Innovation in Products and Services

Abstract

The fourth chapter, jointly with Professor Stephen Barber, examines innovation in the rescue and emergency context. It draws on innovation literature and suggests that such literature has been significantly product based. Innovation in rescue and emergency services is seen as having a social aspect and an approach to assess social innovation is utilised with examples to identify and describe innovation in Falck.

Appendices

Appendix: Examples of Innovation

Examples of incremental innovation

• 1. Falck Air Services

In the 1930s the Zonen ambulance company had developed an air ambulance service with a special aircraft to service the Danish islands. In 1949 Falck Air Services was set up and acquired aircraft and also adapted them with a view to air ambulance transport. Air ambulance transport was not new and there was considerable discussion over whether this was suitable for the Falck given the prior engagement of Zonen.

However, Falck included air ambulance service as part of its subscription assistance to people travelling abroad who already had a subscription to the vehicle assistance policy. Partnerships were formed with other organisations and the fleet reached a total of seven aircrafts in 1959. The service met a need as tourism expanded and distressed travellers needed to be repatriated in situations which required air transport. It took over Zonen in 1963 and 1968 it was rebranded as Falck Air and operated until 1998. ⁹

• 2. Patient stretchers

The history of emergency medical services (EMS) is one of innovation to improve effectiveness, efficiency, speed or safety for patient and staff. Most new products and processes were not invented by Falck, but the organization has always been on the lookout for new ideas and incorporating them into their services.

International expansion has meant adapting to new environments: at some point Falck India provided EMS to a remote site in the Himalayas. ¹⁰ Any casualties would need to be carried along a narrow path for miles to a place accessible for vehicles. As existing stretchers was not suitable for this task, adaptations were therefore made in order to fashion a bespoke stretcher with a single wheel which could be operated by two people.

EMS also need to respond to changes in their client population. As the prevalence of obesity increases in many societies, it has been necessary to develop “bariatric” stretchers that can carry very heavy and large people comfortably and safely for both patient and staff. These use electrical power and hydraulic systems to manoeuver the stretcher and patient.

• 3. Indian remote site medical services ¹¹

Falck India provides medical services to a number of industrial sites, mostly remotely located from quality medical facilities. Falck India provides a doctor and/or paramedics on site to help any member of staff who has a medical problem, whether trivial or serious, and whether work-related or not. On-site staff can consult with more senior medical staff centrally located in New Delhi.

The same medical team also support Indian residents travelling abroad and foreigners travelling in India who subscribe to Falck Global Assistance .

Naturally, there are peaks and troughs in that kind of work. Falck India has developed innovative new business opportunities that uses these resources at less busy times. These include occupational health services to companies such as screening staff at recruitment and monitoring for common chronic conditions such as high blood pressure or diabetes. Services may include random screening for recreational drug use by staff in high risk workplaces such as off-shore oil or gas facilities.

• 4. Grupo EMI and services at home ¹²

Grupo EMI has developed a subscription-based medical service to individuals in Colombia and other Latin American countries. It has developed beyond the provision of emergency ambulance and ‘doctor at home’ to include other services such as a dentistry at home. The medical service also enables subscribers who have a need—typically a long term condition—which is not urgent and does not warrant a home visit or transport to hospital to receive a support, advice and reassurance over the telephone.

• 5. Music intervention in Ambulances during Patient Transport.

Falck worked with Aalborg University Hospital and academics (including a Harvard University academic) to see if music in ambulances would be beneficial to patients and ease distress in transit).

It is scientifically proven that patients experience severe distress during ambulance transport to hospitals in relation to acute illness.

Music intervention was added “on top” of the existing acoustic conditions during ambulance transports. Three evaluations were conducted. In the first study patients were interviewed with regard to their level of distress three times during transportation (at the retrieval site, during transportation and at arrival to hospital). All patients experienced severe distress—with noise from the vehicle and the sirene as dominant eliciting causes. Human voice was on the other hand a significantly calming factor (and sound experience). A second study was established. In preparation for this the company SoundFocus developed loud speakers placed in the ceiling of the ambulance above the patient’s head enabling undisturbed handling of the patient during transport. Specially composed music was used for a short period and patient asked their opinion. A positive wish for continued music was given by 80%.

In the third and main study patient preference was clear: 3 out of 4 patients, who were able to express their opinion, preferred a music environment.

Examples of Institutional Innovation

• 1. The Danish Firefighting Act of 1926

According to Jacobsen, by the 1920s Falck provided fire services by subscription to ‘zones’—a cluster of smaller parishes who had clubbed together. Strictly speaking, this was not legal. Towns were obliged to set up a fire service and acquire the appropriate equipment. Smaller parishes could decide whether they wanted to invest in a fire equipment. This loophole allowed them to contract with a private provider (Jacobsen 2006).

By then it was becoming apparent that the old law was no longer appropriate as Denmark was becoming more urbanised and a new law was proposed. There was agreement in political circles that it was unrealistic to expect each rural parish to have its own fire-fighting equipment. Falck’s zone-based services was highlighted in the debates as a proven, workable solution. The proposal was unanimously agreed and became law in 1926 (Brandpolitiloven af 1926).

This meant that parishes were required to prevent fire as well as to provide an actual fire service, but it was now legal to contract out to a private provider or to have an arrangement with nearby towns. Towns were also allowed to contract out to a private company. Not only did the Act allow Falck to continue its firefighting operations, but also to expand.

The Firefighting Act of 1926) was inspired by Falck but there is no evidence that Falck actively lobbied for it. Maybe the high visibility of Falck and its work made this unnecessary?

• 2. The 112 Volunteer First Responders ¹³

In many countries, including Denmark , 112 is the emergency phone number equivalent to 999 in the UK and 911 in the USA.

Responce , a Danish subsidiary of Falck, is involved with implementing a pilot project for the regional health authority. It takes place in a thinly populated area at some distance from healthcare facilities. In order to reduce the time it takes to get skilled help to a casualty, a number of local people in the community have been trained in first aid including the use of defibrillators . Responce is also responsible for training the people and providing and maintaining equipment. When a 112-call is received from the area, and the emergency is likely to benefit from intervention by lay people, a text is sent to the three volunteers closest to the casualty with the aim of commencing first aid in advance of the ambulance arriving. Note that if the response was planned to be just by volunteers then it would be classified as a ‘disruptive innovation’.

• 3. Out-posting of emergency response staff ¹⁴

In the contracts for emergency response ambulances in the USA a number of Falck (and associated company locations) set up a range of satellite premises to accommodate both a vehicle and a response team to be closer to the location of likely demand and hence enable a fast response. This required a considerable degree of flexibility and imagination on the part of the operational manager. Such sites included a motel suite, a storefront and a unit on a business park. It was the location of the site which was critical and it was not practical to create purpose built or even significantly converted provision. The nature of the relationship with the local fire department also enabled out-posting into fire stations but it had to be handled with considerable diplomacy by both ambulance managers and staff.

Examples of Disruptive Innovation

• 1. A Small Fire Suppression Vehicle

The conventional image of a fire engine is of a very large vehicle with a substantial crew of at least four firefighters and often with a large ladder on top. It is a sight familiar to people all over the world.

Around 1988, the later Fire Chief of Falck in Denmark , visited Australia and saw an example of a growing city which started rethinking fire provision on a risk basis as opposed to a provision basis. ¹⁵ They questioned whether the need was always for large, highly staffed vehicles. He brought the idea back to Denmark and working with firefighters he developed the concept of a small relatively compact vehicle with just two firefighters able to reach fires quickly and extinguish them without the need for a large vehicle. It incorporated new equipment such as advanced cutting equipment which could slice through the walls of buildings.

He encountered predictable resistance from the more traditional stakeholders in fire services . However, he persisted and the small vehicle was introduced on New Years Eve 2000. Soon after he presented the concept to a conference of fire chiefs in the UK where it was met with little enthusiasm.

However, the innovation took hold and vehicles were sold to other countries and copied by fire departments in the UK. Falck had not sought to patent the invention and were relaxed about the copying of the idea. ¹⁶

In 2000 the concept of a small fire vehicle was regarded by many fire chiefs and firefighters as inappropriate (and maybe risky) as a replacement to the traditional form of fire response vehicle. By Hansen’s account, where the vehicle is in use in Denmark it has proven to be able to extinguish some 90% of fires it is called to. By 2016 it is increasingly being adopted in a range of countries perhaps, in part, driven by economic pressures to deliver fire services in a context of austerity.

We regard this innovation as ‘disruptive ’ in nature because it involves a change in both the provider and service recipient mindset over what constitutes a fire response.

• 2. Prehospital Treatment in Ambulance

Falck (in Northern Denmark ) developed a system with the health authorities and an IT company which enabled continuous data exchange and monitoring information between the ambulance and the hospital. This meant that expert medical advice and assistance was available on-line within the ambulance using video conferencing and telemedicine.

This was combined with an electronic patient record system which enabled detailed patient information to be available to the ambulance paramedic such that, in effect, the ambulance crew had the similar medical record access that would have been available in the hospital. This enabled both a detailed analysis of the patient situation and informed decisions to be made as to whether the patient could be managed at home following an intervention in the ambulance or whether a hospital assessment/admission was indicated. It also enabled a decision as to which hospital facility was the most suited thus reducing the need for any later interfacility transport.

Though this could be viewed as an ‘institutional change’ it potentially is disruptive as it moves the medical evaluation away from the hospital and potentially can change the conception of what is involved in an ambulance call out.