Leadership in Ambulance Services - Term Paper Example

Leadership in Ambulance Services Introduction The ambulance service that will undergo a change management process is the London Ambulance Service. Kotter (2012) identified an eight-step process for implementing change in any institution. This will be the guiding process for implementation at the London Ambulance Service (LAS). The LAS is currently living in a false sense of urgency. Employees are busy working yet their actions are not leading to results. The institution is required to keep no patient waiting for longer than four hours in a hospital emergency department. This means that the ambulance service should do more than simply transport a patient to a hospital. It needs to exercise discretion when transferring patients to primary trusts or hospitals across the City of London because it is one of the parties responsible for overcrowding in health institutions. The change management process Development of a sense of urgency It is a known fact that demand for LAS service fluctuates between seasons. Sometimes the institution may be overwhelmed with calls from various parts of the City. It is tempting for employees to simply follow the usual routine when dealing with rising demand. This creates a backlog in corresponding hospitals. Workers need to think of new ways to deal with overwhelming demand. Additionally, funding for acute services from the NHS has been reducing dramatically over the past few years. Therefore, the LAS cannot respond to this issue by using resource-intensive approaches. It is only possible to minimise patient waiting times at hospitals and other partner institutions through alternative methods of response. One such strategy is the Clinical Telephone Advice method, which will be the focus of this change management process (Snooks et. al., 2004). In order to ensure that members of the ambulance service understand the implications of this problem, they will be told about it by their respective supervisors. Each leader will be responsible for ensuring that employees understand why the status quo cannot prevail. They are likely to understand the implications of this when they realise that they are doing too much already. Workers will welcome the opportunity to reduce back log in corresponding health institutions through this approach. Furthermore, senior leaders will also be expected to demonstrate the same urgency by pointing out the need for alternate methods of response. Creating the team It is not possible to lead this change process alone. As a leader, one cannot develop the vision for change single-handedly. Short term wins will arise, yet it may not be possible to communicate or be present when these wins occur. Furthermore, obstacles will arise along the way and the only way to deal with it is through team effort. The LAS has several employees under its wing; the change leader cannot reach and convey information to all these people. Furthermore, organisational culture is a critical component of change management success. It is essential to use other people in embedding this change management process. Therefore, a team will need to be selected to spearhead the process. Care will be taken to ensure that the members of the group are proven leaders in their own right. They will demonstrate that they have carried out change processes in the past and contributed to effective outcomes. Furthermore, they will all be credible members of the institution and have a lot of respect in the LAS. In order to ensure that power politics does not come into play, all team leaders will also have formal positions of power at the ambulance service. Since this matter affects the dispatch system, it will consist of leaders from each of the units involved in it. A supervisor from the call response unit will be in the team. Another one from the collection, regional allocation, dispatch and the ambulance section will all belong to the team. They will contribute in all aspects of the project from planning, to implementation, evaluation and conclusion. Developing a vision and plan Members of the team will discuss and develop a vision for the clinical telephone advice method. In this regard, they will condense all the elements of the plan into one easily understandable statement. Even though this matter will be decided by the group, as the change management leader, it is necessary to have a rough idea about what the vision will be. Roughly the vision will be summarised as follows: To have a real-time alternative response method based on clinical telephone advice designed to minimise overcrowding in hospitals and waiting times at emergency departments in these institutions (Silvestri et. al., 2002). The vision will thus expand the duties of emergency service providers from simple carriers of information to strategic decision makers with partner institutions. This vision will be achieved through the following goals: 1) To increase the rate at which dispatchers identify non urgent calls by 40% 2) To reduce the waiting times at corresponding hospital waiting times by 50% 3) To provide alternative response to non urgent callers through clinical telephone advice by emergency medical technicians 4) To allow paramedics to refer non urgent situations to clinical telephone advice if an urgent emergency situation is nearby Emergency medical technicians will have a huge role to play in this plan because they will be dispensing the telephone advice. Their work will be to talk to callers who have minor issues that they themselves can solve. For instance, a caller may have a shallow cut and could be given advice on how to treat the wound. Most calls will end with a prompt to visit a nearby clinic for further investigation by the callers. They will be urged to do it themselves in order to free up personnel for other urgent cases. Other control staff will also play their part by identifying the category of calls that will be required. Furthermore, ambulance staff will also have the responsibility of directing this category of clients to emergency medical technicians for telephone advice if they have an urgent case to attend. This will free them up to handle cases that really need their help. Communicating the plan Communication can either make or break a change management process. In this case, the plan and goals will be communicated initially in a speech made by the executive team in liaison with the change leader. However, this will only be the beginning of the communication process. All emails, presentations or communications between supervisors and their subordinates will contain aspects of the plan. It will become part of the way the LAS does business on a daily basis. Emergency and dispatch managers will use all the communication channels to inform members about the plan. These communications will consist of the following information: They will highlight the roles of all the members involved in the plan as well as their role in it. As mentioned earlier, unit personnel in the entire dispatch process will be involved in this intervention. Call response personnel will be in charge of assessing whether a call belongs to category C, in that it is not urgent and is minor. Therefore, it needs to be handled by members concerned. In order to categorise these calls effectively, call respondents will receive training on their assessment. Training will occur in-house through emergency managers. They will use their expertise to assess the extent of injury. This protocol will be taught explicitly to dispatch employees. Regional allocators will also receive training on the same by identifying the characteristics that make such calls deserving of clinical telephone advice. The dispatcher will also be well versed with the process and so will ambulance personnel. The latter group should be able to discern whenever their intervention is not needed on location. Thereafter, they need to use the right procedure in order to refer these individuals to a clinical advice correspondent. However, if a patient’s condition is difficult to categorise, then they must continue performing their duties and inform support staff of their decision to do so. Managers themselves will ensure that normal duties continue as members receive training on this part. They will also be responsible for the implementation of a pilot plan in which employees will test whether they have understood the fundamentals of the new intervention. They will communicate every single change that needs to take place as soon as the need arises. Members of the executive change management team will make certain that they simplify communication messages every time they arise. It will always give the members of the LAS a clear picture of what needs to be known at any point in time and remove jargon from their statements. Care will be taken to hear the other side by obtaining feedback from employees concerning any part if the initiative. Implementing the plan and overcoming resistance to change The implementation of the plan will still be taking place in the previous phase as communications happen. The process will start with training, which will last for a period of 6 months. Members will then be pilot tested and once success has been demonstrated then the entire organisation will embrace the Clinical telephone advice system. It is likely that the emergency medical technicians, in charge of this component, may be overwhelmed by the number of activities that must be done. Therefore, a portion of them will be responsible for this service alone. The rest of their colleagues will continue with their routine responses to emergency situations. The team is likely to encounter several structural and cultural forms of resistance to the plan. Some of the structural factors that may cause problems in the implementation process include the organisational structure of the organisation. As the situation is currently, no clinical telephone advice system exists. This implies that a new unit will have to be added to the system. Furthermore, the job descriptions of the emergency managers do not include training for call response employees and dispatchers who need to detect category C, non urgent cases. Therefore, workers may be confused about these new job descriptions. Technical difficulties may also arise during training and pilot testing because paramedics, emergency response managers and other personnel will still be going through their normal duties while carrying out this project. To deal with the issue of organisational structure, the LAS will need to revise this aspect as early as possible and prepare members psychologically for the same. The organisation may also deal with challenges that arise when juggling project implementation with routine duties by giving workers incentives for their contributions. Workers may be compensated for the effort that they put into the change process. Since budgetary constraints have been cited as a key impetus for the change project to begin with, the organisation could simply juggle around its balance sheet in order to meet this additional expense. Software challenges may also arise during the implementation process because the current system does not recognise clinical telephone advice. If a call cannot be recognised through the current dispatch system, it is likely that the problem could be detected at a later part of the chain, and this may lead to certain problems. The members concerned may feel awkward about these difficulties and could refer unserious cases to paramedics even when a clinical telephone advice response would have been adequate (McDougall, 1999). This may create backlog and undermine the very reason for implementing the change process. One way of dealing with this problem is to get a software upgrade during the project implementation process. Furthermore, training ought to involve use of the new software systems as they get installed. The organisational culture of the LAS may also be a problem in this implementation process. Most people in the institution tend to be so caught up in their daily routines that they may be unwilling to engage in a new change process. The culture of doing so much and achieving little will need to be confronted at some point in the project. The project leaders ought to articulate the goals of the initiative from time to time. They need to do this clearly and relate it to every single employee involved in the change process. Workers often resist change when they do not understand it, so they need to share the same visions as the project team. Leaders have the responsibility of forging a common direction for all concerned. Another cultural problem that may be manifested at the individual level is the perception of job value. Some emergency medical technicians may feel that taking the new role of a clinical telephone adviser may undermine the value of ‘real’ technicians. These new activities may seem like light-weight endeavours that cause them to forget about earlier training in acute care. Therefore, individuals may be hesitant to leave their routine duties and engage in this new project (Department of Health, 2001). To deal with this cultural barrier, project team leaders will create a rotation routine. This will expose all members of the technical team to different work tasks. They will switch between routine acute service delivery and clinical telephone advice on an equal basis. As a result, few of them will have to worry about loss of critical skills or the loss of purpose at work. In fact, this will be an opportunity for them to break the monotony of one type of job arrangement. Project team leaders will also talk to members about the long term importance of the project. Once employees realise that they will actually do less dispatches through this initiative, then chances are that they will change their attitude towards it. Therefore, this aspect of resistance to change should be addressed at the initial stages through the communication of the plan. Organisational culture may also become a barrier when certain managers or leaders fail to support the implementation process. It was stated earlier that the project team will consist of people with positions of power in the LAS. However, it is not possible to put all formal leaders in the leadership team. Therefore, some of them may feel left out and could undermine various efforts as they occur. Additionally, problems may also arise when leaders from different units come to work with their subordinates. If the change leader finds that some mangers are continuously undermining their efforts, then it will be imperative to engage in dialogue with them. Confronting their insecurities in a calm and sober way could dissipate them and thus eliminate the problem. Evaluation and short term wins It is likely that as the project implementation continues, some employees may lose motivation for achieving the final vision. Therefore, it is imperative to measure outcomes in order to know how far the organisation has come and whether it is any step closer to achieving its overall gaols. For this reason, the project team members will plan for regular evaluation processes that will be taking place on a monthly basis. Measurements will be concerned with the initial goals that had been set at the third phase of the project. Currently the percentage identification of non urgent, category C calls is 60%; therefore, workers need to work towards 100% recognition (London Ambulance Service, 2007). The number of correct calls recognised by call response workers will be measured monthly and compared to previous results. It will not be realistic to expect an immediate leap to the final goal at the onset of the project. On the other hand, there could be minor improvements as the organisation learns the new system. Once evaluations are done and positive measures found, they should be communicated to the rest of the staff. This will motivate employees to keep working; results will be sources of evidence. Aside from the number of calls recognised by call response agents, waiting times in hospitals will be measured. This was the primary goal for the clinical telephone advice service. Therefore, it must be assessed in the middle of the project. Since this is a long term goal it will be prudent to wait until the project is midway before the parameter can measured. Waiting times will be obtained from partnering institutions and then be compared with previous figures at the start of the program. The number of people referred to the clinical telephone advice system will also be an important measure of project success. It will indicate whether or not the project is working. This number will be assessed on a monthly basis in order to ascertain that the figures are increasing. Finally, the number of paramedics that attend to non urgent situations ought to reduce dramatically. This component will also be measured and used to motivate workers in the change management process. It should be noted that these short term gains need to be planned as they do not just happen. The key behind turning an evaluation process from a high pressure situation that builds resentment into an opportunity for celebration is to put deliberate effort into the achievement of these short term efforts. Managers within the project team need to use their expertise in order to merge short term and long term goals. It is likely that if this done effectively, then cynics will be silenced. Furthermore, it will show other stakeholders, like the NHS, that the initiative is working. Consolidating gains As the project continues, it may be necessary to augment the change management process. In this regard, the institution must add minor changes to work towards effective outcomes. Clarity may need to be given concerning the lead projects or other forms of outcomes. Keeping the sense of urgency high will be imperative in this step. Since evaluations will be carried out and there will proof that the project is working, several leaders are often tempted to relax and let the project continue on its own (Kotter, 2012). This will not be the approach taken by change leaders at the LAS. Because managers have a short term tendency, it is the role of transformational leaders to engage these individuals and get them to appreciate the long term vision of the process. Anchoring the change management process in the culture The organisation will need to ensure that new practices are engrained in the minds of all participants. This last part will attempt to make the clinical telephone service a part of the norms, behaviour and values of the organisation. Here, change leaders will need to show employees that the new way is better than the old system. For this to occur, they will rely on previous successes and communicate it effectively to persons concerned. The team leadership needs to realise that it may not always be possible to get support from all the stakeholders involved. Therefore, the loss of key people in the change process is a reality. Once new employees enter the LAS, they will be trained on the use of the clinical telephone advice such that it will part of their work process. Additionally, a quality assurance system will also be put in place. This will follow the exact regime mentioned in the evaluation process, except for its timing. Once the project is underway, measurements will occur once every four months, or three times annually. This will give employees enough room to adjust and then work towards new goals. Conclusion The change management process under analysis is the implementation of a clinical telephone advice service. It will take place through an eight-step process. Development of a sense of urgency will be necessary, and this will be done by informing employees about the inefficiency and the possibility of a lack of funding. Thereafter, the change leader will create a team made of different members of the ambulance response and support staff. All leaders must have positions of power so as to get buy in from them. The group will develop a vision and plan for implementation. The vision will be to reduce waiting times at hospitals by increasing the number of people who use the clinical telephone advice. Communication in the plan will occur on a frequent basis by managers and senior managers. They will also listen to their subordinates in order to garner support from these individuals. Plan implementation will start with training, pilot testing and a final roll out. Resistance to change may be overcome by adequate preparation and effective project team leadership. Quality assurance will be enabled through frequent measures and planning for those achievements. Finally, the organisation will anchor the change by making it part of members’ work processes. References Department of Health, 2001. Reforming emergency care. London: Department of Health, 2001. Kotter, J., 2012. Leading Change. Harvard: Harvard Business Review Press. London Ambulance Service, 2007. Strategic plan. [online] Available at: http://www.londonambulance.nhs.uk/ [Accessed 29 November 2013]. McDougall, M., 1999. Failure of the London Ambulance Service. [online] Available at: ftp://ftp.cis.upenn.edu [Accessed 29 November 2013]. Silvestri, S., Rothrock, S. and Kennedy, D., 2002. Can paramedics accurately identify patients who do not require emergency department care? Prehospital Emergency Care, 6, p. 387–90. Snooks, H., Dale, J. and Hartley-Sharpe, C., 2004. On-scene alternatives for emergency ambulance crews attending patients who do not need to travel to the accident and emergency department: a review of the literature. Emergency Medical Journal, 21, pp. 212–15. Read More