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ITIL in Practice from
The London Ambulance Service and implementing ITIL
The points that will be covering include a background on the LAS which covers the LAS work and how the IM&T Directorate previously operated. IM&T stands for Information Management & Technology and is often used in the NHS, as it includes a combination of your typical IT services and Management Information.
I will also cover how to secure funding for ITIL, utilising a shared services strategy and securing buy-in.
Furthermore, in line with a sharing approach, we will share our experiences of lessons learnt and what our next steps are. A key reason of us standing here is to share our best practise and hopefully make contacts and build working relationships with a common goal.
The London Ambulance Service is the largest free ambulance service in the world and receives 1.2 million calls per annum. There are two key parts to the business; the first is the 999 emergency service. However, you may be unaware that just as importantly, we run a Patient Transport Service, which transports patients from their homes to hospitals and vice versa.
We have 80 sites across London with 4500 staff that are supported by an IM&T Directorate of over 100 staff. Peter Suter the IM&T Director started 3 years ago and began the vision of implementing ITIL. To deliver this strategy his first recruitment was "me" and our story began...
Although we still have a way to go, we have improved services vastly and the look and feel of the Directorate is completely different to 3 years ago.
So we had the vision, we had the desire, we had the people but we didn't have the money! The initial strategy the Project Executive used to secure funding was to make zero cost, quick and painless changes that would improve services, which were then attributed to ITIL. For example, a very basic Service Desk function using a central email address and an easy to remember phone number which was 3333.
The next key step was securing relatively small amounts of budget in the name of ITIL/Service Management and delivering these to continue building confidence. We used this money to implement a Service Desk tool that is aligned with 7 ITIL Processes and train over 100 staff on ITIL Foundation to create a buzz!
Having gained confidence from the Board, IM&T staff and users, the Project Executive then submitted the official ITIL Project budget request with a business case which was approved and the project started in April 2007. This took place 20 months after the ITIL project had unofficially started and was primarily achieved by demonstrating credibility, breaking down the project into numerous tangible products with clear benefits, and making it clear that ITIL would underpin all IM&T services including the 'life' critical 999 systems.
Within our project plan, we have incorporated a Quick Wins strand of work, so that alongside delivering Products that will increase our ITIL maturity on all ITIL Processes to level 5, we will also carry out relatively quick and simple work that provides immediate benefits, such as a populated Knowledge Management database that would assist in providing quicker resolutions of Incidents.
You need to be creative when looking to establish funding sources. So for example, if there is an established project in your organisation that involves delivering software, you may be able to use an amount of funding from this project to fund ITIL aligned software that integrates between the two.
It was of paramount importance that the ITIL project was included in the Directorate's top 20 strategic objectives, as this provided everyone with a clear vision that our focus was ITIL and our delivery would be measured. And as the saying goes, what gets measured gets done.
However, by making ITIL a key objective, it was vital to manage expectations and therefore from the outset, we informed staff, customers and all relevant people, that there may be occurrences where we would be taking one step backwards in order to move two steps forward. This was important, as staff were ready to pounce on any deterioration in service and be critical of this new initiative and therefore this gave us leeway when things didn't go according to plan.
With any transformational change, it is necessary to empower staff in order for them to feel that they have a voice and can influence the change, rather than something which is being forced upon them. One way of achieving this, is to provide a comprehensive training programme, so that staff are up-skilled and are confident that they are part of the future. Furthermore, training attributed to the change programme can be used to secure buy-in.
A key part of any winning formula is to involve your staff. We achieved this by selecting 10 line managers that would each be responsible for one ITIL Process. This involved changing job titles to include the relevant ITIL responsibility and each Process owner was asked to dedicate at least 1 day per week to the ITIL project.
All staff were constantly encouraged to develop their ITIL skills and think of ways to improve service. In recognition of this, we rewarded staff using a number of methods that included time off work, recognition in the monthly newsletter, training and praise.
Where appropriate, the admin work that was carried out by staff was moved to the newly created Service Desk function and their freed up time was then focused on tasks that would directly support the core business and the ITIL project.
It is important to refresh training that was provided a while ago in order to continue securing buy-in. An example of this is where we had initially provided ITIL training over a year ago and therefore we recently organised internal ITIL Refresher sessions, which were delivered by QA-IQ covering 2hrs on v2 and 2hrs on the differences with v3. Staff really enjoyed these sessions as it challenged their knowledge and gave them confidence that we were moving forward and embracing the future - ITIL v3.
As well as ITIL Foundation, Practitioner and Manager training, we also provided PRINCE2 and technical training to all staff, as this complimented our service improvement ethos and also ensured that staff had a well-rounded skill set.
We invested over £100k in 2 years in training our staff but this would not have been as effective, if we hadn't introduced performance management which was supported by relevant and timely reports. This gave staff the incentive to utilise the training, as all work was being managed. You have heard me mentioning rewards and therefore you may be forgiven for assuming that the 3 LCD screens were prizes but in fact they were placed in a prominent place so that statistics and information were always visible.
This is just a sample of the initiatives we implemented which have all contributed in getting 99.5% staff buy-in, we came to realise that 100% was impossible!
ITIL uses the terminology users to signify the person at the end of a PC. However, as ITIL is not prescriptive, we tailored it to our organisation to use the term customer instead of user, as previously we were not customer oriented and in order to build that connection, we had to enforce a customer services culture. This has resulted in us treating our customers as royalty which has helped in improving customer satisfaction.
Continual Service Improvement played a key role, as this played a significant part in obtaining buy-in from customers, as senior IM&T managers meet every Monday morning, to focus and resolve issues affecting our customers. The reason for the word continual rather than continuous, is because where relevant, we have started to adopt ITIL v3 and as you may be aware, v3 recognises that there are times when you stop your CSI work and then start again, hence the word continual.
It is important to identify Super Users & Champions in your organisation so that they can encourage buy-in and get involved. I would encourage you to identify these key customers as they can be a very powerful ambassador for your service, as positive communication can be the difference between success and failure.
Surveys, feedback and a robust complaint procedure are again part of a successful formula because your customers must feel like they are able to air their concerns and be heard when there is an issue and have confidence that it will be acted upon.
We had no single point of contact. After implementing a central Service Desk and putting in place performance measures, we initially had a first time fix rate of 12% at the desk. In Sept 2007, this figure was 29% in October it was 41% and now in November 2007, I am happy to say it is 45%. This is still short of the 70% target we are aiming for but as you can all appreciate, this has helped in securing buy-in from customers.
Before we can secure buy-in from our stakeholders, we need to first identify who they are. So, who are our key stakeholders? They are as already covered; our customers, staff and Board. However, our stakeholders also include our partners such as the Police, Fire Brigade, St Johns Ambulance etc and the way their buy-in is secured is by providing seamless integration of IM&T services, when carrying out joint work such as planning for New Years Eve.
It is worth taking a minute to mention the LAS Board, as they control the purse strings and therefore as a key stakeholder, we absolutely needed a winning formula to secure their buy-in if we were going to continue developing IM&T services using ITIL. A factor in securing buy-in from the Board was selling ITIL to them as the De facto best practice standard recognised around the globe in delivering IM&T services. However, this on its own may have provided the initial short-term buy-in but to maintain this over years, requires communication communication and communication.
Reporting is obviously important but when producing reports at this level, it is imperative that they focus on high-level information such as return on investment. An example of this for us, was implementing an SMS module to turn computers off at night, which we estimated would save us £45 per PC and with 1500 PCS, this equates to £67,500 per annum.
So this is one example of proving ITIL works but of course there are many other examples. One such report is the ITIL maturity assessments. In January 2007, we were at Level 1 maturity for 8 Processes and level 2 maturity for 2 Processes. In Feb 2008, we reached a level 2 maturity on 7 Processes and level 3 maturity for 3. This by itself doesn't prove too much but it does prove the project is delivering and as it delivers, there are numerous benefits being provided such as, improved customer satisfaction, documented services, understanding of infrastructure, controlled change process etc. 
The end goal of doing all of this work is to improve our patient care, as ultimately patients are the key stakeholder.
Shared services may mean different things to different people and therefore it is important to provide a definition of what it means to us. I have included a summary in the first bullet point and would ask that you take a moment to read this. I have included the hyperlink for further information.
With this in mind and also the ethos of ITIL being used to share best practice and avoid reinventing the wheel, we felt that it was best that we shared our resources, documents, people and premises with other like minded organisations.
Therefore in conjunction with Connecting for Health (CfH), we have developed a web portal where we upload all of our relevant ITIL documents. However, this link will only work for NHS Trusts with the CfH N3 link and therefore please fell free to contact us if your are interested in these documents.
It all started at the itSMF 2006 Conference. The project executive got talking to John Long "our nugget" if you like, from Berkshire who informed him that CfH were investing time and money into NHS Trusts that wanted to implement ITIL. So we contacted CfH and arranged ITIL Foundation and Management training for the LAS and several other NHS Trusts at our premises, which were all paid for by CfH.
We are sharing services with NHS trusts including Barts, Salisbury, Bromley and a few others who are all implementing ITIL.
We all have too much work, don't make enough time to communicate and sometimes are protective of our work but the benefits are vast. For example, standardisation of processes, documents and economies of scale.
I have been asked to present at the Public Sector SIG in December to discuss how we planned the adoption of ITIL at the LAS. So for anyone interested in attending who is from the public sector and wants to be involved in the interest group with other like minded organisations.
Also if anyone is interested in seeing me present at the itSMF conference in Netherlands and Birmingham this year, please again see the website for more information.
It has been a challenging journey and I would just like to mention an important point that I came to realise. With such a massive transformational project, we spent a considerable time managing resistance to change but there may have been a few additional mitigations we could have implemented, such as a suggestion box and rumour board. This is because one of the negative impacts on the project has been the spreading of untruths! And perhaps giving staff an additional communications channel may have helped.
Another method that may have helped is something straight out of Availability Management which is the abbreviation ARMS, which stands for Availability, Reliability, Maintainability and Serviceability. The reason for this is that by implementing so many quick wins/changes, we sometimes negated the disciplines in this acronym, which resulted in the change being deemed unsuccessful a few weeks/months later. Therefore in hindsight, perhaps we should not have introduced as many changes in quick succession and an example of this was the implementation of the web based Self Service tool which was rushed and initially failed, as this concept wasn't applied. It has now been rolled out again successfully!
We have always used the Pareto Principle also known as the 80/20 rule, which states that for many events, 80% of the effects comes from 20% of the causes. Or only aim to achieve 80% perfection and move on. This ensured that we were progressing pragmatically because if we hadn't have applied this rule, many of our staff would not have bought into the transformation. An example of this is when the Service Desk tool was first introduced and staff often logged incomplete Service Desk Incidents but we ensured that they were not criticised and instead were encouraged to keep going as they were doing their best.
However, an important point that we learnt in using the 80/20 rule is that sometimes it is necessary to incorporate the ARMS example and therefore use 81/19 and spend more time on a process before moving on.
As this was a large and complex project that had links to many areas, it needed control. Although we adopted PRINCE2, there were many occasions were we need to take a step back and ensure we maintained Project Governance throughout the project. It was too easy to move forward without the necessary control mechanisms and an e.g. of this would be initially working on the project and producing deliverables which were not aligned to the Project Plan.
Following on from our Lessons learnt there are many implementation tips that we can suggest that worked for us.
Firstly, you must truly believe in the ITIL framework and convince all around you that this is the best thing since sliced bread, even if you do not eat bread! We also used Programme Management where within our project plan we split the Processes into 10 separate but parallel stages. Each stage had its own individual sections tailored for each process and with products being delivered for each section. This is so that we could manage and develop the maturity of each ITIL Process independently. The Project Plan is available to view at the CfH portal mentioned earlier.
During the project we held ITIL workshops with key customers and ITIL Process managers. This was used to ensure that there was two way communication and maintained buy-in throughout. We also held numerous scheduled meetings with each ITIL Process Manager to ensure that they felt supported and where we encouraged healthy competition between being the first to improve maturity.
Promotion was a key factor and the mediums used were advertisements on the intranet, leaflets, posters and business cards. They were all great mediums to promote the project to all customers around London. Self Service tool was even used to promote the project, as satisfaction surveys, reports and ITIL Project progress was available to see via the Self Service tool at any point when staff needed to log an incident.
Alongside the promotional campaign, we invited key customers and ITIL Process Managers to spend a day on the Service Desk. This provided valuable input to the project, as many ideas for developing our Service Desk tool and improvements to service came from this initiative.
Further general tips that I can mention which you may want to take into consideration include:
  1. Recruitment of contractors with ITIL experience to help with short term objectives.
  2. Usage of calendar appointments to enforce engagement
  3. Regularly reviewing and reorganising the team were possible. These changes provided an influx in new ideas and opportunities
  4. Constantly setting new milestones to keep people focused for e.g. this conference was one of many that we set
There are many tips that I can suggest, so:
  1. if you are beginning your ITIL journey
  2. or if you are in the implementation stages
  3. or even if your near completion
Fellow ITILiers, the key tips that I want to convey is persevere because scars heal!!
As mentioned earlier the reason why we are here is to share our best practise and hopefully make contacts and work together in a common goal.
We encourage you to share, share, share but?
  1. Is it because it is the right thing to do?
  2. Is it because it makes us feel good, knowing we are helping other organisations?
  3. Is it so your lives are made easier?
Well it is a combination of these points but far more. The key reason is, it is what makes ITIL. Therefore we will continue to promote shared services and utilise resources and encourage others to do the same.
We are also considering the adoption of other complimentary frameworks and methodologies such as COBIT and Six Sigma to improve the quality of our services.
For those who may not be aware, ITIL defines the "what" of service management and Six Sigma defines the "how" of quality improvement, and think of COBIT as defining the CSF and related KPIs that ITIL processes must deliver against.
Finally, Why are we doing all of this? Patient care. However, in 2012 we are going to have to continue providing the current level of effective services to the public but we are also going to have to support 2000 athletes, 2 millions visitors and 80,000 volunteers. To ensure that the LAS can cope with all of this, it will have to rely on IT and IT will need to excel, which we can only do with the high maturity of all 10 ITIL Processes.
Thank you for reading this article. I'm currently looking to leave the London Ambulance Service after nearly 3 years and would welcome any possible job opportunities.
Hitesh PatelHitesh Patel
My expertise is IT Service Management. I have worked in the public sector for over 5 years. I'm currently working for the London Ambulance Service as an ITIL Project Manager. Responsibilities include managing 10 ITIL Process Managers in delivering the project products within timescale, cost and quality considerations as delegated by the Project Board.
I'm degree educated (1st class), ITIL Red Badge, PRINCE2 foundation, ITIL v3 Managers, COBIT and ISO20000 Consultancy qualified.
Public Speaking
  • itSMF UK Conference (Brighton, Nov 07)
"Aligning ITIL with a Shared Services Strategy for a winning formula"
  • Service Desk & IT Support Show (SITS) (Olympia, Apr 08)
"Aligning ITIL with a Shared Services Strategy for a winning formula"
  • Will present at the itSMF Netherlands Annual Conference (Holland, Oct 08)
"Practical steps in achieving a high-level of maturity with ITIL"
  • Will present at the itSMF UK Conference (Birmingham, Nov 08)
"Practical steps in achieving a high-level of maturity with ITIL"
  • Will present at the itSMF Public Sector SIG (London, Dec 08)
"Adoption of ITIL at the LAS"
Greatest Achievement
One that can be highlighted is convincing the Project Executive and the rest of the Senior Management Team that we needed to invest money on a specific project. The project was surrounding ITIL Service Management. At first they were not convinced that we should invest any money and it would be a waste. So I had to present the justification to invest in a very professional manner, document a report as a business case, sell the benefits tailored to key directors and document an application for financial approval targeted at Finance on how money would be spent and were the benefits would be seen. I had many issues to overcome, but with the hard work and determination I managed to convince them to invest with the approval of the finance team. They agreed to invest over 400k on the project.
Contact Details:
ITIL Service Management Positions Sought:
ITIL Consultant, ITIL Service Support Manager, ITIL Service Delivery Manager, ITIL ISO 20000 Consultant, Service Desk Manager, Problem Manager, Change Manager, Configuration Manager, Release Manager, Service Level Manager


2012-08-29 by "cheryllarson2011"

Love this article. It shows someone who can think so clearly and methodically. I find the article very inspiring. Thank you for sharing.
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Tags; London Ambulance Service,implementing ITIL,Service Desk,Service Management,ITIL Foundation,ITIL processes,ITIL v3,ITIL Process Manager,ITIL
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Keeping up-to-date with ITIL...

Keep up-to-date with ITIL news. Low volume to-the-point bulletins...