Disruptive innovation: barriers, opportunities and differences internationally

Around the world, the paramedic profession evolved from a small number of pilot programmes in the early 1970s, becoming a widespread trend in healthcare across much of the world. This case study focuses primarily on the UK, and England in particular, but also reflects on the international nature of the paramedic phenomenon, seeking to learn lessons from the successful features of individual programmes and approaches, in order that good practice can be promoted and shared. It also indentifies barriers to progress as well as opportunities. The purpose of all early paramedic initiatives described was to address the unmet needs of patients with serious injury and illness. Over the following decades, paramedics developed a clear identity which, in many countries, was professionally recognised and regulated. This trend can be termed ‘disruptive innovation’—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 all ambulance services or emergency medical systems, which in some cases have lagged behind and 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, which have hampered practitioners' ability to make full use of their skills. This has often manifested as low levels of paramedic and other ambulance staff satisfaction, resulting in high rates of staff turnover in the UK and sometimes elsewhere. For many reasons, most evidently the reality of changing patient demand, an increasing number of ambulance services are gradually morphing into primarily urgent care organisations, de-emphasising the transport aspect of the service. Changes are therefore needed to its model of operation and to staff management and support.

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