The Scottish Ambulance Service

The objective of this assignment is to analyze the emergency ambulance service in Scotland, using process mapping techniques and measure quality for the ambulance services and to review literature about quality

What is a process?

The technical definition of a process is that it is a set of activities that converts inputs into outputs which meet agreed customer requirements. Figure 1 (Audit Scotland May 2000). Hammer suggests that even though processes are central to their businesses, most managers are unaware of them, never think about them, never measure them and never consider improving them

What is a process maps?

A process map breaks a process down into a level of detail that makes it easier to see how each step is performed, and how works are organized. Maps clarify roles and contributions, help in identifying opportunities and helps in measuring performance (source: The Basics of process mapping; Robert Damelio)

Process Mapping is:

> The most commonly used quality tool for analyzing and improving business processes.

> A critical analysis tool for defining quality performance issues, benchmarking study topics, and in understanding customer and supplier requirements.

> Translating an existing process into a process map is key to understanding the steps and sequences of activity in the process.

> The process map breaks the process down into component parts and identifies suppliers, customers, and time frames for each step.


According to Anjard, “A process map is a visual aid for picturing work processes. A Process map prompts new thinking about how work is done.”

What are flow charts?

According to management paper published by audit Scotland, Flowcharts are a key part of process mapping and, for many organizations, the starting point for understanding and improving processes. There are a variety of flowcharts that can be produced at different levels to provide varying amounts of detail. Three types of flow charts are:

> A high-level flowchart

> An activity flowchart

> A task flowchart

A high-level flowchart describes the overview of the processes involved which consist of inputs, transformation and outputs (figure: 2). The inputs in this case study are people, Buildings, Vehicles and equipments.

Peoples – managers, support staff, control room staff, paramedics, and technicians ,

Vehicles – Ambulances, Air Ambulances ,Defense and coastguard crafts,

Buildings – Service headquarters, control rooms, ambulance stations and an ambulance training college.

Equipments – radios for communication, stretcher for moving people, defibrillators for cardiac arrest, oxygen and oxygen masks and drugs for pain relief

The transformation here is the process which takes place which includes 277,000 999 emergency transport cases, 193,000 general practioners request, 17000 hospital doctors’ calls and 2500 emergency air transport cases. Transformation also includes the training for technicians and new staff, emergency incident planning and participation in stimulation exercises.

Output is the final process, which evolves from the inputs. It revolutionizes the services to achieve excellence in customer satisfaction and health care. Here the outputs are services to patients, patient’s satisfaction, and peace of mind to their relatives and return of investment to the government by saving patients lives.

An Activity flow chart: Follows on from a high level flow chart, showing more detailed activates that would project the overall process. (Figure 3) shows a system map which gives us details views of the activities

The Task flowchart : Follows on from the activity flowchart and shows in detail the activities of the processes. (Figure 4, 5 shows two different process models of operation)

Deployment Chart

The final type of flowchart that can be useful in process mapping is the

Deployment flowcharts (Figure 6). According to Collins Deployment flowcharting is a simple tool which maps work, processes and procedures and at the same time clearly demonstrates who is responsible for each stage of the work.” Deployment flowcharts can be developed for any level activity or task flowcharts. Looking at processes this way again encourages a positive challenge attitude and stimulates consideration of reconfiguring or redesigning


Measuring Quality in the Scottish ambulance service

A definition for quality depends upon the context in which we define quality. Quality can be defined by a customer according to his needs or it can be used to guide process or grade products and it can be used as a product attributes or it can be measured in service characteristics. Service quality make-up does not just involve “the results” but includes the method and procedures used to convey the service. (Collier, 1991). .John Naylor describes “quality is the degree to which the set of inherent characteristics fulfill requirements “. John Naylor defines 5 factors important in service quality management. They are:

> Reliability – Giving the promise service precisely and dependably

> Responsiveness- Helping patients/customers promptly with their varying needs

> Tangible factor -The condition of facilities and the appearance of staff

> Assurance -The demeanour and knowledge of staff and the way they convey trust and confidence.

> Empathy – Caring and offering individual attention

Quality in the Scottish ambulance service is measured by the service it offers. Faster response times, better patient care, and safe environments are ways of measuring quality .The primary objective of the ambulance service is to respond to all the calls at the earliest. The sooner they reach the site, the more chances of saving lives. The ambulance service is fully equipped with state of the art gadgets and supplies to ensure quality health care to patients at the initial stages of trauma. We can also measure its quality by – availability throughout the country and faster response time. Apart from its own air Ambulance it also has accesses to defence and cost guard crafts which help it in rescue mission in sea or mountains.

Training the staff is very important. Quality can also be measured by the making sure that people are happy with the staff. The ambulance service website also shows that it plans to improve it services quality by introducing new tool like caller identification line to pinpoint the location of caller, use digital map to provide accurate information to the nearest resource, pre-arrival software’s and prerequisites for any introduction of prioritization for better patient care. Also it has plans as to attend and prioritize emergency and non emergency cases. The vehicles crew will be given access to databases to view the clinical history of the patients.

Quality in general

Quality is typically defined in terms of fitness for use or conformance with Specifications; however, the ultimate measure of quality is whether or not the product or service lives up to customer expectations (Sinha and Willborn, 1985; Spencer, 1994). Peter Drucker noted: that Quality in a product or service is not what the supplier puts in. It is what the customer gets out and is willing to pay for (Drucker, 1993). The idea of quality was not very active in the west until late 1970’s.

It was the Japanese who first practiced the idea of quality, which transformed it from being the provider of tawdry rubbish into the highest quality supplier in the world (john Mac Donald) .NBC Christened DR. Deming as the father of the Japanese quality revolution. The Japanese developed tool, concept and techniques which later came to be known as total quality management. The term TQM was introduced to UK in 1983 by the Margret Thatcher government. Companies which practiced TQM included 3M, Procter & gamble and Marks & Spencer, who are still considered leaders in continuous and evolutionary improvement.

I believe that Quality is never an accident; it is always the result of an intelligent effort! There should be a will to produce quality products. Quality can be achieved if companies work closely with customers, suppliers, involvement of people to process approach, systematic approach to management, continual improvement and factual approach to decision making. The influence of quality on customer perceptions and consumption behavior has led some analysts to call quality the single most important factor for long-term competitive success (Akers, 1991; Rastogi and Sahni, 1995).