Qualitative methods were used to explore the aetiology of occupational stress experienced by on-road ambulance officers. The researcher found that the way in which a service is organised and its officers valued Context of the researchA comparison of two very differently structured ambulance services -one a corporatised UK service, the other a paramilitary style bureaucracy in Australia -allowed the researcher to identify which structures and policies were the most stressful for officers. Though different stressors were identified in the two services the common denominator in both services was one of control.The way an ambulance service is organised and its officers valued can create and reproduce workplace stressors which are as causative of occupational stress as the often acknowledged occupational specific stressors such as shift work and witnessing human trauma and tragedy. Though irregular working hours and being present at scenes which are distressing to any human being are unavoidable stressors which go with the territory of being an ambulance officer these seemingly intrinsic stressors of the vocation can also have an organisational dimension. That is, some party controls who does what work, when, how often, the pace and with what resources and support. This paper addresses the findings of research in which a comparison of two very differently organised ambulance services was undertaken. Service Oz (a pseudonym for the Australian service studied) is structured along classic bureaucratic lines, having a paramilitary centralised line of command with many hierarchical levels. Industrybased collective bargaining, where the union bargains on the members' behalf, is still the method used to resolve industrial disputes and to negotiate pay and working conditions. The officers continue to receive penalty rates for irregular working hours and conditions, although this is coming under increasing scrutiny as publicly funded and operated health and welfare services come under increasing pressure to curtail their operating costs.

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A range of health care occupational communities have travelled down various pathways in a quest for professional status. Some have been more successful than others and the evidence indicates that the most successful occupational communities pursued political strategies and tactics. This paper draws on their experiences to suggest ways that Australian ambulance paramedics could proceed in their quest for increased professional status and autonomy.

This paper, by way of a narrative on the author's participation, explains the limits to a planned cultural changeprogram in a large rural health service. Cultural change was identified by the CEO as crucial to the success of a majorrestructuring of the service, and the attitudes and beliefs of the 'old guard' were considered to be constraining progress.Advocates of cultural integration contend that shared core values across an organisation can overcome such obstacles.This is a matter of faith. An application of Habermasian theory suggests that organisational leaders are drawing ontraditional/religious beliefs and practices to bolster their visions and missions at a time of motivational crisis.Though a need for cultural change in some sectors of the health services is acknowledged, the particular challenges inattempting to manipulate the traditionally embedded culture and sub-cultures of the health services is highlighted.An analysis of some of the ideas and beliefs surrounding authority, deference and discipline is undertaken. It is arguedthat the ritualistic reinforcement of these beliefs and the reproduction of sub-cultures along material and ideal interestsmilitate against the implementation of objectives delineated by the CEO.While cultural analysis has revealed the irrational face of organisations and can bring to conscious awareness the taken-for-granted beliefs which inform behaviour, the cultural integrationists have a further agenda. They aim tomanipulate organisational culture to subtly control employees' beliefs and hence behaviour. Cultural control is a covertform of top down authority that can be just as directive and centralising as bureaucratic control. The author alsomaintains that cultural change programs alone cannot fix a problem that arose in the macro-economic sphere: a chroniclack of resources ever since the state responded to the economic crisis by cutting funds to health and welfare services.

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