Aim Ambulance services are experiencing increasing volumes of emergency calls. In response, they have increased the proportion of patients not conveyed to an emergency department (ED). Alternatives to transporting patients to an ED include the provision of telephone advice only, treatment at the scene, or transport to another facility. Variation in the rates of different types of non-conveyance (NC), and in NC overall, exists between ambulance services in England. We explored variability in perceptions of the organisational culture within each individual ambulance service and show this in the context of NC rates.

Method We undertook 50 qualitative telephone interviews with ambulance service providers and commissioners in the 10 larger ambulance services in England, to identify factors that may explain variation in rates of ambulance NC. Data was analysed using a Framework model.

Results Amongst interviewees there was variation in the perceptions they held regarding the organisational culture of the ambulance service which they were employed by. Recent management restructuring within the ambulance service, perception of management support across the organisation, motivation of the organisation to undertake NC, and perceptions of support for staff undertaking NC varied across the ambulance services. There appeared to be a relationship between some of these factors and NC rates.

Conclusion Organisational culture is a complex issue but one which is potentially modifiable. Building a greater understanding of ambulance service organisational culture and how this relates to ambulance NC may help identify ways of improving service delivery across all ambulance services.

Conflict of interest None

Funding National Institute for Health Research (NIHR) Health Services and Delivery Research Programme.