The London Ambulance Service

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The London Ambulance Service, largest among the world, had attempted to introduce a computer-aided despatch system to overcome their operational difficulties and meet the performance requirements of Operational Research Consultancy (ORCON). The project, due to operational and strategic flaws at various levels, was a failure. The report identifies the flaws to produce a lessons learnt report with respect to failure of the London Ambulance Service computer-aided despatch system (LAS CAD).

1 Introduction:

To specify the service, LAS covers an area over 600 sq miles, serves a resident population of 6.8 m people, receiving 2000-2500 phone calls a day, where, 1300 to 1600 are emergency ‘999’ calls. Service has 2700 staff and over 750 ambulances. With a budget of £69.7 m, LAS is largest in world.

Performance Requirements – Reasons for taking a CAD system:

According to ORCON’s standards, the instructions should be given to the ambulance station or crew within 3 min and an ambulance should arrive at the scene within 14 min. This is a critical requirement, which can not be practically met with the manual system of activating emergency services. Lack of information and poor quality of communication with the crews were key concerns along with handling problems arising with organization, over-manning and operational cost of LAS.

Being aware of the complete manual system LAS attempted to introduce a computer-aided despatch system (CAD) in 1980s, but was abandoned due to lack of satisfactory performance during load testing. A new team was formed in 1990 to work out a new CAD system.

The system was commissioned 9 months late and failed within 2 weeks. There were flaws at Project Management and Organizational level which led to the failure of the system.

2. Problems Encountered – Lessons Learnt:

The management made an appreciable step in identifying a system which can help LAS meet nationally recognized ORCON’s performance requirements. But, there were some necessary changes in terms of structure and operational management which were supposed to be done in order to manage the project successfully.

Problems were to be rectified in organizational and Project Management level.

2.1 Organizational Level:

The choice of CAD is termed just as a buy and fix project by LAS, but it was major innovation which needed a business re-engineering approach.

2.1.1 Efficient Human Resource Management:

The manager of the project selected by the Scottish Ambulance Service has no specific project management or contract management experience involved in the process. The choice of a small IT contractor is a serious flaw. The contract analyst and system manager who are supposed to handle the contract placement, were unsuitably qualified. Many managers and staff saw the deadlines set by top management as being rigid. There was a lack of middle level management, where the void is filled by trade unions.

A proper business case analysis should have been done which would have clearly identified the objectives, goals of the project. That would have shown a clear picture of the project as a reengineering activity.

Though the selection of CAD to improve the standards of LAS was convincing, the view would have been properly shared at all levels of the organizational human resource.

The charge of placing the contract would have been given to the personnel with relevant IT procurement experience. The selection of an experienced project manager should have been given a critical importance. A proper communication of plans and requirements should always happen among various levels of organizational human resource.

2.1.2 Change in Organizational Structure/Team Structure:

The division of project into activities, the assignment of responsibilities to relevant personnel, communication during execution and method of monitoring and reporting, differs from various projects within the organization. The structure gives a clear picture of responsibilities once every team member was properly communicated with the structure set.

CAD, being an innovative project being handled by LAS encountered ambiguities over managerial role of the contractor. Project also encountered a lack of middle level management which led to an addition of unexpected and extra responsibilities being fell on the Director of Support Services, who found him spending more of his time in low level coordination and progress chasing.

The involvement of ambulance crews was considered to be very little in developing a SRS. The hard ware manufacturer, who took the role of prime contractor, was not prepared to set up to execute his role and rapidly withdrew from activities of this nature. The contractor and systems manager found them selves not qualified for IT procurement and need to be replaced.

The responsibilities of activities should have been clearly stated before attempting to prepare an SRS (along with team responsible to produce SRS). The ambiguities in managerial role of the contractor which resulted in inefficient progress in him leading the project would have been avoided if the responsibilities are clearly stated before accepting the job by contractor. As this happens only if contractor in the managerial role is self sufficient in terms of his duties and expertise, proper definition of contractor’s responsibilities would have solved a part of problems.

As improving the performance of ambulance crews was considered to be an important criterion, complete involvement of ambulance crews should have been done during the preparation of SRS.

Thus, the way responsibilities were communicated among the team at various levels was not structured right from the initial step of preparing an SRS.

2.2 Project Management Level:

2.2.1 Time/Cost/Quality Estimates:

The management/project team, before being handled the project, would have analyzed the time proximity as the project is too complex to be completed in 9 months in consideration to available technical expertise and feasibility. An accurate business case would have avoided the problem.

2.2.2 Feasibility:

The project was already handled during 1980s where it failed to pass through a load test and proved to be incapable of managing the complexity and unachievable.

With a high technical complexity the SDS should have fully defined details on Radio interface, Communication and Patient Report system. Taking up an unproven combination of Windows and Visual Basic which were into rapid system development rather than fast system development is a serious flaw in terms of operations.

An operational feasibility analysis should have been done to identify what the complexities exactly are.

2.2.3 System Problems & Quality Testing:

The highly imperfect technical ground work led to the failure of CAS.

The technical communications, being a very important factor in the whole system should have been keenly tested. A proper investigation on the validity of the communications infrastructure and its ability to cope up with anticipated load should have been made. That is, how far the system can know the correct location and status of the vehicle.

Aspects which caused lack of information during the execution of the project are communication problems during execution, like poor coverage of radio system, communication bottle necks during busy periods, exact information of allocation of crews and poor interfaces between the operators, inability of system to cope up with established working practices and overload of communication channels. Vehicle location and communication systems were tested with in the north east and faults were identified as incomplete reporting by ambulance crews, inaccurate location fixes.

Though the testing phase went on, the testing environment is not accurate. Exact simulation of executing environment would have been made or new aspects should not have been brought in addition to the decided testing scenarios (printers), which would have avoided the problems LAS CAD encountered due to printers.

Functional testing to ensure that CAD does what is expected of it and Load testing to test the ability of the system to perform under maximum load would have added the completeness and quality to the performance of the system as few problems can not be simulated and can be seen only in real time.

Though CAD was not termed to be a technical failure, the flaws in system development caused the system failure.

A systems development methodology would have helped avoid many flaws in the LAS CAD. A system development life cycle approach would be of better choice rather than a single inheritance model of developing, testing (inappropriate environment), implementing. An experience project manager would have added this sugar and thus, this is to the notice of top level management.

3. Conclusion:

Identifying the flaws it encountered, LAS should under go an analysis phase to figure out operational and technical feasibility in undertaking CAD. With system errors being identified and aligning experienced and relevant human resource would add the proximity of system being a success. An understanding of re-engineering project would help the top level management identify the change-management required. With a better communication of these to the organizational personnel, any future trails to undertake an innovation would be the interest of employees at all levels too, rather than only of top management.

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