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The London Ambulance Service Case
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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