The tensions between organisational culture and professionalisation and their influence on paramedic conveyance decision-making: A constructivist grounded theory framework

Conveyance decision-making is a critical area for research given the potential patient safety and health system efficiency implications. It is understood that numerous factors can impact clinical decision-making such as organisational policy and procedure, scene safety, and patient assessment, along with considerable changes to paramedic education in recent decades. Using constructivist grounded theory methodology, semi-structured interviews and an online asynchronous focus group were employed for data collection. Both data collection and data analysis occurred concurrently, guided by the principles of constant comparative analysis. Three main themes were constructed: fearing and mitigating the repercussions of a potential patient complaint , the evolving professionalisation and expectations of paramedics , and feeling constrained by the organisation and its culture . These themes contributed to the construction of the theoretical framework. The theoretical framework titled The Tensions between Organisational Culture and Professionalisation details how paramedics make conveyance decisions by navigating the tensions between fears of individual blame posed by existing organisational culture and the evolving professionalisation of paramedics. Paramedics were found likely to forego responsibility for making alternative or non-conveyance decisions when working in a culture of blame, resulting in transporting patients to an emergency department when this may not be clinically required. When working in an organisation with an existing blame culture, paramedics forgo clinical decision-making. Paramedics must be educated and supported to make quality, patient-focused conveyance decisions. The theoretical framework explains how paramedics navigate conveyance decisions.