Cultural change and perpetuation in organisations: evidence from an English emergency ambulance service

Decision making for patients categorised as ‘amber’ in a rural setting

“…However, without clarity on what is expected of paramedics and a shared understanding of the role, the risk remains that the default position to convey patients to hospital, even if this is inappropriate, may remain. This tension between traditional cultures and organisational control has also been recognised in other ambulance trusts (Wankhade et al, 2018).…”

Work intensification and ambidexterity - the notions of extreme and ‘everyday’ experiences in emergency contexts: surfacing dynamics in the ambulance service

“…In relation to organizational ambidexterity it was interesting to observe how respondent roles appeared to oscillate and transform across exploitative/mundane-extreme and explorative/intense-extreme domains. Alternatively, the exploitative view cast ambulance workers primarily as 'blue collar' staff mainly in a 'transport' role juxtaposing with a perception often projected by others of ambulance staff as dynamic, fast moving medical practitioners in a constant explorative mode (Granter et al 2019;Wankhade et al 2018). One of the key underlying features in the data concerned the language used and weariness of tone employed by respondents.…”

“…Furthermore, this positive contribution is reflected in various official reports (NAO 2011; Association of Ambulance Chief Executives AACE 2016; NHS England 2013) and academic publications (McCann et al 2015;Turner et al 2015; Wankhade and Mackway-Jones 2015). However, a number of challenges continue to hamper the working of these services including: an annual rise of demand for ambulance services of 5.2% between 2009-16 (NAO 2017); insufficient funding for urgent and emergency activity related to demand (House of Commons 2017); confusion over response time targets with only one trust meeting the three national targets in -16 (NAO 2017; shortage and retention of paramedic workface (NAO 2017); high sickness absence rates (Wankhade 2016); and, the challenge of working within an increasingly complex health system and developing new skills (Wankhade et al 2018).…”

“…The over-prioritisation of 'red' calls (8-minute response to life-threatening emergencies) is often cited as one of the main reasons for crew dissatisfaction due to the fact that it tends to be driven by organizational and political reporting imperatives rather than genuine medical necessity (Wankhade 2018;NAO 2017). This 'extreme and normal' duality has been overlooked in the literature as the emphasis has rather tended to be primarily on ambulance professionalization and work intensification (Granter et al 2019;McCann et al 2015) or ambulance culture (Wankhade et al 2018;Wankhade et al 2015).…”

“…Given its civic importance, and the transitions taking place therein, emergency services represent an important area for examination corning how 'extreme' situations unfold in relation to everyday contexts. Extant literature on the emergency services has considered a number of prevalent issues and topics including: network structures and command systems (Griffith and Roberts 2015); culture change (Wankhade et al 2018); performance (Barton & Beynon 2012); decision-making (Shaw et al 2013); inter-professional collaboration (Collin et al 2015); leadership dynamics (Van Wart 2014); and mental health (Wagner et al 2016). Much of this work has generally concentrated on a functionalistic frame of reference typically focusing on issues of efficiency and effectiveness.…”