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Telecommunications Update

Produced by:

Alex Baldwin, General Manager

Dean Gornall, Head of Facilities

Presented by:Tracy Luckett, Director of Nursing

Board of Directors Meeting

30 October 2014

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Action for Board:

For information For consideration

For decision

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1.0 Introduction

The aim of this paper is to update the Board on the performance of call handling within the organization. The report will provide an overview of progress since the last report in November 2013.

Improved telecommunications performance, whether it be call handling by switchboard or call handling between internal departments remains a priority for the Trust. Patient feedback suggests that we could do better and, as a consequence, we have identified call handling as one of the patient experience measures for improvement in 2014/15.

We have made some progress in the last year, primarily around the telecoms infrastructure, initially to the switchboard and now clinical services. The implementation of the 59R telecommunication system has been a significant achievement and has resulted in obtaining a rich source of data about our telecommunication performance, this will pave the way in helping us to understand and address longstanding issues especially in relation to resource provision and performance.

Progress on the project has been overseen by a project steering group that meets fortnightly and has a strong steer from the patient representative on the group.

2.0 Defining and agreeing the key elements of the project

In January 2014 the Management Executive agreed to support a proposal that would improve the telecommunications function in four key areas:-

Moorfields Direct Advice line Switchboard Optometry Outpatients (includes appointment queries)

The four priority areas, noted above, were determined largely by patient feedback via complaints and PALS enquiries. It became apparent that in order to achieve a significant improvement to the current service, the trust would need to invest in a software package (Netcall 59R) that would enable the existing telecoms to have improved automation capabilities.

Alongside improved data quality, it was agreed that a review of the clerical function, as part of realigning roles and responsibilities, was required and this concluded in August 2014.

3.0 Changes to the Telecoms Infrastructure

The existing telecoms system has been replaced by a software package (Netcall’s 59R). This system has been implemented in the following areas:

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Switchboard Private Patients Booking Centre Moorfields Direct Advice line Outpatients (12 independent mini call-centre) Optometry

3.1 Functionality and Implementation of 59R The data produced from the 59R system is very robust and includes detailed aspects about the performance of the calls that are handled. The suite of information includes queuing times, call handling times – duration of call, total number of calls to each queue, unanswered calls and agent availability. This is presented in a dashboard style format for ease of oversight by managers and supervisors. The agent console (the call handler) is a PC based application that presents key call information to the call handler – this includes the calling number or name, whether it is internal or external, call time and time in queue.

There is additional function within the booking centre that allows patients to enter their NHS number. This information is available before the call is taken; this can support staff to obtain medical records prior to having a conversation with the patient.

Agent (call handler) software is saved within their user profiles so they can log in at any location/desk and receive the calls from their dedicated departments. This is particularly useful for Business Continuity Processes.

Members of staff (call handlers) are required to log on at the start of the day and log off when they leave. Staff are also required to log off when they are away from their desk. Initial data extracted from week beginning October 6th 2014 gives an overview of the log- off reasons.

Agent Busy Code Breakdown - Mon 6th Oct 2014 to Fri 10th Oct 2014 (Booking office)

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3.2 Switchboard

The 59R system was implemented in the main switchboard in February 2014. The system now captures the activity of all calls and performance can be monitored by the switchboard supervisor.

Below are two screenshots from switchboard data, the first shows the agent (staff member) console and the second shows a performance dashboard. The dashboard can quickly alert the switchboard supervisor to potential problems such as ‘call build- up’. Since its implementation in February 2014 there has been a significant improvement in performance against Key Performance Indicators (KPIs). This in part, is as a result of receiving improved data which highlighted the requirement for additional staff and /or a more focused approach to staff rota management.

Agent Console – Switchboard

Performance Dashboard - Switchboard

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Performance dashboard for switchboard

SLA QTR1 QTR2Key Performance Indicators (KPI's) Target April May June Jul Aug Sep YTD

Volume of inbound calls 19895 19996 20858 22249 19676 22678 0% of calls -Answered 91.4% 94.5% 93.7% 94.1% 94.3% 93.3% 93.6%Queued 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%Abandoned 8.6% 5.4% 6.2% 5.8% 5.6% 6.6% 6.4%% of callsAnswered within 15 secs 80.0% 59.2% 74.5% 75.0% 75.2% 74.8% 70.1% 71.5%Answered within 1 minute 100.0% 88.0% 94.1% 93.0% 94.2% 94.3% 90.9% 92.4%Average time to answer call 26 17 19 17 17 19Average call duration (sec) 36 36 33 33 36 35Number of redirected calls 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0%Queue times (answered)0-10 secs 9222 12103 12726 13177 11595 15003 7382611-30 secs 5198 4458 4412 5240 4691 2863 2686231- 60 secs 1999 1421 1470 1532 1424 1829 96751 - 2 mins 1152 715 698 765 654 1021 5005Over 2 mins 608 205 228 234 209 450 1934

Calls abandoned breakdown0-10 secs 679 552 590 619 542 751 373311-30 secs 384 229 240 264 245 198 156031- 60 secs 251 128 160 165 127 213 10441 - 2 mins 205 102 132 132 91 183 845Over 2 mins 190 74 172 115 68 160 779Total calls abandoned 1709 1085 1294 1295 1073 1505 7961

Outbound call volumes 0 0 0 0 0 0 0

Average call volumes per operator 3,316 3,333 3,476 3,708 3,279 3,780 3,482

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3.3 Outpatient Areas

One of the driving forces behind the telecommunications review was the requirement to improve the experience of patients who ring in to the hospital to enquire about clinical care or administration queries, such as appointment times/ appointment changes/cancellations.

Historical working practices have dictated how effective and responsive clerical teams have been in dealing promptly and efficiently with patient queries. In addition to traditional working practices, the telephony infrastructure has not been fit for purpose with too few telephone lines for an expanding and complex business.

A review of the job roles has separated the function of the majority of the clerical staff and there is now clear demarcation of responsibilities. The review has resulted in clerks being more available to answer phones and deal with patient queries. Furthermore the administrative teams are now co-located to ensure greater cross cover is provided in line with one of the objectives of the review.

Although only concluded in September, the recruitment of the additional staff is nearly complete and a training programme commenced in October. The programme will include telephone etiquette as part of the training package.

Implementation of Netcall 59R in outpatient areas

Netcall 59R is now is in place for all clinical sub-specialties and has been operational for just over 3 weeks. Initial feedback from staff has been positive and there has been little resistance to its use. The recruitment of an outpatient manager has strengthened the implementation and the post holder must be credited for the relatively problem free transition. Prior to go-live approximately 30 additional telephone extensions were configured within this group to ensure that all staff/agents have their own dedicated number so this can be reported on more clearly.

Many of reportable features on the caller console and the supervisors’ dashboard are similar to the suite of switchboard information. The call handler (in this case the administrator) can view incoming call data and the queuing performance. They also have the ability to log-on or retrieve calls from alternative extensions. The dashboard also allows the supervisor or any manager to react quickly to potential problems e.g. queuing calls.

The 59R telephony system is designed to provide an effective call handling function and provider data reports that can support changes in administrative practices and assist in reconfiguring services to improve the patient experience.

An example of this is the activity breakdown retrieved from the booking centre (see below), which demonstrates the types of calls received by the booking centre.

The system has the ability to add as many activity codes as necessary. This is achieved by selecting the relevant text from a drop down box to show the nature of the call. Although staff have received

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training on this aspect of the system work is ongoing to ensure that staff are disciplined to complete reason codes for every call.

Activity Code for the Booking Centre

3.4 Call handling in Optometry

Patient feedback has indicated that call handling in the optometry department could be improved. The initial scoping exercise highlighted the need for additional administrative support and the department has successfully recruited two new administration officers. The department was the most recent area to implement the Netcall 59R system and initial data shows that there have been minimal calls abandoned.

Optometry Screenshot

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3.4 Moorfields Direct Telephone Advice Line

The Moorfields Direct Advice line provides telephone advice to patients and members of the public about ophthalmic conditions. Patients may choose to contact the hospital for advice about aspects of their outpatient or surgical care.

The advice line is manned by senior ophthalmic nurses and has traditionally been supported by the Accident and Emergency Department. The initial scoping exercise highlighted the need to increase the service provision of the advice line, in that the service needed to extend the hours to meet caller need. The appointment of two additional senior nurses will support the provision of the advice line hours to offer a more comprehensive service, covering evenings until 9pm and Saturdays. For the time being the service will be co-located with the A&E service.

4.0 Additional Functionality Netcall 59R

The Netcall system has the capability to provide an enhanced service delivery in addition to the current data set outlined in this paper. The project group agreed that it was vital to embed the service properly and strengthen the resource prior to introducing additional functionality, some of which may introduce an element of risk to the process.

It is anticipated that the next phase of the implementation will introduce the following functions:–

Queuebuster

Queuebuster is a system that gives the caller/patient the ability to contact Moorfields, simply leave their details and hang up with an expectation that staff will return the call. QueueBuster can improve productivity by smoothing out call peaks, enabling staff to manage calls more effectively.

Call recording

As part of the ContactCentre 59R we have also procured call recording.

Call recording allows conversations between the caller and staff member to be recorded. The information will be stored and may be used for training purposes. The information may also be used to support complaint investigations. The recording sound file is securely stored in on 2xRAID 500GB hard drives. This gives 18,000 hours of call recording capability. Calls can then be played back at any time or archived via zip file.

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4. Next Steps

The implementation of the Netcall 59R system has, for the first time, provided the organisation with meaningful data that has surfaced bottlenecks in the system that need resolving, whether that be resource or process issues.

The data so far has helped us identify areas of improved practice, such as switchboard and more recently helped us understand were we need to focus our efforts in outpatient performance, with an emphasis on transforming appointment processes. 4.1 Monitoring and Managing Performance

The Management Executive has already started to scrutinize the data and early indications suggest that additional resource is required to bolster administrative support in some services. The project group has been reluctant to agree a set of Key Performance Indicators too soon after implementation as it is necessary to fully understand the data in order for the KPIs to be meaningful. Currently performance is monitored on a daily basis, data is stored and is available on excel spreadsheets. It is expected that the KPIs will be agreed in November once the Trust has two months’ worth of data to review.

5. Summary

The Board is asked to note progress to date with this project, recognising the successful implementation of the new telephone system, whilst acknowledging further work is required to improve performance standards across the organisation. The board will receive a further update in four months.

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