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South Australia Ambulance Service
Instructor Manual
Case Summary
The South Australia Ambulance Service (SAAS) case describes the transition from a hierarchical
organization to a team-based one. SAAS provides ambulance service for South Australia through
more than 600 employees organized into over 60 teams. In 1993, the CEO of SAAS announced
an organizational restructuring which included a move to a team-based structure. Since then,
Case Objectives
Students are to develop a specific action plan for Ray Main to assist in SAAS’s move to team-
based management. The case demonstrates the complexities of moving to team-based
management and allows for an exploration of exactly what ‘team-based management’ and
Theoretical Links
Quinn and Spreitzer’s article on empowerment provides useful reading. Their seven questions
are attached as Overhead 1. Bowen and Lawler’s article, “The Empowerment of Service
Workers,” is also a useful reference.
Assignment Questions
1. What are the critical success factors in the delivery of service by the SAAS? What would
AOs consider critical in their job?
2. Define ‘team management.’ In your view, how should it operate?
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3. How does SAAS define team management? What is the team? How can teams assist
SAAS to improve their service delivery?
Analysis
1. What are the critical success factors in the delivery of service by the SAAS? What would
AOs consider critical in their job?
Exhibit 5 of the case diagrams many of the essential relationships required to understand the
delivery of service by SAAS teams. Anything directly associated with getting the patient to the
hospital ready for treatment deals with critical issues in service delivery. The ability to respond
quickly to emergency calls is essential. (For example, one of the critical issues with cardiac
patients is the speed of response.) The ability of AOs to diagnose patient needs and to provide
initial medical treatment is critical. Finally, the information transmitted to the hospital is
important in ongoing treatment.
SAAS expanded their definition of ‘success’ to include the attitudes and satisfaction of family
members and of hospital staff. Thus, the handling of anxious family members was highlighted,
and the relationships within hospitals took on new importance.
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2. Define ‘team management.’ In your view, how should it operate?
In our experience, most students and many managers have a naïve view of team management or
empowerment. They view a team as ‘empowered’ or ‘not empowered’ – a full ‘on’ or full ‘off’
state. Students often pick up a value set that says that ‘teams are good’ and are equivalent to
organic organizational structures and processes. Similarly, this value set suggests that authority is
‘bad’ and is matched with mechanistic organizational structures and processes.
We propose a more sophisticated view that means you have to ask the question: in what parts of
the job will teams provide better solutions than a more mechanistic approach? As Quinn and
Spreitzer suggest, “the successful implementation of empowerment does not require a choice
between mechanistic or organic views. It requires something much more complex – the
integration of both” (Quinn and Spreitzer, 1997, 38). As the case points out, legal requirements
mean an individual must take responsibility for certain health and safety situations – an
organization cannot assign the responsibility to a team. As well, a team of AOs would have no
interest in being involved in some things – and perhaps should have little involvement. (For
example, the pricing decisions for the service provided.) Many decisions, by the nature of the
job, cannot be taken from the AOs without incredible damage to service delivery – such as the
treatment given to the patient on the spot; and many decisions require joint consideration. For
example, if SAAS were to purchase a new vehicle type, the organization would be foolhardy not
to include AOs in the decision process. However, even in this decision, it is difficult to know
who should have the final say over design. Could AOs recognize the financial restraints faced by
SAAS, or would they opt for a cadillac version of an ambulance, with technical frills that are not
needed?
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3. How does SAAS define team management? What is the team? How can teams assist
SAAS to improve their service delivery?
SAAS has organized its employees into teams of 10-13 in Metro Adelaide and teams of five in
country areas. So its definition of the team focuses on the number in the team as designated by
management – generally the number of individuals at a station. As well, it is the administrative
side of teams that appears to predominate management’s thinking. Handling of budgets, setting
By contrast, we would argue that the two-person team in the ambulance is the natural work
group. These are the operating teams – already self-managed in a crisis. Why then are the station
teams the focus of self-management?
We believe that this is the crux of the oversimplification of self-management. Self-management
does not mean totally independent teams running themselves. In reality, there are different
people and sets of people who need to be involved in making different decisions. As we argued
So, for example, previously the medical protocols followed were decided primarily by doctors,
and that is still the case. These decisions are unlikely to be delegated to AOs. But the medical
profession does seem to be recognizing the improved medical qualifications and skill of the
paramedics. Thus, many more medical procedures can be used by paramedics – but the decision
to approve these was made by medical doctors.
How can teams improve service delivery? Teams have made a difference, particularly in the
development of the case card audit. As well, they do increase AOs feelings of involvement and
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5. What risks does Ray Main face in his role? What priority issues must he address?
The biggest risk that Ray faces is that the organization will expect him to ‘solve’ the team
problem(s) and Ray may accept this responsibility unwittingly. After all, he believes in this
program and thinks he can make a contribution; he is a full time coordinator; he is responsible
Ray is in a highly visible role, reporting to senior management – Chris Lemmer in particular will
be aware of Ray’s actions. Thus, there is considerable career risk.
6. Develop an action plan for Ray for the next month; for the next year.
Any action plan should flow from the student’s analysis. It should include short-term and longer-
term objectives and action steps to achieve those goals or objectives. An excellent action plan
would prepare for contingencies which would otherwise make the plan fail.
Any action plan should deal with:
1. the upcoming meeting of the Workforce Empowerment Implementation Team
2. the range of success and failures in the implementation of teams.
References
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Suggested Teaching Plan
Topic
Comments 50-minute
class time
(cumulative)
80-minute
class time
(cumulative)
Introduction Outline the objectives of the
class: discuss the prevalence of
self-managed work teams today.
5 (5) 5 (5)
Critical Success
Variables Discuss what ‘success’ is for the
SAAS and what variables are
critical.
10 (15) 10 (15)
Team
Management at
SAAS
Discuss the history of teams at
SAAS and what ‘team
management’ means there.
Capture what the class considers
team management then contrast
that to the reality of teams at
15 (30) 25 (40)
Issues
Developing an
Action Plan Discuss Ray’s objectives and how
they will affect the
implementation of teams. A
number of alternatives can be
examined but two in particular
are worth looking at:
10 (45) 20 (70)
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What Really Happened
At the end of November, 1997, Ray Main was still very keen on the move to teams. Plans to hire
a consultant to train employees in self-management were progressing. Training schemes were
being developed and a call for tenders for training had been issued.
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Overhead 1
SEVEN QUESTIONS
ON THE ROAD TO EMPOWERMENT
1. WHAT DO WE MEAN WHEN WE SAY WE
WANT TO EMPOWER PEOPLE?
2. WHAT ARE THE CHARACTERISTICS OF AN
EMPOWERED PERSON?
