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– Ring station or radio ambulance

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

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

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

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

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

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

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

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

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

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