Driving forward patient care

As head of IT Customer Services & Networks at the London Ambulance Service NHS Trust, my key responsibilities include managing the organisation’s around-the-clock critical IT support services and I am also the IT Infrastructure Library (ITIL) and ISO 20000 Project Board Executive.
The London Ambulance Service is the busiest ambulance service in the world; providing healthcare that is free to patients at the point of delivery and receiving over 1.2 million calls per year. There are two key parts to the business - the 999 emergency service, and the Patient Transport Service, which involves taking patients from their homes to hospitals and vice versa.
The service has 80 sites across London with around 4,500 staff that are supported by an IT Directorate of over 100 staff. When I joined the service, I knew that I would face some big challenges and it became clear that we needed a major overhaul and ITIL would be the perfect driver. Although we still have a way to go, we have improved services vastly and I believe the look and feel of this part of the IT Directorate is completely different to three years ago when I started.
This has been achieved by implementing ITIL internally with little involvement from external suppliers. A key reason for this is that we have a large number of staff who were keen to get involved and deliver. I saw this as an opportunity to secure buy-in from staff, which I believe has turned out to be the right decision.
I realised that selling the concept of ITIL would be key and that the language involved would play an important part. Examples of this include changing the name of the key customer facing department from Applications to Customer Services, and preaching the virtues of ITIL whenever I had an opportunity.

Delivering the vision
So we had the vision, we had the desire, we had the people but we didn’t have the money. The initial strategy I used to secure funding was to make changes that were quick and zero cost that would improve services, which I then attributed to ITIL. For example, I implemented a very basic Service Desk function using a central e-mail address and an easy to remember internal phone number, which is 3333.
The next key step was securing relatively small amounts of budget in the name of ITIL and delivering these to continue building confidence. We used this money to implement a Service Desk tool that is aligned with seven ITIL processes and trained over 100 staff on ITIL Foundation to create a positive feeling about it.
Having gained confidence from the Board and IM&T staff, I submitted the official ITIL Project budget request with a business case, which was approved and the project officially started in April 2007. This took place 20 months after the ITIL project had unofficially started and was primarily achieved by demonstrating credibility, breaking down the project into numerous tangible products with clear benefits, and making it clear that ITIL would underpin all IT services including, of course, the 999 systems.

Sharing responsibility
The project management responsibility of our two-year ITIL project was divided into two strands, so that we had one ITIL Project Manager focused on Service Support and the other on Service Delivery. There is a ‘quick wins’ strand of work, so that alongside delivering products that will increase our ITIL maturity on all ITIL processes to level five, we will also carry out relatively quick and simple work that provides immediate benefits, such as a populated knowledge management database that would assist in providing quicker resolutions of incidents.
With this in mind, and also the ethos of ITIL being used to share best practice and avoid reinventing the wheel, we felt that it was best that we shared our resources, documents, people and premises with other like-minded organisations. Therefore, in conjunction with Connecting for Health, we have developed a web portal where all our relevant ITIL documents are uploaded for other NHS Trusts to access.
It was of paramount importance that the ITIL project was included in the IT Directorate’s top 20 strategic objectives, as this provided everyone with a clear vision that our focus was ITIL and our delivery would be measured. However, by making ITIL a key objective, it was vital to manage expectations and therefore, from the outset, we informed staff, customers and all relevant people, that there may be occurrences where we would be taking one step backwards in order to move two steps forward.

Empowering staff
With any transformational change, it is necessary to empower staff in order for them to feel that they have a voice and can influence the change, rather than it being something that is forced upon them. One way of achieving this is to provide a comprehensive training programme, so that staff are up-skilled and confident that they are part of the future. Furthermore, training attributed to the change programme can be used to secure buy-in.
A key part of any winning formula is to involve your staff and this was achieved by selecting ten line managers who would each be responsible for one ITIL process. This involved changing job titles to include the relevant ITIL responsibility and each process owner was asked to dedicate at least one day per week to the ITIL project. All staff were constantly encouraged to develop their ITIL skills and think of ways to improve service. In recognition of this, we rewarded staff using a number of methods that included time off work, recognition in the monthly newsletter, training and praise.
As well as ITIL Foundation, practitioner and manager training, we also provided PRINCE2 and technical training to all staff, as this complimented our service improvement ethos and also ensured that staff had a well-rounded skill set.
It is important to identify ‘super users’ and ‘champions’ in your organisation so that they can encourage buy-in and get involved. These are key customers who can be very powerful ambassadors for your service, as positive communication can be the difference between success and failure.
As mentioned earlier, we had no single point of contact. After implementing a central service desk and putting in place performance measures, we initially had a first time fix rate of 12 per cent at the desk. In September 2007 this figure was 29 per cent, in October 2007 it was 41 per cent, and now it is 66 per cent. This is still short of the 70 per cent target we are aiming for but we are confident that it will be achieved in due course.
This has all contributed in obtaining a very high level of IT staff buy-in – we came to realise that 100 per cent was impossible. A factor in securing buy-in from the board was selling ITIL to them as the de facto best practice standard recognised around the globe in delivering IT services. However, this on its own may have provided the initial short-term buy-in but to maintain this over years requires effective communication.

Looking ahead
Being a forward-thinking organisation, the service has already started considering adopting elements of ITIL v3, with full alignment in 2010. We are also considering the adoption of other complementary frameworks and methodologies such as COBIT and Six Sigma to improve the quality of our services.
Of course, at the heart of all of this is patient care. In 2012, when the Olympics comes to London, we are going to have to continue providing the current level of effective emergency services to the public at the same time as supporting 10,000 athletes and countless volunteers and visitors. To ensure that the service can cope with all of this, it will have to rely on IT and IT will need to excel, which we can only do with the high maturity of all ten ITIL processes. 

For more information
The London Ambulance Service is an itSMF member – www.itsmf.com