control centre improvement project ‘every second counts for the patient’

Control Centre Improvement Project

‘Every second counts for the patient’

Agenda

• Ambulance Service of NSW’s case for change

• Change approach

• What we did

• What we achieved

• What we learnt

• Questions

Case for change

1. Opportunity improve the patient journey, with higher quality and more efficient responses to requests for emergency and non-emergency services to deliver on the vision of “Excellence in care”

2. Increased external scrutiny through external inquiries that made recommendations for changes to Control Centres

3. Need to create a multi-skilled, flexible workforce and a defined and structured career pathway for staff to train, develop and retain high quality talent

4. Four Control Centres operating with variances in protocols and procedures provided an opportunity to standardise protocols, procedures and training

Improving the patient journey

Caller Call Taking DispatchHospital

Incident Incident

+ +HAC

CADMPDS

Paramedic Specialist

Reduced time to answer call due to removal of non-emergency call taking and interCAD links with Police and Fire

Increased quality of call taking through: • Increased screening of candidates• Increased training, mentoring and coaching• Increased availability of Call taking supervision, HAC and Paramedic Specialist support• KPIs based on quality and time• Reduced fatigue from resourcing to meet relief ratios

Reduced time to dispatch resources through an automated CAD system using:• Initial assignment of on-road resources• Automated alerts to paramedic pagers, mobile phones and stations• Updates of local names

Automated fluid deployment to increase on-road coverage

Non-emergency clinical advice and support available

Improved quality of Dispatching through• Increased training, mentoring and coaching• Reduced non-core functions (i.e. rostering, MDT sign on / sign off)• Duplicate incident warnings

Activation time -reduced

Call response time -

reduced

Mobilisation time - reduced

Response time - reduced

Specialist clinical skills available when required

Ambulance’s vision is to deliver ‘Excellence in Care’

Improving the patient journey

Change approach

May – June 2009 December 2009 –September 2010

Phase 1: Develop the Optimal Model

Phase 2: Implementation

Future

Phase 3: Business as Usual

What we did

Voice of Patient

An online survey of Ambulance triple zero callers was completed

Voice of the possible

global scan of international best practice

‘Voice of the possible’:

global scan of international best practice

involving seven high performing international and national Ambulance Services; Interviews with key staff at the alternative Ambulance Services

Voice of external

stakeholdersInvitations to participate were emailed to subscribers of the Service’s e-newsletter, Ambulance Service staff and staff within PwC’s Sydney office.

Voice of Control Centre

Staff

Conducted Control Centre Manager workshops and interviews; Engaged with staff through on site visits staff workshops at Western, Northern, Southern and Sydney Operations Centres

Voice of Control Centre staff

To hear the voice of Control Centres we engaged the front line through outcome focused

management and staff workshops and site visits to deliver outcomes and areas for improvement

Voice of patients & callers

“I have used the service only once and have nothing but praise. My

wife was missing after a suicide call and the service kept me informed on the phone when they had found her and where she had been transferred

to.”

“It was definitely reassuring to be told that while I was being asked

questions, the ambulance had already been alerted. This is so

important as it is a panicky situation anyway and at least this is one thing I didn't need to worry

about.”

“The 000 person insisted on a street address. She did not seem to understand

that there was none. I gave as much information as I could about location, but she continued to ask for a street

address, and a cross street!! I made 3 phone calls and there seemed to be no

knowledge of previous calls. “

“I have used the emergency service 000 on a few occasions, needing an ambulance on a few of those. These calls have mostly been for my ageing Mum (I am her carer) and I have been

so relieved not just by the friendly, knowledgeable and empathetic assistance on

the call but from the prompt arrival of the ambulance and the expertise of the paramedics or offices on board. Thank you a million times

over. “

“You are amazing people doing amazing things, you

have my unqualified respect and support.”

“Operator could not identify my town (Quirindi) despite having it spelt several times. 3rd person

went & got ambulance (after 000 call connected) from station while I was still trying to get operator to

find town.”

“The call taker was utterly unsympathetic to a serious and painful eye injury that caused substantial distress

and about which the severity was unknown”.

Ambulance Service of NSW received positive and negative feedback in a survey of Triple Zero callers about their experiences with Control Centres

Global scan of best practice

MAS, VictoriaQAS, QueenslandASNSW, New South Wales

St Johns, New Zealand

TEMS, Canada

LAS, UKSAS, UKNEAS, UK

We have engaged with seven Ambulance Services around the world to learn about world class service

Designing the optimal model

Enhancements to the interactions with Control Centre support

functions including education,systems support,

workforce and recruitment

Better leverage technology

Standardise and enhance policies, protocols and procedures

Interaction model

Organisation structure

Call taking process

Get the right

people

Systems

Supervision process

Dispatching process

Develop the right skills and

behaviours

Supervise, coach and recognise

Keep the right

people

Providea clearer

career path

Patient centric redesign; Single Control Centre in four locationsImproved opportunities and environment for staff

Control Centre model moving toward a stronger production

and distribution model

Transform our people’s experience

“Excellence in Care”

Emergency and NEPT

Patientsand users

Vision

Strategy

Business model

Guiding principles

A single state-wide structure for Control Centres and clearer demarcation between Emergency and NEPT

The Optimal Model is aligned to the “Excellence in Care” vision of the Service

Optimal Model Conceptual FrameworkThe project developed a best practice Control Centre model aligned to the vision and strategy of the Service which

would support the implementation of a Production and Distribution model

Cascading and aligning the vision

Systems

Resourcing

Training

Structure

Shared Values

Leveraging technology to improve the Patient journey and the

experience of Ambulance staf f

Develop positions and processes to enhance the depth of the workforce

and create career paths

Skills and support required to deliver high quality service to Ambulance

Patients and enhance the employee experience

Four Control Centre locations performing consistently as one with

clear goals and protocols

Underpinned by a consistent and collaborative working environment

Component Vision

The Optimal Control

Centre Model

Objective

The vision was cascaded to the key project components of systems, resourcing, training, structure and shared values to align the design and implementation of the Optimal Control

Centre model

What we achieved

Improve Call Taking

Improve Dispatching

Record performance: exceeded target of 90% of Triple Zero calls answered in 10 seconds without additional

migrated a significant number of calls from hospitals

Control Centre in four

Improve opportunities

• Improved effectiveness and efficiency through process improvements and enhanced technology delivered and explored

• Consistent, communicated and enhanced Protocols and Procedures• Improved training and recruitment of staff

• Enhanced coaching and supervision through delivery of High Performing Teams model, plan and phase 1• Enhanced communications – access to intranet and email at desks and development of the knowledge

base• Implemented pre-shift briefings• Single uniform across Call Takers and Dispatch consistent with on-road Paramedics

• Centralised Leadership of Control Centres under single Director• Implemented Control Centre Protocols Committee and Policy, Protocol & Procedure working

group

OUTCOMES• Improve Patient

Journey• Operate a single

Control Centre in four locations

• Improve opportunities & environment for staff

Improve Supervision,

Support & Training

Improve Structure & Governance

• Record performance: exceeded target of 90% of Triple Zero calls answered in 10 seconds without additional resources; best ever 131233 performance

• Dedicated Non-Emergency Patient Transport Call Talking & integrated a significant number of calls from hospitals and medical practitioners to the Electronic Booking System (EBS)


• Improved effectiveness and efficiency through process improvements and enhanced technology delivered and explored


• Enhanced coaching and supervision through delivery of High Performing Teams model, plan and phase 1• Enhanced communications – access to intranet and email at desks and development of the knowledge

base• Implemented pre-shift briefings• Single uniform across Call Takers and Dispatch consistent with on-road Paramedics

• Centralised Leadership of Control Centres under single Director• Implemented Control Centre Protocols Committee and Policy, Protocol & Procedure working

group






• Consistent, communicated and enhanced Protocols and Procedures

• Improved training and recruitment of staff

Improve Call Taking

•Improved effectiveness and efficiency through process improvements and enhanced technology delivered and explored

•Consistent, communicated and enhanced Protocols and Procedures

•Improved training and recruitment of staff

Improve Dispatching

• Enhanced coaching and supervision through delivery of High Performing Teams model, plan and phase 1

• Enhanced communications – access to intranet and email at desks and development of the knowledge base

• Implemented pre-shift briefings• Single uniform across Call Takers and Dispatch consistent with on-road Paramedics

Improve Supervision, Support & Training

•Centralised Leadership of Control Centres under single Director

•Implemented Control Centre Protocols Committee and Policy, Protocol & Procedure working group

Improve Structure & Governance

What we achieved

Emergency Average % calls answered in 45 secs

91% 92%94%

99.7%

Beginning of year to NEPT Separation

(5/7/10)

NEPT Separation

(5/7/10) to HPT Ph1 (25/8/10)

HPT Ph1 (26/8/10) to

before global routing

(2/10/10)

Global Routing (3/10/10) to 13/10/10

Emergency Average % calls answered in 10 secs

Beginning of year to NEPT Separation

(5/7/10)

72% 75%82%

93%

NEPT Separation

(5/7/10) to HPT Ph1 (25/8/10)

HPT Ph1 (26/8/10) to

before global routing

(2/10/10)

Global Routing (3/10/10) to 13/10/10

The CCIP made significant improvement in Call Taking performance measures: since the shift to Global Routing on 5 October 2010, performance has been sustained above 90%

of calls answered in 10 seconds

Data source: ASNSW

What we achieved

Actual % calls answered in 10 secs

50%

55%

60%

65%

70%

75%

80%

85%

90%

95%

100%

20

10

01

01

20

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23

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31

20

10

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11

20

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22

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03

20

10

10

13

High Performing

Teams

Global Routing

Actual % calls answered in 45 secs

Target % calls answered in 10 secs Target % calls answered in 45 secs

Estimate: no data recorded in Genesys

The CCIP made significant improvement in Call Taking performance measures: since the shift to Global Routing on 5 October 2010, performance has been sustained above 90%

of calls answered in 10 seconds

Data source: ASNSW

What we achieved

The CCIP made significant improvement in Call Taking performance measures: Triple Zero Average Speed of Answer has improved by over two seconds

0

2

4

6

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ASA

20

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03

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13

High Performing

Teams

Global Routing

Estimate: no data recorded in Genesys

Emergency Average Speed of Answer Performance Summary

Data source: ASNSW

What we achieved

0

50

100

150

200

250

300

20

10

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ASA

131233 Average Speed of Answer Performance Summary

The CCIP made significant improvement in Call Taking performance measures by prioritising Emergency need and enhancing and promoting the Electronic Booking Systems to improve

131 233 Call Taking performance.

Data source: ASNSW

What we achieved

State-wide Average Call Ringing Time (secs)

4

5

6

7

8

20

10

01

01

20

10

01

12

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23

20

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25

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30

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03

Average Call Ringing Time (secs)Data errors to be investigated

HPT

Se

con

ds

Through the first phase of High Performing Teams (HPT), the Average Call Ringing Time (average time the phone rings at a Call Takers desk) has improved by a full second on

average. This has significantly impacted performance.

Data source: ASNSW

Structured career pathway

Control Centre Officer Grade 1




New recruitControl Centre

Manager

Control Centre Supervisor

Control CentreManager Support

Officer


Quality Support Coordinator

Induction Training Certificate IICertificate IIICall Taking Quality Audits Certificate IV Advanced Dispatch

AMQ

AMQLeadership etc.

Postgraduate

Postgraduate

Control Centre staff now have a structured career pathway that enables development and promotion through the provision of accredited training and ongoing quality service delivery.

An example career path for Control Officer staff, with training programs provided for career progression.

What we achieved

Collaborated with Control Centre stakeholders to develop a clear and consistent set of Control Centre Policies, Protocols and Procedures which will assist in reducing operational

errors and improve patient outcomes

Standard Operating

Policy

Protocols

Procedures

What it is …A rule; a governing policy

What it is …High level process steps

What it is …

Detailed instructions

What it isn’t …

A process; a set of instructions

What it isn’t …

A process; a set of instructions

What it isn’t …

High level or vague

The PPP infrastructure to standardise the multiple procedures exist for every protocol, and multiple protocols exist for every

SOP.

The PPP infrastructure

Standardise protocols and procedures

Four Control Centres operating with variances in protocols and procedures provided an opportunity to standardise protocols, procedures and training

What we achieved

0

2,000

4,000

6,000

8,000

10,000

12,000

Jan Feb Mar Apr May Jun Jul Aug

Re

qu

es

ts p

er

mo

nth

EBS bookings Non EBS bookings

R5 to R7 EBS and Non EBS usage

(January to August 2010)

What we learnt

• Collaboration and support through a truly whole-of-business program obtained buy in and retained stakeholder involvement

• Strong leadership and sponsorship through a dedicated Steering Committee and Program Management and Governance team leads to effective project delivery

• Managed multiple streams as a single and integrated program of work

• Leveraged the Service Improvement Office methodology, PwC’s best practice PMO methodology and learning's from our previous projects

• Collaborative approach• Evidence based and hypothesis-driven• Patient centric and looking outside

What we learnt

• Communication• Continual learning• Investment in implementation support• Focus on skills and knowledge transfer• Letting leaders lead

Recognition

Organisation Country Interviewees

North East Ambulance Service United Kingdom

Graham Robinson - Control Manager

Metropolitan Ambulance Service Australia Ron Eke - Support Manager, Communications

Queensland Ambulance Service Australia Steve Moore - Assistant Commissioner

St Johns New Zealand Tony Blaber - Operations DirectorColin Lawrence - Communications ManagerAlan Goudge - Operations Manager

Toronto Emergency Medical Dispatch

Canada Norm Lambert - Director Central Ambulance Communications Centre

London Ambulance Service United Kingdom

Richard Webber - Director of Operations

Scottish Ambulance Service United Kingdom

Grant Leslie - EMDC General ManagerRichard Muirhead - Quality & DevelopmentManager

In appreciation of the insights and knowledge provided by national and international Ambulance Services, ASNSW would like to recognise the following organisations for their

support and contributions.

Questions

control centre improvement project ‘every second counts for the patient’

Documents