 244-257.
LONDON AMBULANCE SERVICE WEB SITE. https://www.londonambulance.nhs.uk.
Various entries, accessed 7 March 2002.
LONDON AMBULANCE SERVICE (LAS) (1994a). Corporate Plan 1994/5.
Misra, M., Greenberg, N., Hutchinson, C., Brain, A., & Glozier, N. (2009). Psychological impact upon London Ambulance Service of the 2005 bombings. Occupational Medicine, 59(6), 428-433.