Ambulance services are experiencing increasing demand for response to emergency calls. In response, they have increased the proportion of patients not conveyed to an emergency department (ED). Alternatives to transporting patients to an ED include the provision of telephone advice only (‘hear and treat’), treatment at the scene (‘see and treat’) and transport to another facility (‘see and convey elsewhere’). There is considerable variation in the rates of different types of non-conveyance, and in non-conveyance overall, between ambulance services in England. Understanding of the reasons for this variation has been limited and relatively unexplored. We will explore if there is variability in perceptions of the organisational culture within each individual ambulance service and show this in the context of non conveyance rates.Methods
We undertook 50 qualitative telephone interviews with ambulance service providers and commissioners in the 10 larger ambulance services in England, to identify factors that may explain variation in rates of ambulance non-conveyance. Data was analysed using a Framework model.Results
Amongst interviewees there was variation in the perceptions they held regarding the organisational culture of the ambulance service which they were employed by. Recent management restructuring within the ambulance service, perception of management support across the organisation, motivation of the organisation to undertake non conveyance, and perceptions of support for staff undertaking non conveyance varied across the 10 ambulance services. We will present this qualitative data alongside routine data identifying non conveyance rates in each service, and explore whether organisational culture appears to be related to ambulance non conveyance rates.Implications
Organisational culture is a complex issue but one which is potentially modifiable. Building a greater understanding of ambulance service organisational culture and how this relates to ambulance non conveyance may help identify ways of improving service delivery across all ambulance services.