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The paramedic profession: disruptive innovation and barriers to further progress

02 April 2020
Volume 12 · Issue 4


The paramedic profession in the UK evolved from a small number of pilot programmes in the early 1970s that focused on training selected NHS ambulance crews in advanced resuscitation techniques. Similar initiatives occurred almost simultaneously in the United States, Australia, New Zealand and Canada. This case study focuses primarily on the UK, and England in particular. The purpose of the initiatives described was to address the unmet needs of patients with serious injury and illness. Over the following decades, paramedics developed a clear identity and became fully professionally recognised and regulated as allied health professionals, becoming an example of the phenomenon termed ‘disruptive Innovation’; this is something that creates a new market and value network while disrupting existing ones. The steep developmental trajectory of paramedics has not been mirrored by a comparable pace of reform and modernisation in NHS ambulance services which, in comparison, have lagged behind and also failed to adapt to significant changes in the pattern, quantity and epidemiological characteristics of patient demand. This has led to a mismatch between the capabilities offered by paramedics and the professional opportunities available to them in ambulance services, and hampered these practitioners' ability to make full use of their skills. The consequence of this has often manifested as low levels of paramedic and other ambulance staff satisfaction, resulting in high rates of staff turnover. Parallel developments in medical personnel deployment have increased the quantity of medical labour available to patients with serious or life-threatening injuries, with medical staff added to helicopter emergency medical crews. While many patients with urgent conditions would have benefited from general practitioners being available out of hours, proportionally fewer doctors are available to fulfil this role today and those that are attracted to working with the ambulance service often prefer to respond to cases involving major injury. For these reasons and given the reality that the ambulance service is morphing into primarily an urgent care organisation, de-emphasising the transport aspect of the service, changes are needed to its model of operation and to staff management and support.

Some inventions can be viewed as ‘disruptive innovations’—a concept that started to enter the managerial lexicon after being devised by Joseph Bower and Clayton Christensen in the Harvard Business Review in 1995 (Bower and Christensen, 1995). These innovations create a new market and value network, disrupting existing ones. This designation is normally applied to new technologies, such as microcomputers, digital cameras, mobile phones and small home photocopiers.

One important feature of this phenomenon is that the new product is initially inferior to established products but, over time, becomes progressively more capable and relatively less expensive. The relationship of film and digital cameras demonstrates this reality.

Disruptive innovation has been applied to many service industries, as exemplified by low-cost airlines or specific groups of workers, particularly if they offer technical capabilities that are broadly equal and effective as those offered by traditional providers but at a lower cost.

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