Scottish Ambulance Service, Edinburgh, U.K.

The Scottish Ambulance Service is the national ambulance service for the country of Scotland. The organization has a long history of leading in quality and safety within the National Health Service, and the leadership was pursuing quality as their organizational strategy. Like most EMS systems, the leadership recognized that the request for services comprised only a small number of life-threatening emergencies requiring emergency response, advanced level care, and rapid transport to Accident and Emergency services.

As part of the National Health Service, the organization was in the position to study how the patient’s presented when accessing 999 and how they were triaged by the Medical Priority Dispatch System, how they presented to the ambulance paramedics and what care they received, and what the resulting physician diagnosis was in the A&E and the patient’s ultimate disposition. This holistic view of an ambulance patient led to redesigning their clinical response model to better match the needs of patients and reduce the use of emergency response and transport.

The clinical response model and the organization’s new strategy represented a major change effort. Leadership and clinical staff wished to ensure they could see the changes and sustain the results. This required development of a vector of measures and sophisticated use of Shewhart charts to monitor performance variation, identify special cause events, and act appropriately to achieve the desired results. Dr. Williams advised the leadership and supported building capability.