London Ambulance Service: Case Study

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Analyzing the case of the London Ambulance Service on the third level is aimed not only at understanding the general situation, but also at introducing the concrete solutions for the problems. Thus, it is important to consider all the previously made conclusions. For instance, it is necessary to define the benefits and disadvantages of the system work, find the reasons for failures and offer the options for improvement.

On the previous two levels of analysis, we have drawn the general picture of the system work. We got acquainted with the consequences of its improper work, and tried to search for the reasons for the errors. The system appeared to fail at the beginning stage, being unable to receive all the calls from patients. Next, the distributions of the calls among the available ambulance vehicles was also done improperly. And finally, the displaying of the current situation in the city and in the LAS was done in a wrong way. In the level three analysis we will try to deal with all these issues and understand them more deeply.

System and Problems

The analysis of the system and its problems is of a vital importance, as far as identifying mistakes can help to correct them and to avoid them in future. In addition, the precise analysis of the system can help to find solutions which can improve its work.

There is a multitude of criteria to be considered while evaluating the work of the system. Thus, in order to analyze the work system of the London Ambulance Service fully, we use the checklist offered in the introductory section.

Work system principle Degree of concern Comment or explanation
#1: Please the customers. 3 The patients were dissatisfied with the work of the system, as their calls were often missed. In addition, even in case of successful connection with the station, it took up to 3 hours for the ambulance to arrive. Moreover, the ineffective service caused from 10 to 20 deaths.
#2: Balance priorities of different customers. 2 Both the ordinary cases and the life-threatening cases were missed by the system. The patients who died and those who stayed alive but did not get the emergency help became the victims of an insufficient work of the system.
#3: Match process flexibility with product variability. 2 The system had a lot of opportunities to simplify and improve the work of the ambulance service station; however, the process was not flexible enough because of the inexperienced workers and the program which was not debugged.
Work services
#4: Perform the work efficiently. 3 The work of the system failed to perform efficiently, as all of the stages suffered from the system’s errors. The system did not receive all the calls to the ambulance center; neither did it display all the data correctly. The human part of the system, which consists of the ambulance workers, also did not perform well, as far as they were confused by the new mechanism and unfamiliar with the peculiarities of its work.
#5: Encourage appropriate use of judgment. 3 The system did not allow the workers judge the situation discretely, as not all the factors were monitored.
#6: Control problems and their source. 2 The problems and their sources were uncontrolled as the system had a lot of errors which were discovered only afterwards. The problems were also missed because of the wrong monitoring results.
#7: Monitor the quality of both inputs and outputs. 2 While the outputs quality was monitored, the input quality was left without attention.
#8: Boundaries between process steps should facilitate control. 2 The errors on the initial stages (missed calls) led to the errors on all the subsequent stages (ambulance distribution and arrival).
#9: Match the work practices with participants. 3 The participants were unfamiliar with the peculiarities and main principles with the new work system.
#10: Serve the participants. 3 The system basically failed to serve the participants. For instance, there were calls from the patients which were not received. In addition, some patients had to wait for the ambulance for too long.
#11: Align participant incentives with system goals. 2 There were no benefits offered by the system which could compensate the damage caused to the thousands of patients.
#12: Operate with clear roles and responsibilities. 1 The crew was divided into several sections, each responsible for a certain stage of the operation. The computerized system also had different phases, each aimed at a different goal. In general, the distribution of roles and responsibilities in the system was clear.
#13: Provide information where it will affect action. 3 The computerized mechanism had a lot of errors, which monitored the false data. Thus, the lack of information caused a lot of mistakes in all the phases of the LAS work.
#14: Protect information from inappropriate use. 1 The received calls were considered and the ambulances were sent to the patients; therefore, the received information was used appropriately.
#15: Use cost/effective technology 2 The expensive technology appeared to be less effective than expected.
#16: Minimize effort consumed by technology. 1 The technology needed no additional mechanisms or instrument to realize its operations.
#17: Take full advantage of infrastructure 2 The system did not manage to use all of the infrastructure’s possibilities, as the crew failed to work jointly.
#18: Minimize unnecessary conflicts with the external environment. 1 There were no conflicts with the external environment.
#19: Support the firm’s strategy. 3 The system did not help, but even prevent the strategy from being followed because of the multiple errors.
Work system as a whole
#20: Maintain compatibility and coordination with other work systems. 3 The LASCAD did not show the compatibility with the semi-manual and manual systems of work.
#21: Control the system using goals, measurement, evaluation and feedback. 2 The system control was insufficient; due to the lack of testing, the evaluation was impossible. The measurement of the system work was also hard to imply, as the displayed data was often false.
#22: Minimize unnecessary risks. 3 The risks of the system were not avoided; the errors in the computer led to the false data and misleading information being delivered to the station, which caused a lot of disasters, including people’s deaths.
#23: Maintain the balance between the work system elements. 2 The work system elements were not balanced enough because of the lack of cooperation between the different support centers.
#24: Maintain the ability to adapt, change, and grow. 3 The work system did not adapt to the demanding conditions. Because of lack of the system’s development, it had no opportunity to extend its boundaries.

Analysis and Possibilities

Having analyzed the system work and defined its main disadvantages, we now can work on the ideas which can be implemented and develop the ways of its improvement. As it was stated in the previous levels of analysis, the system definitely needs a proper testing. Obviously, the implementation of the system should be made gradually,which means that the whole computer system of the London Ambulance Service should be updated. Installation of the hardware is also important. In addition, the workers should get acquainted to the new system in order to operate jointly. In addition, the system should be debugged, as well as the hardware of the LAS. All the precautions need to be taken in order to avoid the possible risks, such as the repetitive errors in the system work.

In case of the implementation of the mentioned changes, the system working properly would look like the next scheme:

Analysis and Possibilities

As shown in the scheme, the beginning of the ideal scheme suggests that the patients should call to the LAS, where their calls are received by the computer. The computer is controlled by the workers, who are supposed to be experienced in this field and know how to operate the system quickly and effectively. The computer inserts the call into the database, which matches it with an ambulance station, located near the patient. The available vehicles at that station get a signal from the computer system and go to the patients.

As it can be seen, the system has an opportunity to work properly and satisfy the needs of both the customers and workers. Making the minor changes can help the London Ambulance Service to become more effective.

Recommendations and Justification

Having introduced the possible changes for the system, it is important to define whether these changes are profitable for the organization. As far as the London Ambulance Service is a governmental institution, its financing is rather limited and should be thoroughly planned. With this purpose, we can compare the needed costs, risks and benefits. In order not to miss any of the points, we use a template offered in the appendix section (Atler, 232):

Aspect of the justification How the recommendation addresses the issue
Direct costs by major category The development of the system, the improvement of the hardware and the new codes are the main costs of the project.
Tangible benefits by category (in monetary terms) The computerized system is beneficial, as it is able to work on its own. This significantly reduces the number of workers needed, and therefore the number of salaries to be paid.
In addition, in case the system works properly, there is no need to finance the call centers, as the dispatches will be realized automatically.
Intangible benefits The service of the ambulance will be improved considerably. All the operations will be automated and therefore less time-consuming. This will lead to the satisfaction of the patients’ needs and the efficient functioning of the medical crew.
Indirect and hidden costs The system has no additional costs.
Benefits compared to costs Indisputably, the benefits of the system are greater than the cost of its improvement.
Payback period The money spent for the project will return to its owner during the approximate period of 1 year.
Value of options opened by the project The project gives the LAS a lot of options for development.
Business and strategic priority The LAS will have a lot of benefits from using the improved system. For instance, the project will make the London Ambulance Service become more effective and trusted; it also gives the company an opportunity to grow.
Significant risks The system will not be able to consider the human factor; in addition, the errors in the system may repeat again. Moreover, the system is dependent on the electricity supply, so if there is something wrong (e.g. during a storm), the system may work insufficiently.
Comparison with other possible uses of resources The resources could also be spent for improving the semi-manual system of the LAS. Equipping the stations and vehicles with modern devices could improve the work of the company.


The failure in the system work at the London Ambulance Station caused a lot of damage both for patients and workers. Having analyzed the system thoroughly, we defined the main drawbacks and their reasons. This enabled us to introduce a system of changes which may improve the technology work. In order to define whether it is justified to make the offered changes, we considered all the possible risks and benefits connected to them. In conclusion we can say that the LAS system can be computerized, but only in case of debugging and numerous testing of the system.

Reference List

Atler, S. 2006, “The Work System Method”, Work System Press, Larkspur.

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