Organizational models of prehospital care: experiences from Austria

In quality management (QM), a general distinction is drawn between organizational and operational structures of companies. The organizational structure of a company (i.e. a functional-organization) is depicted in the organization chart and determined by different hierarchical levels, and staff and line functions. The guiding idea of organizational structured companies is to attain highest quality by specialization and differentiation within each single discipline. In such organizations, topics regarding overall operational procedures quite often take a back seat.

As a classic example, dispatchers; medical emergency technicians; paramedics or prehospital emergency physicians, and the staff of the emergency department may each be highly specialized and work in harmony together; but often do not consider whether and how emergency patients experience the entire prehospital emergency process—from the emergency call and treatment to the admission to the hospital—as satisfying and efficient. Besides that, highly specialized disciplines are usually costintensive and prone to cause interface management troubles due to competitive exclusion (Schmidt, 1995; Mangler, 2006; Nicolai, 2009) (Figure 1).