Analysing London Ambulance Service (LAS) - Assignment Example

Task Part – I: Services went wrong with London Ambulance Service (LAS Failure of CAD system known as London Ambulance Service Computer Aided Dispatch (LASCAD) to deliver the goods required for ambulance services. The system was installed in 1992 to automate many services in the U.K. This LASCAD system was supplied by a company which had no previous experience for dispatch system for ambulance services. It was badly designed for manual CAD system and implemented which had led to many serious problems including increasing in number of ambulance incidents, increasing in wrong recording of vehicle allocation including multiple allocation of vehicles at the same place of incident, nearby vehicle was not chosen for dispatch etc. In 2000 a Service Improvement Program , a program of change transformed as the Trust, was implemented to improve many services aiming to provide a new world class ambulance services to the people of London. During currency of the program around 250 initiations were implemented among three major heads patients, people and performances. Despite some improvement in the services, much criticized were blown for poor performance response times which caused to danger to lives. During London Bomb blast on July 07,2005 serious questions were raised in LAS internal documents for proper functioning of radio and communication equipments used in the emergency operations. Despite up gradation of software in July 2006 repeated computer system crashes continued and dispatches had to be carried out through old pen-and-paper system. Recommendations to avoid occurrence of tragedy again: LAS should procure necessary software from a reputed software company developing software specially for ambulance services. If not available nationally , LAS should explore possibilities for international companies including from India. Installation and commissioning of the software by the supplier company should be conducted in presence of LAS’s technical staff. LAS should also depute its concerned technical staff for on the job training at supplier company’s works for proper training for future trouble shoot. Technical details from supplier company must be preserved well for future use. Page 2 Part – II: Suggested steps for a project plan from now and 2012/13: Dedication of LAS for health: LAS should adopt a policy of ‘dedication’ to reach all patients irrespective of their race, color ,and diseases as early and easily as possible. LAS should also adopt a development plan exploring the needs of the patients both internally and externally like need of bed, police assistance etc. and arrange to develop a software for their instant implementation through information technology system. Measures to improve responses: LAS should arrange necessary changes in the existing software to speed up responses to deliver care to the increasing number of patients by 2012/13. LAS should also create the resources to provide appropriate care first time to more patients to reduce the number of calls in future. LAS can also make responses more efficient to the patients through providing more care options like telephonic consultations, care at home, handling of emergency care by a single responder, direct referral of alternate care provider like walk-in centers , minor injuries units rather than to run a hospital, services in community , deployment of more vehicles to attend more calls etc. Development of organizational management: Development of management is the key process and reflects the image of an organization. LAS should arrange training, workshops etc. to improve the working skills of their existing staff to become more supportive to the patients as well as handling of vehicle movement and employ more staff to cope up the increasing number of patients by 2012/13. Public involvement: Keeping in view for growing population in London LAS should create patient and public interaction platforms like organizing camps, workshops etc. to listen the patients and act upon their problems instantly to provide care. LAS may also conduct surveys to collect information among the public at large and make changes wherever necessary to provide better care. Monitoring of process: LAS should develop its own monitoring process internally to monitor the aims, targets and performances in terms of courtesy , respect, problem-solving , quality of service / care providing etc. to the patients and initiate corrective actions wherever necessary for further improvement. These interaction platforms would become inevitable during Olympic games in year 2012 in London. Milestones: LAS would achieve milestones for dedication and public involvement. Page 3 Gantt Chart for LAS until year 2013 Searched lot and found London Ambulance Service NHS Trust Strategic Plan 2006/7 – 2012/13 which gives some statistics for Workforce Planning and Financial Planning until year 2013. These statistics are available in simple text form only. Mostly preparation of any chart (gantt or bar) or plotting of graph is effective when different figures are envisaged to achieve w.r.t. future years. LAS has envisaged either fixed or flat figures in the form of target to achieve until year 2013 which has no significance to show them in gantt chart or to plot on graph and can be provided in simple text form as LAS did in this plan. The salient features of LAS Plan until year 2013: 1. Workforce Planning: Workforce requirements are based on assumptions: (a) Increase in number of incidents (all categories) by 3% per annum. (b) Increase in emergency transfers by 6% per annum. (c) All types of Category A and Category B patients will be transferred to Fast Response Unit for responses except cardiac arrest cases and all other patients will get ambulance automatically. (d) Reduction of 25%-30% calls in Category A by year 2010 and balance will be transferred to Category B. (e) 10% of Category B calls will be transferred to Clinical Telephone Advice (CTA). (f) Additional increase of incidents of 30000 per annum after year 2010 because of Thames Gateway developments. Present staff of around 2700 would be increased to 3150 and CTA staff from 50 to 120 until year 2013. 2. Financial Planning: Financial assumptions for income, costs and assets: (a) Increase in income by 3.2% in 2013. (b) Increase in expenses by 3.3% per annum excluding Financial, Depreciation and Other costs which would remain constant during planning period. (c) Reduction of total cost per A&E incident by 1% per annum. (d) Increase in total assets by 1% annually. Source: London Ambulance Service NHS Trust Strategic Plan 2006/7 – 2012/13: http://www.londonambulance.nhs.uk/ABOUTUS/publication_scheme/publication_scheme_files/Strategic%20Plan%20(Jan%2007%20TB)%20v6.pdf Task -2 Part I: Quality Assurance in ambulance service restricts potential risks of harms to the patients, expected patients, member of staff and public as well. Management of Quality Assurance in ambulance service is management of avoidance of risks. LAS has adopted the strategy for Risk Management Policy. Factors for Quality Assurance i.e. Risk Management: Drawing of clear service plan for all support services and their implementations including allocation of maximum resources to reduce risks. Making clear policies, procedures and guidelines to provide safe and good working environment to the staff , patients and other related persons for identification and elimination or reduction of risks to acceptable limit. Each member of the staff should be aware with his / her responsibility in respect of managing risks effectively including reporting of risk and its assessment promptly. Identification of causes of previous incidents through experiences Continuation of quality services and other businesses during major accident or system failure. LAS must meet its mandatory obligations in compliance with National Standers and targets. Tools for Quality Assurance i.e. Risk management: Deputation of exclusive staff or team with assigned responsibility. Identification of type of risk and allocation of responsibility for the risk to an individual or team. Completion of reporting and assessing form and submission of the form to the competent authority for processing. Assessing of risk through framed evaluation system, determination of its priority and allocation and deployment of resources related with the priority. Maintaining of an exclusive register for all types of risks and monitoring of its completion for various information. The register should be reviewed half-yearly for monitoring risks and actions. Circulation of policies and other related information among the staff engaged in risk management for their promotion and implementations through various channels. Connecting of Risk Management with services and systems of LAS to avoid or reduce the risks. Page 2 Part II: Professional Standard for Computing Systems: International Standard Organization: ISO-9000 is an international accredited professional standard accepted and adopted by more companies around the world for standardization of their products, systems or services. ISO-9000 would equally be good enough for London Ambulance Service. ISO-9000 specifies the requirements for quality management system for an organization for demonstration of its ability for consistence products, systems and services for customer satisfaction. For LAS it would be patient satisfaction. Besides others, some requirements applicable for LAS are: 1. Quality management system: The system would ensure for proper functioning of all systems and coordination among different departments of LAS for smooth and trouble free services. The system would include changes in organizational structure, operating systems and processes. 2. Management responsibility: The system would ensure for fulfilling of commitment for patient focus, quality policy, planning, communication, reviewing of the policies, procedures and guidelines for health and safety. 3. Resource management: The system would ensure responsibility for logistics systems relating to vehicle, equipment and supplies, human resources, work environment and other infrastructure including purchasing process and information. 4. Service Realization: The system would ensure for planning of services, patient related processes, determination and review of requirements related to services, patient communication, development of inputs and outputs, review and verification, validation, changes etc. 5. Measurement, analysis and improvement: The system would ensure for monitoring and measurement for patient satisfaction, processes, services, internal audit, analysis of data and protection of data, up-gradation or improvement of data system etc. Advantages of compliance: Compliance of the requirements of ISO-9000 in LAS would ensure not only to deliver quality of working, quality of care to the patient and use of resources effectively but would reduce or eliminate the chances too to the great extent for occurrence of risks. Task -3 Part I: Following steps are suggested towards development methodology for London Ambulance Service: Reformation Changes in organization structure, operating system and processes Development of leadership and management skills Partnering with different agencies, bodies etc. Vision Communication Justification for selection: Reformation: Reformation gives way to modify the old system for creation of new working environment removing the bottlenecks of the old system. LAS would need to identify the procedures and processes which require to be reformed or abandoned to provide better care to the patient either directly or indirectly. The reformation should not be restricted to clinical services but should include the quality of life for staff and patients as well. Each staff member should be encouraged to understand his / her responsibility to care the patient in effective way. Reformation should be continuous process and depends much on patience and dedication of staff. Changes in organization structure, operating system and processes: Change is a part of life and becomes necessary to meet the present situation. LAS would need to launch a drive to make changes in the existing organizational structure, operating systems and processes to meet the aspirations of the patients as per the time. Changes should be flexible enough to incorporate future needs. The changes must be made within the stipulated management policies and procedures. Behavior and team work within the organization sometimes avoid to make changes in the structure and systems. Development of leadership and management skills: Every service organization keeps a mission to provide better service they can. Leadership and management skills play the key role to achieve the mission. LAS would need to draw policies and procedures to make leadership capable enough, implement national standards of NHS and improve the management skills to create supportive and ideal staff to achieve the mission. Page 2 Partnership with different agencies, bodies etc. Sharing of views , ideas etc. is the best way for self-improvement. LAS can explore to work in partnership with different private and government agencies like trade unions, health and social care organizations, staff associations and other public service agencies for discussing and sharing of opinions in close engagement with them. Their feedbacks would help LAS to improve their working culture time to time. Vision: Every organization keeps a vision to work for. LAS would require to publicize its vision which should be understood by a common person. LAS should arrange to incorporate policies and procedures in the management policies and procedures specially required to achieve vision. Communication: Correct communication is one of the tools for success. Keeping in view for its wide area coverage and more staff, efficient communication is necessary for LAS among its staff working on sites, public at large for services etc. LAS may use different channels for communication like bulletins, magazines, newspapers, websites, city centers for face to face talks etc. Part II: Testing strategy for system development would involve following three steps: Implementation of each step through making policies, procedures and guidelines, drawing work program, developing teams to work using different tools both internally and externally, taking help from other organizations etc. Accountability of each step through following the principles applicable “ what it does, how it does it, why it does it and with whom” by a responsible person or team and make necessary comments and recommendations. Monitoring and evaluating process – report from different departments is called for monthly, half-yearly or yearly and information are complied for consultations by the management for evaluation. Necessary comments and recommendations by the management would help LAS to make its better environment for working. Task -4 Reflection summary for organizing and managing of the assignment to achieve the production of final report: Requirements: Final Report should contain aims, performance targets and achievements. The criteria for check for Final Report has also been provided.. Aims: LAS would need to outline a plan to provide quality care to the patient. keeping in view the growing demand and population as well as Olympic in year 2012 in London. Performance targets and achievements: LAS Trust would need not only to fulfill its given obligations in law but would need to meet the financial targets set out by the Department of Health. The Director of Finance sends a report to the Trust for financial targets and suggests steps to meet the targets. The ambulance performance is measured through Government-set targets on the time taken to arrive at ‘999 calls’ system where Category A for potentially life-threatening have eight minutes and Category B calls have 19 minutes to process these calls for emergency care. Performance should also be measured on the Trust’s policies of Risk Management and Clinical Governance. Trust Board should monitor the performance. Criteria for check: The Healthcare Commission checks the report submitted by LAS NHS Trust annually. The Healthcare Commission conducts independent, authoritative and patient-centered assessments of the performance of NHS organization. The Healthcare Commission gives rating to the Trust mainly on two elements – Quality of Care and Use of Resources. The performance is measured within framework of 24 core national standards set by the Government. A score of annual performance rating is given on scale excellent, good, fair and weak. Compliance by LAS: Earlier LAS was in bad shape for both Quality of Care and Use of Resources. They were handling task of wide area coverage , big resident population and fleet of vehicles through manual process. The manual process had many bottlenecks which affected badly the Quality of Care and Use of Resources. To win over the problem, LAS decided to incorporate Computer Aided Dispatch (CAD) for automation of their services in 1992 but the system could not work satisfactorily and Page 2 LAS had to abandoned the system and became forced to go back the original pen and paper method. Later LAS implemented some Service Improvements Plans but they did not deliver the goods too and service problems continued including crashing of computer systems etc. Recommendations have been made to avoid software failure for resulting problems in services, like purchase of software from reputed company developing software specially for ambulance services, development of skills for technical staff for handling the software for trouble shoot and keeping of technical details for software perfect for future use. LAS would need to adhere to the factors of Quality Assurance and implement them through different tools / systems applicable. Compliance of Professional Standards including ISO-9000 should also be ensured. A development methodology together with testing strategy have been suggested like reformation of old system to develop a new system to meet present needs, changes in the organizational structure, operating system and processes to meet the aspirations of the patients, development of leadership and management skills to upgrade the status of services, partnering with private and government agencies etc. for more close interaction to improve working system, to draw and achieve vision and making communication more effective among their staff on the sites and public at large for services. Suggested testing strategy through implementation of different steps for making polices , procedure and guidelines, accountability of each department by a responsible person or team through applicable principles, and monitoring and evaluation of reports from different departments for consultations of the management to decide for future action. Final Task Contents: Task-1 Part I – LAS services which went wrong Part II – Suggested steps for a project plan until 2012/13 Task -2 Part I - Factors and tools for Quality Assurance Part II – Professional Standards for Computing Systems (ISO-9000) Task – 3 Part I – Suggested steps for development methodology Part II – Testing strategy for system development Task – 4 Reflection of summary for organizing and managing of the assignment to achieve the production of final report Final Task Contents, Introduction, Conclusion and Bibliography Introduction: LAS claimed at a time the largest ambulance service in the world covering a wide area of over 600 sq. miles and population of over 7 millions. With a strength of around 2700 staff including operational staff , LAS was handling transportation of around 5000 patients and attending telephonic calls of over 2000 per day. LAS was also handling deployment of around 750 vehicles to the incident sites daily. It was a tough challenging job before LAS to identify its available resources and provide assistance on time to the incident areas manually through pen and paper method. To remove these bottlenecks LAS explored for an automated solution to replace the whole manual process to bring accountability of responses to the national standards and decided to install Computer Aided Dispatch (CAD) commonly known as London Ambulance Service Computer Aided Dispatch (LASCAD). CAD system was loaded to handler different key functions but the system did not work as expected and the project was a complete failure. LAS became forced to return to the original manual process of pen and paper method Page 2 An inquiry revealed many factors which caused for failure of the project including the major cause of single management decision. Many improvements plans later also did not work and service problems continued including crashes of computer systems. Conclusion: LAS would need to have a vision to enter into a new era with an object to provide a world class ambulance service as well as to meet the future challenges for rising population and Olympics in year 2012 in London. Being a part of NHS’s national modernization program NHS is also contributing investment under an Improvement Plan to LAS to improve patient’s care and to improve its working environment including staff satisfaction. LAS in turn would need to adopt different programs for organizational development (OD) to give its different look, feel and behavior with focus on Quality of Care and Use of Resources. LAS should also take all measures to achieve highest score of annual performance rating by the Healthcare Commission. This continued high rating every year would contribute much to reach vision quickly. Bibliography : Source: CAD Failure LAS. 1992 - http://www.lond.ambulance.freeuk.com/cad.html References: 1. SERVICE IMPROVEMENT PLAN – http://www.londonambulance.nhs.uk/aboutus/improvement/improvement_main.html 2. London Ambulance Service – NHS Trust – Risk Management Policy http://www.londonambulance.nhs.uk/aboutus/publication_scheme/publication_scheme_files/policies%20and%20procedures/TP-005%20Risk%20Management%20Policy%20-%20Revised%2006-3-07.pdf 3. Dispatching Failure: The LASCAD Project – http://www.hoozy.com/pinchbeck/College/Work/Papers/DispatchingFailure.htm 4. LONDON AMBULANCE SERVICE NHS TRUST ORGANISATION DEVELOPMENT STRATEGY – http://www.londonambulance.nhs.uk/aboutus/publication_scheme/publication_scheme_files/Organisation%20Development%20strategy%20-%20Aug%2004.pdf Read More