Experienced Challenges in Prehospital Management

Abstract

The article presents an exploratory qualitative study of how managers of ambulance stations experience communication with employees working as authorized paramedics. The aim was to understand how the managers perceived challenges in this communication, and how they thought it was possible to meet these challenges.

Method:

The study involved semi-structured interviews with 20 managers, supplemented with observation studies in ambulance stations. The interviews were analyzed on the basis of a methodological reflective lifeworld approach, and compared to the participant observations of interaction between managers and employees.

Results:

The managers thought it was difficult to secure good communication. The reasons varied, but everybody referred to lack of time, knowledge gaps and unpredictable, hectic work schedules. This implied that employee dialogue often had to be brief and direct, and that it was difficult to conform to ideals of extensive communication. In the light of these challenges, the managers held that it was important to focus on attitudes, interpersonal relations and team building in order to develop well-functioning services.

Discussion:

It is challenging to implement modern ideals of communicative human resource management (HRM) in prehospital management. Practical limits justify communication practices with elements from top-down management (TDM). In recent management theory, TDM has been conceived of as a brutal and old-fashioned communication model, but it is sometimes necessary to use principles from TDM in prehospital management.

Conclusion:

In management theory, HRM is often presented as a communication model that health managers should conform to. This study suggests that HRM should not be implemented in all areas of health management. It is important to develop models that combine elements from HRM and TDM with ethical frameworks and team-building approaches, in order to capture the reality of health care services where lack of time and other resources are salient aspects. Such models can help managers to cope with difficult situations and should, therefore, be a focus area in health management theory.