With any state health service, it is important that the health of the business is as sound as the speed of its response. So when two such organisations merge, it is vital that the systems are consistently applied across all of the business.
This is what happened when Ambulance Victoria emerged as the result of the recent merger between Metropolitan Ambulance Service, Rural Ambulance Victoria and the Alexandra and District Ambulance Service.
Ambulance Victoria continues to provides high level pre-hospital emergency care and patient transport for every person who lives and works in Victoria.
Merging of these two services, and ensuring their standard of quality care continued, required a thorough approach to quality management. NCS International (NCSI) has worked with both services for over seven years, ensuring they meet world best practice with ISO 9001:2008 certification.
Better Together
This new state-wide ambulance service was established in July 2008. By having one organisation serve the entire state, communities would receive equitable access to services, and resources could be better allocated on a flexible basis.
Ambulance Victoria can now develop a consistent strategic plan for the whole state, respond quickly to mass casualty accidents – no matter where they are, and build focused relationships with other health and emergency providers.
One aspect of the merger process was ensuring effi ciencies and economies of scale in processes such as consumables, legal services, recruitment campaigns, fi nancial and probity auditing and vehicle procurement.
Challenges in a Merger
As with any merger, there are challenges in bringing two large and complex bodies together. From a quality perspective, there was an immediate need to understand and map existing business processes, so that they can support the integration of functions.
David Bugeja is the Manager for Service Quality and Improvements Improvement with Ambulance Victoria. He says, “This merger is an ongoing process – it’s not something that happens overnight. It is essential to have a well-structured approach to integration.”
NCSI has certified Metropolitan Ambulance Service to ISO 9001:2000 and AS/NZ 4801:2001 since 2002. Prior to the merger, Rural Ambulance Victoria was certifi ed to ISO 9001 in the Clinical Governance area only, but this was extended to the entire rural sector in January 2009.
As a result, all of Ambulance Victoria is now fully certifi ed to ISO 9001:2008. Ambulance Victoria is now working with NCSI to roll out an integrated Occupational Health and Safety system with the aim of having organisation wide certifi cation to AS/NZS 4801:2001 within the next twelve months.
A key challenge arising from the merger was to design and implement a standard approach to document review and control. “We have focused heavily on ensuring that we have a standard and well implemented approach to how we manage policies, procedures, work instructions and other quality documents”, says David.
“Our team has also been facilitating process mapping workshops with line managers, looking at opportunities to integrate policies and procedures between the metropolitan and rural sectors. We have focused on a few specific areas at a time – issues such as contractor safety, learning and development training, graduate management, and crash reporting and investigation processes.”
He admits it’s a labour intensive process but says “it very rewarding as it is providing practical and value adding support. Whilst the challenges are signifi cant, this is where the quality function within an organisation can really demonstrate a positive role which extends beyond internal auditing.”
A Change in Culture
Since the merger, NCSI has completed one metropolitan and one rural audit. “As from late 2009 we will have single surveillance and certifi cation audits for both standards,” says David.
As a result of certifi cation David believes that “quality thinking is now well embedded in how we develop, implement and review systems and processes.”
“It’s now about continuous improvement, rather than compliance,” he says. “More than simply having the right documentation to show the auditors. Our Line Managers are now seeing how this adds real value to their areas.” Erik Schanssema, Ambulance Victoria’s Service Improvement Co-ordinator, agrees. “Our internal audit system is now more robust. The quality function has become more strategic. We’re looking at the whole health of the system, to see where improvements can be made.”
David adds that certifi cation also gives staff, the community, and the government confi dence in their ambulance services. “Our business systems can be independently assessed against world best practice. We’re unique in that our processes are much more open to public and media scrutiny and questions can be raised in Parliament.”
“Making sure we manage our risk, making sure our services to the public have clear, robust processes behind them - that’s absolutely essential.” This is clearly one organisation where achieving the best standard in quality management can make an enormous difference for the community it serves – and perhaps even save lives.
