We think you have liked this presentation. If you wish to download it, please recommend it to your friends in any social system. Share buttons are a little bit lower. Thank you!
Presentation is loading. Please wait.
Published byChelsey Peak
Modified over 2 years ago
©Ian Sommerville 2004Software Engineering Case Studies Slide 1 The London Ambulance fiasco l The London Ambulance Service (LAS) Computer Aided Despatch (CAD) system failed dramatically on October 26th 1992 shortly after it was introduced: The system could not cope with the load placed on it by normal use; The response to emergency calls was several hours; Ambulance communications failed and ambulances were lost from the system. l A series of errors were made in the procurement, design, implementation, and introduction of the system.
©Ian Sommerville 2004Software Engineering Case Studies Slide 2 London Ambulance Service l Managed by South West Thames Regional Health Authority. l Largest ambulance service in the world (LAS inquiry report) Covers geographical area of over 600 square miles Resident population of 6.8 million people (greater during daytime, especially central London); Carries over 5,000 patients every day; 2,000-2,500 calls received daily, of which 1,300- 1,600 are emergency calls.
©Ian Sommerville 2004Software Engineering Case Studies Slide 3 Computer-aided despatch systems l Provide one or more of the following: Call taking; Resource identification; Resource mobilisation; Ambulance resource management. l Consist of: CAD software & hardware; Gazetteer and mapping software; Communications interface (RIFS). Radio system; Mobile data terminals (MDTs); Automatic vehicle location system (AVLS).
©Ian Sommerville 2004Software Engineering Case Studies Slide 4 The manual system to be replaced l Call taking Recorded on form; location identified in map book; forms sent to central collection point on conveyor belt; l Resource identification Form collected; passed onto resource allocator depending on region; duplicates identified. Resource allocator decides on which resource to be mobilised; recorded on form and passed to dispatcher; l Resource mobilisation Dispatcher telephones relevant ambulance station, or passes mobilisation instructions to radio operator if ambulance already on road; l Whole process meant to take < 3 minutes.
©Ian Sommerville 2004Software Engineering Case Studies Slide 5 Concept/design of the CAD system l Existing systems dismissed as inadequate and impossible to modify to meet LAS’s needs Intended functionality “greater than available from any existing system”. l Desired system: To consist of Computer Aided Dispatch; Computer map display; Automatic Vehicle Location System (AVLS); Must integrate with existing MDTs and RIFS (Radio Interface System). l Success dependent upon: Near 100% accuracy and reliability of technology; Absolute cooperation from all parties including CAC staff and ambulance crews.
©Ian Sommerville 2004Software Engineering Case Studies Slide 6 Problems: Procurement (i) l Contract had to be put out to open tender Regulations emphasis is on best price; 35 companies expressed interest in providing all or part of the system Most raised concerns over the proposed timetable of less than 1 year until full implementation. l Previous Arthur Andersen report largely ignored Recommended budget of £1.5M and 19 month timetable for packaged solution. Both estimates to be significantly increased if packaged solution not available; Report never shown to new Director of Support Services. l Only 1 out of 17 proposals met all of the project team’s requirements, including budget of £1.5M.
©Ian Sommerville 2004Software Engineering Case Studies Slide 7 Problems: Procurement (ii) l Successful consortium Apricot, Systems Options (SO), Datatrak; bid at £937k was £700k cheaper than the nearest bid; SO’s quote for the CAD development was only £35k Their previous development experience for the emergency services was only for administrative systems. Ambiguity over lead contractor. l 2 key members of evaluation team: Systems manager: Career ambulance man, not an IT professional, already told that he was to make way for a properly qualified systems manager; Analyst: Contractor with 5 years experience working with LAS.
©Ian Sommerville 2004Software Engineering Case Studies Slide 8 Problems: Project management l Lead contractor responsible Meant to be SO, but they quickly became snowed under, so LAS became more responsible by default; No relevant experience at LAS or SO. l Concerns raised at project meeting not followed-up. l SO regularly late in delivering software Often also of suspect quality, with software changes put through ‘on the fly’. l Formal, independent QA did not exist at any stage throughout the CAD system development. l Meanwhile, various technical components of the system are failing regularly, and deadlines missed.
©Ian Sommerville 2004Software Engineering Case Studies Slide 9 Problems: Human resources & training (i) l Generally positive attitude to the introduction of new technology. l Ambiguity over consultation of ambulance crews for development of original requirements. l Circumstantial evidence of resistance by crews to Datatrak equipment, and deliberate misleading of the system. l Large gap between when crews and CAC staff were trained and implementation of the system. l Inability of the CAC and ambulance staff to appreciate each others’ role Exacerbated by separate training sessions.
©Ian Sommerville 2004Software Engineering Case Studies Slide 10 Problems: Human resources & training (ii) l Poor industrial relations. l Management ‘fear of failure’. l CAD system seen as solution to management’s desire to reduce ‘outdated’ working practices. l System allocated nearest resource, regardless of originating station. l System removed flexibility in resource allocation. l Lack of voice contact exacerbated “them and us”. l Technical problems reduced confidence in the system for ambulance crews and CAC staff.
©Ian Sommerville 2004Software Engineering Case Studies Slide 11 System problems l Need for near perfect information Without accurate knowledge of vehicle locations and status, the system could not allocate optimum resources. l Poor interface between crews, MDTs & the system There were numerous possible reasons for incorrect information being passed back to the system. l Unreliability, slowness and operator interface Numerous technical problems with the system, including: Failure to identify all duplicated calls; Lack of prioritisation of exception messages; Exception messages and awaiting attention queues scroll off top of screen.
©Ian Sommerville 2004Software Engineering Case Studies Slide 12 Configuration changes l Implementation of the system on 26 October involved a number of significant changes to CAC operation, in particular: Re-configuring the control room; Installing more CAD terminals and RIFS screens; No paper backup system; Physically separating resource allocators from radio operators and exception rectifiers; Going ‘pan London’ rather than operating in 3 divisions; Using only the system proposed resource allocations; Allowing some call takers to allocate resources; Separate allocators for different call sources.
©Ian Sommerville 2004Software Engineering Case Studies Slide 13 So, what happened? l Changes to CAC operation made it extremely difficult for staff to intervene and correct the system. l As a consequence, the system rapidly knew the correct location and status of fewer and fewer vehicles, leading to: Poor, duplicated and delayed allocations; A build up of exception messages and the awaiting attention list; A slow up of the system as the messages and lists built up; An increased number of call backs and hence delays in telephone answering.
©Ian Sommerville 2004Software Engineering Case Studies Slide 14 Why did it fail? l Technically, the system did not fail on October 26th Response times did become unacceptable, but overall the system did what it had been designed to do! Failed 3 weeks later due to a program error - this was a memory leak where allocated memory was not completely released. l It depends who you ask! Management; Union; System manager; Government.
©Ian Sommerville 2004Software Engineering Case Studies Slide 15 Lessons learned l Inquiry report makes detailed recommendations for future development of the LAS CAD system, including: Focus on repairing reputation of CAD within the service; Increasing sense of ‘ownership’ for all stakeholders; They still believe that a technological solution is required; Development process must allow fully for consultation, quality assurance, testing, training; Management and staff must have total, demonstrable, confidence in the reliability of the system; Any new system should be introduced in a stepwise approach.
The London Ambulance fiasco The London Ambulance Service (LAS) Computer Aided Despatch (CAD) system failed dramatically on October 26th 1992 shortly.
Topic 10Summer London Ambulance System Some of the slides created by Sommerville.
9/12/2015Dr Andy Brooks1 Lecture 3 London Ambulance System (LAS) 26 & 27 October and November FOR0383 Software Quality Assurance.
The Failure of the London Ambulance Service Michael McDougall CIS 573 November 16 th, 1999.
Methods: Deciding What to Design In-Young Ko iko.AT. icu.ac.kr Information and Communications University (ICU) iko.AT. icu.ac.kr Fall 2005 ICE0575 Lecture.
©Ian Sommerville 2000Software Engineering, 6th edition. Chapter 29Slide 1 Configuration management l Managing the products of system change l Objectives.
©Ian Sommerville 2000Software Engineering, 6th edition. Chapter 4 Slide 1 Objectives l To introduce software project management and to describe its distinctive.
The London Ambulance Service Case. The Manual System 999 call to BT Call switched to LAS call takers –Record details & map reference onto a form Send.
©Ian Sommerville 2000Software Engineering, 6th edition. Chapter 4 Slide 1 Chapter 4 Project Management.
©Ian Sommerville 2004Software Engineering, 7th edition. Chapter 5 Slide 1 Project management.
©Ian Sommerville 2007Change Management Slide 1 Software change management.
©Ian Sommerville 2000 Software Engineering, 6th edition. Chapter 24Slide 1 Chapter 24 Quality Management.
©Ian Sommerville 2004Software Engineering, 7th edition. Chapter 23 Slide 1 Software testing.
©Ian Sommerville 2000 Software Engineering, 6th edition. Chapter 27Slide 1 Chapter 27 Software Change.
©Ian Sommerville 2004Software Engineering, 7th edition. Chapter 4 Slide 1 Software Processes.
©Ian Sommerville 2004Software Engineering, 7th edition. Chapter 17 Slide 1 Rapid software development.
©Ian Sommerville 2004Software Engineering, 7th edition. Chapter 17 Slide 1 Extreme Programming.
1 SWE Introduction to Software Engineering Lecture 2.
©Ian Sommerville 2004Software Engineering, 7th edition. Chapter 27 Slide 1 Quality Management.
Acceptance Testing Senior Design Fall 2013 Don Evans 1.
WHY THEY FAILED AND LESSONS TO BE DRAWN Samuel Franklin G53QAT: Quality Assurance and Testing Famous Software Failures.
©Ian Sommerville 2000 Software Engineering, 6th edition. Chapter 6 Slide 1 Chapter 6 Requirements Engineering Process.
Dr Izzat M Alsmadi Edited from ©Ian Sommerville & others Software Engineering, Chapter 3 Slide 1 Project management (Chapter 5 from the textbook)
Corvelle Drives Concepts to Completion It's 10 a.m.! Do you know where your IT projects are? Project World Vancouver, B. C. 26 October
INFO 3: Use of ICT In The Digital World Topic 7: Developing ICT Solutions Factors that contribute to the success and failure of ICT Systems.
Extreme/Agile Programming Prabhaker Mateti. ACK These slides are collected from many authors along with a few of mine. Many thanks to all these authors.
SWE 316: Software Design and Architecture Objectives Lecture # 22 Software Evolution SWE 316: Software Design and Architecture To explain why change.
Creator: ACSession No: 16 Slide No: 1Reviewer: SS CSE300Advanced Software EngineeringFebruary 2006 (Software Quality) Configuration Management CSE300 Advanced.
©Ian Sommerville 2004Software Engineering, 7th edition. Chapter 21 Slide 1 Software evolution.
S-Curves & the Zero Bug Bounce: Plotting Your Way to More Effective Test Management Presented By: Shaun Bradshaw Director of Quality Solutions Questcon.
1 Institute for Software Research, International Methods of Software Development Problem Frames 3 (This lecture is largely based on material graciously.
©Ian Sommerville 2000 Software Engineering, 6th edition. Chapter 26Slide 1 Chapter 26 Legacy Systems.
LiberRATE Estimating It thinks like you do! Edition 3 Instructions Click on buttons to advance or to repeat the previous slide PreviousNext.
©Ian Sommerville 2000Software Engineering, 6th edition. Chapter 4 Slide 1 Concerned with activities involved in ensuring that software is delivered: on.
CHAPTER 3 Pre-Project Components. 2 Learning Objectives: To discuss: Contract Review Development and Quality Plan.
Chapter 9 – Software Evolution and Maintenance 1Chapter 9 Software evolution.
Systems Life Cycle A summary of what needs to be done.
المحاضرة الثالثة. Software Requirements Topics covered Functional and non-functional requirements User requirements System requirements Interface specification.
Lecture 5: Requirements Engineering Dr Valentina Plekhanova University of Sunderland, UK
©Ian Sommerville 2000 Slide 1 Project management l Organising, planning and scheduling software projects l Objectives To introduce software project management.
Testing Relational Database
©Ian Sommerville 2000 Software Engineering, 6th edition. Chapter 2Slide 1 Chapter2: Systems Engineering l Designing, implementing, deploying and operating.
Information Management in British Telecom Jon Hill.
Rapid software development 1. Topics covered Agile methods Extreme programming Rapid application development Software prototyping 2.
Imagine that you have been appointed head of a big project. As it often the case in the software industry, you come under serious time pressures from.
© 2017 SlidePlayer.com Inc. All rights reserved.