Models of ambulance service delivery for rural Victoria Full Name and Degrees of Candidate: Peter Francis O’Meara Student No. 8401608 Admitted to the Degree of Bachelor of Health Administration The University of New South Wales 22 May 1992 Admitted to the Degree of Master of Public Policy Deakin University 8 May 1998 Full Title: Models of ambulance service delivery for rural Victoria. Institution: The University of New South Wales School of Public Health and Community Medicine Submission Date: 1 June 2002. © Peter O’Meara 2002. Models of ambulance service delivery for rural Victoria Abstract The primary aim of the research project was to develop conceptual models of rural ambulance service delivery based on different worldviews or philosophical positions, and then to compare and contrast these new and emerging models with existing organisational policy and practice. Four research aims were explored: community expectations of pre-hospital care, the existing organization of rural ambulance services, the measurement of ambulance service performance, and the comparative suitability of different pre-hospital models of service delivery. A unique feature was the use of soft systems methodology to develop the models of service delivery. It is one of the major non-traditional systems approaches to organisational research and lends itself to problem solving in the real world. The classic literature-hypothesis-experiment-results-conclusion model of research was not followed. Instead, policy and political analysis techniques were used as counter-points to the systems approach. The program of research employed a triangulation technique to adduce evidence from various sources in order to analyse ambulance services in rural Victoria. In particular, information from questionnaires, a focus group, interviews and performance data from the ambulance services themselves were used. These formed a rich dataset that provided new insight into rural ambulance services. Five service delivery models based on different worldviews were developed, each with its own characteristics, transformation processes and performance criteria. The models developed are titled: competitive; sufficing; community; expert; and practitioner. These conceptual models are presented as metaphors and in the form of holons and rich pictures, and then transformed into patient pathways for operational implementation. All five conceptual models meet the criteria for systemic desirability and were assessed for their political and cultural feasibility in a range of different rural communities. They provide a solid foundation for future discourse, debate and discussion about possible changes to the way pre-hospital services are delivered in rural Victoria. Keywords Ambulance Rural Australia Pre-hospital Model Soft Systems Policy Problem-solving Models of Ambulance Service Delivery for Rural Victoria Peter F. O’Meara Table of Contents SECTION 1 INTRODUCTION...........................................................................1 1.0 Overview of Study............................................................................................................................ 1 1.1 Rationale for the study................................................................................................................... 1 1.2 Aims and objectives....................................................................................................................... 4 1.3 Research methods used.................................................................................................................. 5 1.4 Main findings 7 1.5 Future directions .......................................................................................................................... 10 SECTION 2 THEORY AND METHODS .........................................................11 2.0 Theoretical Framework and Empirical Foundations ................................................................ 11 2.1 Introduction.................................................................................................................................. 12 2.2 Systems theory ............................................................................................................................. 14 2.3 Socio-political context ................................................................................................................. 27 2.4 Health policy context ................................................................................................................... 36 2.5 Ambulance context ...................................................................................................................... 46 2.6 Aims and objectives..................................................................................................................... 72 3.0 Methods ........................................................................................................................................... 74 3.1 Introduction.................................................................................................................................. 75 3.2 The communities and ambulance stations................................................................................... 79 3.3 Determining expectations of rural ambulance services .............................................................. 85 3.4 Structure and culture of ambulance services in rural Victoria.................................................... 90 3.5 Measuring performance of ambulance services .......................................................................... 98 3.6 Formulating models of service delivery.................................................................................... 104 3.7 Integration of findings................................................................................................................ 112 SECTION 3 FINDINGS AND DISCUSSION.................................................119 4.0 Rural Communities and Respondents to Study ....................................................................... 119 4.1 Introduction................................................................................................................................ 120 4.2 Sample rural communities ......................................................................................................... 121 4.3 Respondents to study ................................................................................................................. 129 4.4 Discussion .................................................................................................................................. 133 The University of New South Wales – Doctor of Philosophy i Models of Ambulance Service Delivery for Rural Victoria Peter F. O’Meara 5.0 Expectations of Rural Communities.......................................................................................... 136 5.1 Introduction................................................................................................................................ 137 5.2 Expectations of health professionals and community members............................................... 138 5.3 Suggested changes to rural ambulance services........................................................................ 144 5.4 Discussion .................................................................................................................................. 166 6.0 Structure and Culture of Rural Ambulance Services.............................................................. 172 6.1 Introduction................................................................................................................................ 173 6.2 Rural ambulance structure in Victoria....................................................................................... 177 6.3 Cultural landscape of Rural Ambulance Victoria ..................................................................... 193 6.4 Discussion .................................................................................................................................. 217 7.0 Performance of Rural Ambulance Services.............................................................................. 223 7.1 Introduction................................................................................................................................ 224 7.2 Satisfaction with services........................................................................................................... 230 7.3 Operational performance ........................................................................................................... 235 7.4 Performance framework............................................................................................................. 244 8.0 Models of Service Delivery.......................................................................................................... 256 8.1 Introduction................................................................................................................................ 257 8.2 Competitive model..................................................................................................................... 269 8.2 Sufficing model.......................................................................................................................... 278 8.4 Community model.....................................................................................................................