Single Point of Contact (SPoC) Rapid Improvement

Hi, everyone. I'm Verity Trynka-Watson, and I'm part of the Improvement Transformation team, and Grace is here with me today as well, I think.

Are you still Grace? I am here. I am here. Brilliant. I pressed the button three times and it would work. So I'm Grace. I'm the Admin Ops lead here at the NCH and soon to be with you guys as well. So nice to meet you all.

So we're going to talk about a piece of rapid improvement that we are kind of getting towards the end of it.

Isn't quite finished, but we'll go through that. So Grace is going to introduce and explain kind of what the problem was and why we started looking at this area. Yep. So, the problem area as such was our single point of contact service, which is where all our referrals for nursing and therapy come through. So it's like the first-stop shop for all our patients that come in, and we also deal with two-hour urgent care referrals that need to be processed quickly.

The referrals coming through telephone, through email, and through tasks. So they're coming through several different areas. But what we were finding is that our calls were particularly troublesome. So patients are waiting sometimes over two hours to be picked up on the phone, and they could have been those two-hour urgent calls, so they're already waiting two hours before they were picked up. While the average wait time was around 8 to 9 minutes, there was a lot of fluctuation within that throughout the day.

We had really high call abandonment rates, 17 to 50% in October, and this was noticed in November, and it was highlighted up, and it was agreed that we need to do something about this because it's not fair on our patients. We're seeing increased complaints coming through, not only to us, but to other areas in the trust where patients are then complaining too because they couldn't get through to us.

So there was a lot of contributing factors to what was happening in SPOC. So there was high sickness coming in the system, various different reasons in the service. There was a system one data transfer that was happening at the time, so the trust was moving all our nursing and therapy units onto one system one unit, which was creating more work for the SPOC team. There was new processes that had to be learned, additional system one units that had to be open.

It was just really time-consuming. So something that was then taking two minutes previously was now taking longer because there was different things to do.

We also had a new telephony system and IVR put in at the same time as well, which, although we didn't realize at the time, was also giving us unclear data because that was also causing issues. So altogether, SPOC was not in a very happy place. The morale of the team was really low.

So we urgently needed to stabilize the service, not only for our patients, but only for our internal process as well, our internal development, especially with our system one project that was happening. May I have the next slide, please?

So we came in, and initially, the focus was on providing some stability within SPOC. So you can see that we kind of put a number of actioners in place to provide that stability. And then we focused on kind of really doing a root cause analysis to look at what was going on.

As Grace has kind of overviewed there, we thought that there were multiple potential contributory causes, and we wanted to use our QI tools and approach to really do a deep dive and understand what was going on there. So we did that using a number of different QI tools.

We looked at process mapping, understanding what was currently going on in SPOC and where some of the wastes and opportunities would be.

We looked at a root cause analysis approach. We used statistical process control to really dig into the data and try and understand were these two-hour long waits exceptional, or were they something that we expected to have as a product of a system, and we'll show you the results of that in a minute. And we also did some stakeholder interviews with some of the staff and service users, as well as looking at the complaints and incidents, the patient patterns within the service.

And from that analysis, we identified that actually, the main cause of the deterioration in performance was an issue with how the new telephone platform was functioning. Without going into too much detail on that, essentially, it wasn't seeing calls in the order that we expected it to, which meant that one patient might wait for two or three minutes, and then the next patient that joined the queue after them might wait for two hours with kind of no rhyme or reason within that.

But we also identified some contributory factors as well within that, which were about some of the early warning systems that were or weren't in place within SPOC, and Grace and team did some really quick work to make sure that in future we had the data and processes in place to identify those. So if we could have the next slide, please.

So I think on the next slide, you'll see the SPC chart, which spans the whole period of the rapid improvement and the period before it. So you can see, for those of you who aren't familiar with SPC, SPC stands for statistical process control, and it's a way of explaining whether a process is performing as you would expect it to or whether unusual things are happening within that. And on this particular chart, those unusual things happening are marked in two colours. An improvement is marked in blue, and a deterioration is marked in red.

So on this chart, which shows the percentage of calls abandoned, we can see 2 patches of red, points in the process at which things were going much worse than we expected them to. And you can see two contributory factors here. Actually, we could map those two periods of performance. The first one was related to the system one data transfer, and you can see that deterioration in performance actually resolves quite quickly

But then that longer deterioration in performance towards the right-hand side of the chart marked RingCX is when the new telephone system was introduced. So we could see within the data that actually there was something going on with that telephone system that had resulted in a deterioration in performance. And the good news story here is that you can see that once we identified that issue with the phone system in mid-December, we got that blue area on the right-hand side of the chart.

Those call abandonment rates dropped significantly. And we can see that mirrored in the next two charts in similar statistics.

So the kind of- The statistic that really gave the game away, that there was likely to be a fault within the telephone system, was the longest wait times within SPOC, and you can see on there, when the new phone system was introduced, there was a massive spike.

We moved from our longest waiters generally waiting somewhere between 10 and 30 minutes to all of a sudden, our longest waiters were waiting 2 hours plus. So we knew something from this chart that really something completely exceptional was going on there that we needed to address.

And then the final chart as well shows that even though those longest waiters were affected the most, it was having a significant impact on our average waits as well. So from doing that SPC analysis, we were able to really quickly get to the root of the issue, identify that fault with the phone system, and fix it. And, yeah, pleased to say, and as you can see in this chart, that since we did this piece of work, fixed the issue with the phone system, put in place those early warning mechanisms, our times have dropped substantially and our average wait time now is hovering around the five-minute mark and often much less than that. Can I have the next slide?

Do you want to talk a little bit about this one, Grace, what we've done so far and what we do next?

Yeah. So as you can see, I won't go through everything on there, but where we started November '25, we did a little piece of work that Verity was talking about. We've also been doing some internal work with our processes and our coordinators in the team, trying to get them a bit more involved and get them doing what they should be doing rather than having to always kind of firefight on the day.

So we're trying to be a bit more future-focused and think about how we can make it more sustainable in the long term. We know there's a piece of work that we're doing with Tom, who I think is on the call, regarding demand capacity and do we actually have enough resource in the team at the moment for the demand coming in.

So we're still looking at that. Yeah, and the future's looking bright. I think it's a lot better than it was.

I think the RingCX problem, which we knew there was one, but I think having the actual data and all the stuff that Verity has done is really helpful.

So we're nearly at the end of the journey, but there's still a little way to go. So I think we've just got one final last quick slide.

So just to say, although one of the big contributing factors was in fact a system element, because we then had a really good understanding of the processes and how we were performing, one of the pieces we've been trying to put in place is early warning systems and the right tools that Grace and the team within the service know in future, when things are going forward, that we've got those early warning systems in place so they can see what's going on.

So Grace has mentioned their demand and capacity analysis. We've also been looking at how they measure and monitor performance so that we pick up issues earlier. Grace has designed some really effective escalation processes so that as call times are escalating, we find out about them and we have visibility and action with those within the working day rather than waiting for a report to tell us that something's gone wrong.

And we've also done some significant work streamlining processes within the SPOC and are about to do a piece of work working with the triage team as well to make those even smarter.

So although we've already made a massive improvement, there's always more we can do. And I'll stop there because it's time for questions. Thank you.