Managing major incidents in the NHS

With the recent cyber attacks on the NHS still fresh in the mind, The Forum talks to Gerardine Hope, assistant head of Operations Centre from North East Ambulance Service, about how their customer service and patient safety processes stood up to such a major incident

Over the past five years or so, healthcare organisations have adopted many of the mainstream planning principles and technologies used by the private sector. Recognised planning cycles include improved forecasting, scheduling, real-time management and robust management information and insights to provide a continuous improvement loop. These disciplines are being used in both the contact centre and increasingly across the field operations. In parallel to this, improved workforce management software has been widely implemented, with the result that forecasts and schedules are becoming more accurate and robust.

The Forum has been leading the way in this area for over 15 years now, helping organisations across both the private and public sectors to share best practice and raise standards across the industry. Of critical consequence for environments such as healthcare, which demand that robust business continuity plans are in place, are the skills of the real-time teams. These teams are required to be able to manage a robust and pro-active escalation model which has trigger points and levers that can be pulled to either reduce or deflect demand or re-prioritise workload. Each lever is associated with a predictive outcome that can be proactively employed.

The North East Ambulance Service
This approach was well tested in the recent cyber attacks at the North East Ambulance Service and resulted in the extremely successful management of the situation. As the service already had an effective procedure to deal with systems issues, it could put these in place very quickly and continued over the weekend until it was confirmed that all OOH (out of hours) services were back up and running.

As Gerardine Hope explains: “As well as managing an increase in AHT (average handling time) because of the manual processes, we also had to manage additional OOA (out of area) calls – due to problems with their OOH services, DHU (Derbyshire Health United) invoked national contingency for between 50 per cent and 100 per cent of their calls for the entire period. (3.48 per cent of our calls over that weekend were OOA).

“What also worked well was that we worked together – as you can imagine, there were numerous conference calls over the weekend – both internally and externally – and whilst I joined all of them on the Saturday, I also shared these on the Saturday and Sunday with colleagues – who were also involved in other calls – so it meant that we all had a good understanding of what was happening and had a few short breaks.

“Because of the communication over the weekend, as well as the fact that we knew GPs who had left the surgery on the Friday would return on the Monday and have no knowledge of the situation, I arranged for additional call handlers to be brought in on the Monday morning. This proved beneficial as between 8.15am and noon we received 48 per cent calls above forecast as GP surgeries told patients who contacted them to ring 111 as they had no systems or, just played an IVR message which said the surgery was shut and to call 111. “

Gerardine goes on to add: “We dealt with all of the above whilst still managing an overall increase in calls to 111 of 13 per cent from 1 April following media campaigns and service changes on a scale with the roll out of 111 across the region.” 

Robust planning of customer service processes plays a critical role in ensuring that members of the public (whether that be present or potential patients, their families or staff) are kept abreast with the latest developments and follow the advice and guidance provided by the hospital. This becomes particularly vital when major incidents occur. As technology advances, the number of possible ways of contacting a hospital develops apace and call centres and control rooms are developing strategies to manage this increasing demand on the health service - whether it be appointment booking, ambulance services or patient feedback.

A North East Ambulance Service extract from Friday 12 May
We finished on 83.96 per cent on 999 (call volumes 6.43 per cent above forecast) against a standard of 95 per cent answered within five seconds; and 77.63 per cent on 111 against a standard of 95 per cent answered within 60 seconds (call volumes 4.71 per cent above forecast – the biggest impact was on call handling time which was 6.39 per cent above forecast due to the various workarounds we had to put in place and system issues).

The Forum’s National Planning Conference on 28 November will be exploring some of these related issues and provides a platform to learn about what’s new and working successfully in other organisations.