"We're not the enemy"
Effective call triage is a crucial aspect of emergency medical services, in which staff make critical decisions to help deliver urgent, emergency and non-emergency transport care to patients in a timely manner. South Central Ambulance Service (SCAS), one of the largest ambulance services in the United Kingdom, uses a robust call triage system that helps prioritize emergency calls and allocate appropriate resources.
With a population of over 7 million people, and over 500,000 urgent calls a year, delivering this service naturally generates a vast amount of data for reporting, analysis and benchmarking. How does the SCAS get the most out of that data to make the right decisions in providing efficient emergency medical care? During QlikWorld 2023, I talked to Simon Mortimore, Assistant Director for Business Information at South Central Ambulance Service NHS Foundation Trust.
When a new telephony system was brought in, Mortimor's team started training people how to use the data generated from the calls - the number of calls, average call time and outcomes. Knowing that call handling times, ambulance dispatches and urgent decusions are being measured and reported regularly can add pressure. But rather than using the data as a performance monitoring process, Mortimore explained how business intelligence can be used to support staff:
Our approach isn't one of command and control – we’re moving to more integration, real conversations and using information to tell the story and start relating things to each other. It's a long journey. But as a result, we're getting people coming to us saying they feel empowered.
Rather than just teaching them how to use it, we sat down and talked with them about how you start to use the big strategic picture, so that it's not a case of Big Brother watching people's call times. You may have people who handle a high amount of calls with a shorter call time, whereas others highlight data points showing a really long call. But that's not a data point to stress about – it's just a long call, rather than a sign of inefficiency.
Data gathering has always been intenstive - but using Qlik has helped to reduce reporting time and complexities. Mortimore says it's all about trust:
We're not the enemy. We're here to help. We used to have loads of people producing information on a 45-page PowerPoint presentation. What we do now is work with colleagues to find out what the story is for a manager or supervisor, and we do this with an independent view.
Most importantly, we’ve got very bright people handling calls, paramedics, managers leading teams – and ultimately we’re sending people out to save lives. Information is empowering.
During our conversation, I learned that Mortimore and his team go into the call center every few months to meet with managers to talk to them about what problems they face as part of their role, and how data can add evidence to the issues being faced:
It's not about dashboards, not about numbers, it's about understanding the business - building relationships, empowering. And because we focus on relationship building, it means that people can step away from the spreadsheets and focus on quality, performance analysis and be seen as part of the management team because they trust us because we’ve gotten to know them over time rather than rushing to engage with information and monitoring.
In emergency medical services, time is of the essence, and prompt responses to life-threatening situations can make a significant difference in patient outcomes. By effectively triaging calls, SCAS ensures that critical cases receive immediate attention, while non-urgent cases are appropriately managed, reducing strain on resources and enhancing overall efficiency. But this can also take it's toll on call center staff.
I’ll give you an example of impact – last year when there was a rise in Streptococcus infections in England, the 111 helpline number was resourced to handle about 3,000 calls a day. It hit 11,500 calls in a day. The stress that staff were under was immense – and they get stressed because they care. We were able to use the data to point to the fact that they were receiving two-thirds more calls than they could cope with. We were able to say ‘You were still answering about 40% more calls than you should have been. If you had 2000 calls, we'd be wondering. But there's no way to keep up under that circumstance. You did your best - it's not a failure’.
Data is used for more than reporting on the number of calls being handled. As data storytelling continues to build trust with staff, there are more opportunities to break down silos across departments within the ambulance service. Mortimor elaborates:
There's lots of things like that we will try and do support staff and be that balance sheet, because it builds the credibility that gets you a space at the table to think. We’re moving towards an internal management consultant function rather than just showing people how to use it ; we’re trying to move to back-office functions as well. We’re talking to finance colleagues about automation with an integrated scorecard, so that you’ve got one point for information for finance, operations,and HR, all in one dashboard. I'm a strong believer that the back office should be managed as a part of a strategy towards managing operational costs and defining quality.
SCAS utilizes the NHS Pathways system, a robust clinical triage tool widely used across the UK, to assess and prioritize emergency calls. The system employs a series of structured questions to gather relevant information from callers, allowing call handlers to make informed decisions based on the severity and urgency of the situation. staff undergo extensive training to help determine the best response for patients, and the Business Information team takes pride in the value of data certainty for both staff and patients.
We do a lot of good analysis around the triage pathway – for example with category threes and fours, we are able to quantify and analyse aspects that can not only stop 150 to 200 ambulance dispatches per day, but gets people the help they need from either their doctor, pharmacy, out-of-hours services. Firstly, it's better for the patient, because they're getting the right treatment. Secondly, it's faster, it's safe, the ambulance crews can go out to the right patients – and over time staff start to see that the information exchange can lead to cultural and behavioral change in the system. It's fascinating when you can take the clinical aspects of it and overlay it with cultural, social, ethnicity, and age demographics. In the end, your healthcare service is there to look after people – some of whom are in the most dire times of their lives. We’re there to be allies to those staff.
Throught the discussion, it was evident from Mortimores' enthusiasm how much the Business Information team want to make a difference to the wellbeing of staff, as well as the millions of patients within the service's care. It's all very well saying "it's all about the data" when looking at the challenges faced by the NHS, but once again, culture and change comes to the fore in these experiences. Along with trustworthy data, relationships are equally vital to add that certainty to change the way information is used. Building trust and relationships that lead to culture change is a very long journey. However, there's no question that the time saved by getting the best use from data empowers staff to save lives in the community.