Organisational and Professional Cultures: An Ambulance Perspective

This chapter concerns the place of culture in ambulance services. There are issues around organisational cultures and sub-cultures, and the ways these are cross-cut by professional cultures. It is difficult to define culture adequately and the ways in which it affects behaviour are obscure. In the case of ambulance services, for instance, does it make sense to refer to a single culture within, let alone across, organisations? Similarly, cultures may not be transformed as easily as sometimes suggested. Nevertheless, governments increasingly seek to move the focus in the NHS from changing structures and systems towards changing cultures; raising a number of interesting questions. What happens when attempts to change organisational cultures encounter professional cultures, which support power and status based on professional standing? This is particularly relevant given the changing role of ambulance paramedics, which is an international phenomenon. In analysing these issues, Schein's identification of pluralistic dimensions of culture has been used. We conclude that ambulance organisations have multiple cultures, some of which counter change. This complexity adds to the difficulties of delivering effective reforms.