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 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 implementation collapsed in chaos –headlines of 30 deaths; Wilby resigns; public inquiry ordered

LASCAD 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 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 – 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 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 – a bit too black & white? Understanding is constrained by the frame of reference of manager/researcher