Ambulance Services Strategic Plan Issues - Case Study Example

THE SOUTH AUSTRALIA AMBULANCE SERVICE This paper has opted to render an analysis of SA Ambulance Service (SAAS, for brevity), the sole provider of emergency ambulance transport, clinical care and patient transport services in South Australia. The organization is going to be studied through the modernist, symbolic-interpretive and post-modernist perspectives, with an aim to bring into light issues or concerns that SAAS may have to face or is currently facing with respect to its organizational design and function. SAAS is owned by the South Australian state government. It provides pre-hospital care and emergency and non-emergency ambulance services in South Australia. It operates one hundred eight (108) ambulance stations across South Australia, with its fleet of three hundred fifty (350) ambulance vehicles. SAAS employs approximately one thousand two hundred (1,200) full time staff, who are backstopped by double this number of volunteers (cf. Facts and figures, [n.d.]). Its head quarter is in Eastwood, South Australia (IBIS World, 2009). SAAS offers such services as: patient transport service, which attends to all non-emergency cases; education unit that provides training for its employees and volunteers; emergency operations center answering emergency triple-zero calls and coordinates the state’s ambulance resources; special operations team for specially-trained paramedics for high-risk rescue procedures; and, support services that includes computer systems maintenance and corporate services (IBIS World, 2009). On daily basis, SAAS receives an average of four hundred (400) triple zero calls. In a year, the inbound calls reach an average of four hundred thousand (400,000). And, SAAS paramedics and ambulances actually respond to an average of two hundred fifty thousand (250,000) cases yearly (see Who we are, [n.d.]). SAAS is being managed by an Executive Management Team. The chief executive of South Australia Health is responsible for the administration of SAAS, and appoints and delegates appropriate managerial powers to its chief executive officer. At the corporate level, SAAS ultimately reports through SA Health to the Minister for Health. However, it maintains its status as a separate entity as it reports to the Department of Treasury and Finance. For operational matters, the SAAS has a close relationship with the Operations Division of SA Health (see Structure, [n.d.]). MODERNIST PERSPECTIVE ON SAAS At the outset, to analyze SAAS through the modernist point of view of organization theory, let it be disclosed that the focus of the scrutiny is the environment of our ambulance service provider. It is true that a fuller analysis of an organization will only be done by considering not just the environment of the organization – a delimitation of this paper – but also its social structure, technology and culture. However, this paper is biased in primarily taking into account the integrative framework of the organization and its environment. Just as all other social groups, an organization such as the SAAS is considered an open social system. In itself, an organization is involved with myriads of external elements. Daft, Murphy and Willmott (2010, p. 166-167) write that the change and complexity in environmental domains translate to major implications for the design or order and action or activities by an organization. In fact, the decisions and actions taken by organizations are said to be traceable to the changes that are perceived (by the same organization) in the external environment. The Vision 2010 (n.d.), the SAAS’ five-year strategic plan, clarifies that the general environment of the organization is the health service industry in Australia and its specific environment is the Australian ambulance service. IBIS World (2009) notes that its major competitors are the Ambulance Service of New South Wales, the Ambulance Victoria, and the Department of Community Safety. The industry of ambulance service was expected to generate revenue of around $2.3 billion in 2010-2011. This is up 5.2% from the industry revenue in 2009-2010. Hence, the industry has actually been expanding. Further, the SAAS is – as said in the preceding – a state-owned organization. It is overseen by the Chief Executive of the South Australia Health. Its management team reports to the country’s Ministry of Health. It is also accountable to the Department of Treasury and Finance, which assures the organization’s financial bloodline. SAAS has simpler structure in comparison to other Australian government agency. It has its Executive Management Team, supervising the activities of its full time personnel and volunteers. Its ambulance stations across the entire South Australian state are run – not independently, though – by sub-management teams. Over-all, the organization is operating under the auspice of the Ministry of Health and the Department of Treasury and Finance. Given such set up, SAAS may be perceived to be more stable or permanent in structure than the other private business enterprises. Its structure is formal, through departmentalization and work divisions. Its hierarchy is obviously planned and shown. And, it has a clear framework for defining managerial authority, responsibility and accountability. The roles and functions – for instance, by the full time staff and the volunteers – are defined and systematically arranged (Marquis and Houston, 2009, pp. 265). There are call takers, paramedics, ambulance officers – among others. The organizational set-up of SAAS fits the category of organic structure. SAAS has many volunteers, so it is expected that participation and teamwork are valued practice of the organization. The ambulance stations likewise indicate that some degree of decentralization is being provided by the structure of SAAS. While the set up of SAAS is simple, its environment is marked by a high-moderate uncertainty (cf. Daft, Murphy and Willmott, 2010, p. 168). It may be true that the ambulance service industry is being significantly restricted by the federal and state governments particularly by the Ambulance Services Act 1992, and that the total revenue of the industry has been on the rise. However, the industry is currently being challenged to develop or picked up its clinical outcomes as evidenced by the fact that pre-hospital care saves lives or at least provides valuable outcomes (O’Meara, 2005; Shapiro, 2000). Lennox (2009, p. 5) explains that this is rendered comprehensible by the fact that ambulance service caters to instances when human lives are on the line and every minute counts. In fact, it is the developments in the health sector of Australia that make the environment of the SAAS – and the other ambulance service providers – very variable. O’Meara (2005) mentions about a particular challenge to SAAS by Australian health sector to develop performance measures that satisfy the need for improved accountability and – concomitantly – promote more effective and efficient operational management. This is a clear departure from the traditional measures of performance that simply include the patients’ survival from cardiac arrest, the lesser impact of the pre-hospital system on trauma patients (Brazier et al., 1999), and the time intervals of one sort or another (O’Meara, 2005) that incorporate activation time, call processing, allocation of resources, mobilization, travel to the scene, time at scene, travel to hospital, and time spent at the hospital (Spaite, et al. 2001; Guppy and Woollard, 2000). In addition, the more economic in nature indicators of performance are health resource indicators such as the measure of labor force and expenditure, and health service use or utilization. And, now, healthcare professionals and researchers are envisioning the use of other broader indicators, such as effectiveness and equity of importance (Duckett, 1999; Hancock, 1999; Humphreys and Cowey, 1999). More comprehensibly, Lennox (2009, pp. 34-37) has identified what he calls the (Australian) health trends that have tremendous impact on the ambulance service industry of the nation. He observes that there is an increased throughput for public hospital beds, higher bed occupancy and more hospital separations. In major hospitals, there is an observed reduced length of hospital stay. In Australia, too, the number of elderly patients who occupy acute hospital beds and the presentation to public hospital emergency departments are on the rise. The chronically ill patients, however, are found to be cared for more at home. Australian health care system is also emphasizing more on safety and quality. Too, the trend is now to integrate mental patients as well as people with disabilities into the main stream society. Greater media exposure to public health risks is complemented by the people’s greater awareness of medico legal risks. There is also the woe of insufficient number of general practitioners in some areas. Too, the most costly and specialized health service for both diagnostic services and inpatients and outpatients treatment is now being centralized. Finally, there is also the trend of providing wider range of palliative care services. With all these developments in the national health care sector, the environment of the SAAS has put the organization to task to face a good number of problems for its continued operation. It has to deal with increasing demand for ambulance year upon year. Now, this is not without repercussions. It would mean, at the surface level, higher level of crew utilization and lesser down time. It has to delve into the issue of supporting changes in hospital and health service delivery including more people with chronic illnesses cared for at home, shorter hospital stays and earlier discharge from hospital, as well as greater volumes of elective surgery and a greater range of modern medical diagnostic and treatment services. Furthermore, it has to address the concern for increased presentations to hospital emergency departments which cause delays in capacity of hospital staff to take over care of ambulance patients on account of the volume of total cases they have at certain times of the day. This issue actually decreases the ambulance emergency response capability. In addition, SAAS is expected to keep pace with improvements in medical treatment and technologies so that ambulance care capability reflects best practice, drugs, medical equipment and clinical procedures. This similarly includes the need for SAAS to develop and maintain some additional specialist capabilities, which may arise from the increased risk of multi-casualty incidents such as counter terrorism, chemical, biological and radiological incidents, and urban search and rescue capability. Then, there is also a need to meet rising community expectations of the total health system partly fed by medical dramas on television and current affairs segment on miracle cures. Moreover, there is a public expectation to address relative to very high cost of aero-medical transport capability to cope with responses into rugged terrain and serious incidents including road trauma at a distance from hospitals. Finally, there is an occupational health and safety challenges for staff who provide care in the front line – which include risk of injuries handling obese patients, increased exposure to incidents associated with alcohol and drug consumption, and the stresses of front line emergency operations (Lennox, 2009, pp. 23-24). Actually, SAAS has shown that it is able to evolve into survival and even morph into a better ambulance service provider year after year as it has successful so far to adapt to its environment and endeavor to control its effects on its structure and actions. The strategic planning of SAAS – for instance, the Vision 2010 (n.d.) – is a very crucial and important measure to consistently take for the organization. THE SYMBOLIC-INTERPRETIVE PERSPECTIVE ON SAAS The preceding analysis of SAAS, which is done with the modernist perspective as the point of departure, somehow clears the way for one to do an equally important scrutiny of the organization but this time through the symbolic-interpretive perspective on organization theory. Differing from the former point of view that understands an organization through an organism metaphor, the symbolic-interpretive perspective takes it as a metaphor of culture (Hatch and Cunliffe, 2006). The SAAS as an organization will be understood in this section, then, as a pattern of meanings created and maintained by its members through shared values, traditions and customs. But, more than delving into the symbolic-interpretive constructs and examples comprising predispositions, practices and processes and products of SAAS (see Frey 2004, pp. 285), this paper would focus on the organizational culture (the concept of which is very much nuanced as it is very complex [see Rafaeli and Worline, 1999]) of SAAS principally as its personnel and volunteers deal with mental cases. And, for this task, the results of the research study by Roberts and Henderson (2009) are very instructive. Not only did the study make use of the SAAS clinical data in establishing quantitative measure of workload viz. the cases that have been classified as psychiatric, but the research precisely explores the perceptions of paramedics as regards their role, education and training, organizational culture and interaction with allied professionals when they attend to suspected or known cases of mental illness. As intimated in the preceding analysis, among the anticipated trends in healthcare industry in Australia concerns the care of the mentally ill. Now, Roberts and Henderson have specifically found out that SAAS paramedics view their role viz. the mentally ill as simply to provide transportation. Accordingly, it is just their secondary duty to attend to any obvious life threatening conditions of their mentally-ill patient. And, when they extend treatment to their patient, it is merely to those cases when the patient gets hurt as consequence of their behavior such as overdose of medication or physical trauma. This adamancy is actually a subsequence to the SAAS paramedics’ view that dealing with mental illness is simply beyond their skill level. In fact, Roberts and Henderson are also able to uncover that the paramedics perceive the mentally ill patients, particularly those by drug and alcohol, to be potentially risk to their safety. This was bared in the survey with the paramedics’ disclosure that they always need to be prepared for any eventuality of attending to cases of mental illness. Likewise, Roberts and Henderson has highlighted the factor of SAAS’ organizational culture in relation to cases of mental illness its personnel attend to. Understandably, ambulance service provider’s organizational culture is fixed on providing emergency care or rapid response and timely pre-hospital provision of medical care and service. But, this conditioned task by the ambulance service personnel is helpful when dealing with trauma or time critical patients. This works with obvious limitation when they attend to cases of mental illness. The paramedics have known their role specifically to get the patient to further care the soonest possible time. As we have seen, the modernist perspective of organization theory has painted a rather bright future for SAAS. The previous section concluded that with the measures the organization has been taking there is no doubt that it will be able to withstand the challenges that are being posed by its environment. Now, the symbolic-interpretive analysis has looked at the culture of SAAS. It has highlighted the necessity for SAAS to similarly do introspection and seriously study the frame of mind of its personnel. Otherwise, all its efforts to address the elements of its external environment will amount to nay. THE POST MODERNIST PERSPECTIVE ON SAAS Completing our task, we now consider the post modernist perspective of organization theory that practically views organizations as a collage made up of bits of knowledge and understanding brought together to form a new perspective that has reference to the past (Hatch and Cunliffe, 2006). For this section, what we shall highlight is the post-modernist critique of the very structure of SAAS. This paper posited at the outset that SAAS’ structure is very formal and – if we may belatedly add – bureaucratic, to some extent. Now, to do our post modernist analysis, we would have to use as our point of departure the concept of gendered organizations by Joan Acker, an American sociologist and early pioneer in gender studies in organizations. Gendered organizations theory claims that power in organizations is made to depend on symbolic representations of ideal roles – primarily masculine – which are not grounded in any rational or structural reasoning. In effect, this has led to marginalization and domination of women in organizations. Burrell (1984) wrote that traditionally bureaucratically structured organizations were constructed to be gender neutral and asexual. He furthered his thesis by saying that the purpose of which was to eliminate sexuality as means of control in advancing the progress of the organization. The result of this, according to Acker (1990, p. 151), is the differentiation of the home, the location of legitimate sexual activity, from the place of capitalist production – which proved to be the germinal seed of the eventual delineation between sexuality and capitalist production that subsequently propagated gender-based power relations in organizations. The structured and rational workplace began to represent masculine qualities such as competition, rationality and toughness; the home started to represent emotion, passivity and caring (see also Hatch and Cunliffe, 2006). Unfortunately, the dynamics of power in organizations have become strongly masculine-oriented; and, the role and value of women have been largely marginalized (Acker, 1990). From the modernist perspective, the structure of SAAS is among its contributing factors in dealing and coping with its external environment. Succinctly put, it is SAAS’ facilitating factor for survival and even development. On the other hand, however, Acker’s concept sees the same formal and bureaucratic structure as the very foundation of – if not the breeding ground for – organizational domination by men over women as well as the minorities (Ashcraft and Mumby, 2003). Unfortunately, this domination gets legitimized through hegemonic masculinity, which is “typified by the image of the strong, technically competent, authoritative leader who is sexually potent and attractive, has a family, and had his emotions under control” (Acker, 1990, pp. 153). Obviously, this precludes feminine equality in the organization. CONCLUSION In this paper, we have attempted to understand more fully the organization of the ambulance service provider in the state of South Australia – SAAS – through the modernist, symbolic-interpretive and post-modernist approaches. The modernist perspective has shown the promising state of the SAAS. It has been able to adapt to the challenges of its environment. However, the symbolic-interpretive point of view has disclosed that the mind set of SAAS’ personnel needs to be fine tuned especially with regards one of the trends of healthcare in Australia – that is, the care of the mentally ill patients. Finally, the post-modernist viewpoint questions the very structure that the modernist approach vouches to be a facilitating factor for the growth of the organization. The post-modernist perspective posits that such hierarchical or bureaucratic structure is not gender-friendly after all. Over-all, while these perspectives of understanding an organization may seem to contradict one another, there is no denying that they provide a fuller grasp of any organization. References: Acker J 1990, ‘Hierarchies, jobs, bodies: a theory of gendered organizations’, Gender and Society, vol. 4, no. 2, pp. 139-158. Ashcraft KL and Mumby DK 2003, Reworking gender: a feminist communicology of organization, Sage Publications, Inc., New Jersey. Brazier H, Murphy AW, Lynch C and Bury G 1999, ‘Searching for the evidence in pre-hospital care: a review of randomized controlled trials. On behalf of the Ambulance Response Time Sub-Group of the National Ambulance Advisory Committee,’ Journal of Accident and Emergency Medicine, vol. 16, no. 1, pp. 18-23. Burrel G 1984, ‘Sex and organizational analysis’, Organization Studies, vol. 5, no. 2, pp. 72. Daft J, Murphy H and Willmott H 2010, Organization theory and design, Cengage Learning EMEA, Hampshire. Duckett S 1999, ‘Policy challenges for the Australian health care system’, Australian Health Review, vol. 22, no. 2, pp. 130-147. Frey L 2004, ‘The symbolic-interpretive perspective on group dynamics’, Small Group Research, vol. 35, pp. 277-306. Guppy L and Woollard M 2000, ‘Emergency ambulance services: performance management and review,’ Pre-Hospital Immediate Care, vol. 4, pp. 40-45. Hancock L (Ed.) 1999, Health policy in the market state, Allen & Unwin, Sydney. Hatch M and Cunliffe AL 2006, Organization theory: modern, symbolic and postmodern perspectives, Oxford University Press, Oxford. Humphreys JS and Cowey S 1999, Models of health service delivery for small rural and remote communities, La Trobe University, Bendigo. IBIS World 2009, SA Ambulance Service Incorporated – Premium Company Report, viewed 20 August 2011, http://www.ibisworld.com.au/car/personnel.aspx?entid=4674 Lennox G 2010, Review of ACT ambulance service, viewed 21 August 2011, http://www.esa.act.gov.au/ESAWebsite/content_actas/home_page/lennox_report_4_may_2010.pdf Marquis BL and Huston CJ 2009, Leadership roles and management functions in nursing: theory and application, Lippincoat Williams and Wilkins, Philadelphia. O’Meara P 2005, ‘A generic performance framework for ambulance services: an Australian health services perspective’, Journal of Emergency Primary Health Care, vol. 3, no. 3, Rafaeli A and Worline M, 1999, ‘Symbols in organizational culture’, viewed 21 August 2011, http://iew3.technion.ac.il/Home/Users/anatr/symbol.html Roberts L and Henderson J 2009, ‘Paramedic perceptions of their role, education, training and working relations when attending cases of mental illness’, Journal of Emergency Primary Health Care, vol. 7, no. 3, viewed 21 August 2011, http://www.jephc.com/full_article.cfm?content_id=538 SA Ambulance Service n.d., Facts and figures, viewed 19 August 2011, http://www/saambulance.com.au/Whoweare/factsandfigures.aspx SA Ambulance Service n.d., Structure, viewed 19 August 2011, http://www/saambulance.com.au/Whoweare/structure.aspx SA Ambulance Service n.d., Who we are, viewed 19 August 2011, http://www.saambulance.com.au/Whoweare.aspx Shapiro SE 2000, ‘Outcomes of prehospital care: do we really make a difference?’, Journal of Emergency Nursing, vol. 26, no. 3, pp. 239-241. Spaite DW, et al. 2001, ‘Emergency medical Services Outcomes Project (EMSOP) II: developing the foundation and conceptual models for out-of-hospital outcomes research,’ Annals of Emergency Medicine, vol. 37, pp. 657-663. South Australia 1992, Ambulance Services Act Vision 2010: SA Ambulance Service’s Strategic Plan Read More