The truth is incontrovertible. Malice may attack it, ignorance may deride it..... Winston Churchill

Churchill once said,

"The truth is incontrovertible. Malice may attack it, ignorance may deride it, but in the end, there it is."

This has to be one of my favourite quotes.

Please forgive me if I seem to ramble through this blog but I would like to discuss an issue that has been on my mind for quite some time. This goes along the lines of something like this;

Why are so many organisations so inefficient and badly run? and perhaps even more compelling, why do we as employees or end service users accept this inefficiency?

As an almost 30 year active Paramedic with extensive experience both in the UK and the US I have encountered this far more often than not. From a street level Paramedic to a member of the senior management team of an ambulance service so large it was traded on the New York Stock Exchange the same inefficient themes were to be found again and again. To move against the "status quo" was met with resistance and outright hostility.

Through my lens and observing the ambulance service as this taken up the majority of my adult professional life may I make the following observations. These observations are heavily influenced from an article I recently read;

In this article, the author Brian Cattle eloquently makes the following observations in regards to the loss of an RAF aircraft over Afghanistan due to mechanical failure.

"While the technical reason for the loss of the Nimrod was understood relatively quickly, it took Haddon-Cave two years to fully investigate the underlying latent technical and organisational causes which dated back to the 1960s..........latent issues laying dormant in an organisation for a long time until all the conditions are right for them to suddenly manifest as a catastrophic accident."

There are so many parallels to be drawn to the Ambulance Service especially in the light of current pandemic and the release of the Kerslake Report. We seem to spend inordinate amounts of time investigating incidents (such as the recent postural asphyxia case) rather than looking at the environment that led to the sentinel event. Although often superficially portraying a sense of support and understanding an air of persecution and retribution within a punitive organisation still infuses the EMS system.

"Meanwhile there were distractions of major organisational change and cuts in funding in 2000 to 2005 following the Strategic Defence Review of 1998. Consequently the Nimrod Operational Safety Case was outsourced to the Nimrod's manufacturer in 2004. The retrospective Safety Case, which cost £400,000, missed obvious risks while producing a large amount of paper reinforcing the false belief that the aircraft was "inherently safe" because it had flown for 30 years."

In the EMS industry we are all too often guilty of producing large amounts of paper with very little evidence of impact or change. What resonates with me is the statement concerning false beliefs in systems being inherently safe due the length of their tenure. When we look at this in terms of medical intervention our belief in performing such tasks or administration of medication may lie not so much in evidence-based medicine but in the fact that we have always done it this way, why change it now? This has far reaching influence not only upon our actions in the field but the way we recruit, select and educate new candidates aa well as the manner in which we continue to educate them after their initial training and throughout the rest of their EMS careers.

As Cattle eloquently wrote about the Nimrod disaster,

"Ultimately the aircraft was manifestly not safe but this "paper safety" gave the impression that risks were being managed when they were not."

Need I say more.....

All too often we seem to write meaningless reports and tick endless boxes on lists that are inconsequential and as a result miss the essential missives due to the volume of information that passes through our email inboxes or appear on staff notice boards. We become complacent, who can place their hand on heart and say that they perfectly checked off every VDI? How do we check that new protocols have been read and understood by staff other than having them tick a box on an email or paper form? To do this correctly would take time, effort and of course expense so we trot out the usual list of excuses such as,

"They are all adults and professionals that hold a registration"

"It's on their heads, they signed it, they are responsible for it."

Does this really ensure that the individual read it and comprehended it? Does this have an air of defensiveness about it which adds to the subliminal culture of retribution and punitiveness (is that even a word?). Not quite the supportive, nurturing organisation with slick catchy slogans found on banners, websites and letterhead intimating that this is a great place to work.

Who, if applying to the ambulance service (especially the privates) has not had to trawl through endless mid-numbing online courses on fire safety, GDPR, equality and diversity (to mention but a few) that purely are a tick box exercise. Content retention I suspect post only a few days will be negligible as the candidate only views these courses as a hurdle to be traversed in order to start work and the content is stale and completely uninspiring. Result, a tick box exercise that is clearly completely ineffectual in order to meet an NHS requirement. Is it no wonder that the datexes start to fly consuming yet more wasted investigational time and patient safety jeopardized, which all costs money?

Although seen by so many in management and operations as non-revenue generating, effectual education has always had hidden cost benefit. Doing things right at the beginning of a candidate's journey through solid education and effectively continuing that educational support throughout their careers can save any organisation a small fortune. In a similar vein, so is the educational support of those being promoted to leadership roles. A good clinician does not necessarily make a good educator or leader. Selection, initial leadership education and continued support is essential. Moving those up the ladder or placing them in lateral roles away from the field because they are consciously or unconsciously incompetent is no strategy for a strong and effectual organisation yet I feel sure that there are many out there nodding their heads in agreement.

I will draw this to a close for now. As always your comments are all most welcome.

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