Health Connection: Evaluating the quality and impact of a public health telephone response service CHNC Conference: Knowledge to Action - June 17 th, 2010

Health Connection: Evaluating the quality and impact of

a public health telephone response service

CHNC Conference: Knowledge to Action - June 17 th, 2010Presenters: Reina Barker, RN, BSc.N

Joyce Fox, RN, BSc.N, MHS

22

Simcoe Muskoka District Health UnitSimcoe Muskoka District Health Unit

OutlineOutline

Overview of Health ConnectionOverview of Health Connection Review Health Connection Client SurveyReview Health Connection Client Survey

Purpose & ObjectivePurpose & Objective Methodology Methodology Survey limitationsSurvey limitations Findings Findings RecommendationsRecommendations Implementation enablers & barriersImplementation enablers & barriers

33


Health ConnectionHealth Connection local public health information and referral servicelocal public health information and referral service

serves as the first point of contact for the public seeking serves as the first point of contact for the public seeking access to public health information and the services, access to public health information and the services, programs and resources programs and resources

service consist of 8 separate linesservice consist of 8 separate lines access is primarily by phoneaccess is primarily by phone staffed by public health nurses, public health inspectors and staffed by public health nurses, public health inspectors and

customer service representativescustomer service representatives inquiries relate to the full spectrum of public health topicsinquiries relate to the full spectrum of public health topics

health promotion approach used to help clients get the health promotion approach used to help clients get the information, knowledge and skills required to make choices information, knowledge and skills required to make choices that support health that support health

44


Client Survey Client Survey conducted as part the data gathering activities of a larger conducted as part the data gathering activities of a larger

Health Connection reviewHealth Connection review

external researcher hired to conduct the survey of clients who external researcher hired to conduct the survey of clients who access HCaccess HC

to identify changes to improve the client experience and to identify changes to improve the client experience and service deliveryservice delivery

undertaken as a way of obtaining information directly from undertaken as a way of obtaining information directly from users with respect to:users with respect to:

client characteristicsclient characteristics client satisfaction client satisfaction how clients use the service and the information providedhow clients use the service and the information provided the impact of the service on clientsthe impact of the service on clients client needs and expectations client needs and expectations barriers to using and accessing the servicebarriers to using and accessing the service

55


Research QuestionsResearch Questions

Does Health Connection provide information and service Does Health Connection provide information and service that meets the needs and expectations of its users?that meets the needs and expectations of its users?

How satisfied are users with the information and service How satisfied are users with the information and service provided?provided?

What are the barriers to using and accessing the What are the barriers to using and accessing the service?service?

What changes are needed to improve the effectiveness What changes are needed to improve the effectiveness and the quality of the service?and the quality of the service?

66


MethodologyMethodology

telephone surveytelephone survey

eligible clients solicited by staff between October 9 – eligible clients solicited by staff between October 9 – November 16, 2007November 16, 2007

clients contacted 2-3 weeks later by independent surveyorsclients contacted 2-3 weeks later by independent surveyors

sample size = 290 sample size = 290

data analyzed using SPSS software and descriptive statistics data analyzed using SPSS software and descriptive statistics complied for each itemcomplied for each item

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SampleSample

60% of clients solicited to participate actually completed the survey60% of clients solicited to participate actually completed the survey

Target and Actual Number of Survey Solicitations and Completions

0

100

200

300

400

500

600

700

800

Solicitations Completions

Survey

Nu

mb

er

Target # Acutal #

70% of Target

83% of Target(n=290)

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LimitationsLimitations

Reliance on human reporting as the primary data source Reliance on human reporting as the primary data source

Potential respondent bias related to social desirability of Potential respondent bias related to social desirability of responses responses

Potential selection bias related to staff soliciting clients to Potential selection bias related to staff soliciting clients to participateparticipate

Small sample size and resulting sensitivity to Small sample size and resulting sensitivity to respondents responses. respondents responses.

99


Key Findings: Client CharacteristicsKey Findings: Client Characteristics

predominantly female (88%)predominantly female (88%) majority had completed post secondary education (60%)majority had completed post secondary education (60%) geographical breakdown of respondents close to population distribution in geographical breakdown of respondents close to population distribution in

Simcoe and Muskoka Simcoe and Muskoka

Financial Status among Survey Respondents

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%

Not enough money for necessities Enough money for necessities Enough money for necessities & someextras

Enough money for necessities, extras &saving

Financial Status

Per

cen

t

1010


Key Findings: Access to ServiceKey Findings: Access to Service

service was accessed equally throughout the dayservice was accessed equally throughout the day

Number of Times Called Health Connection in the Past Year

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

1st time caller 1-2 3-5 > 5

Frequency of Calling in the Past Year

Per

cen

t

Among Repeat Callers (N=113)

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Key Findings: Access to ServiceKey Findings: Access to Service majority of respondents heard about the service through a notice to majority of respondents heard about the service through a notice to

callcall most were seeking informationmost were seeking information

Reason for Calling Health Connection

To Obtain Information77%

To Access Service5%

To Book an Appointment16%

To Report Something2%

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Key Findings: Access to ServiceKey Findings: Access to Service

86% of respondents reported being satisfied to very satisfied with 86% of respondents reported being satisfied to very satisfied with their overall experience of how their call was directedtheir overall experience of how their call was directed

most respondents who went to voicemail reported feeling most respondents who went to voicemail reported feeling comfortable doing socomfortable doing so

Direction of Health Connection Client Calls

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%

Put right through and spoke toone person

Put right through; spoke to morethan one person

Call w ent directly to voice mail Other

Call Direction

Per

cen

t

1313


Key Findings: Service Quality & ImpactKey Findings: Service Quality & Impact

Respondents reported a high level of satisfaction with Respondents reported a high level of satisfaction with the service, information and recommendations provided the service, information and recommendations provided

by staffby staff

92% indicated they were 92% indicated they were very satisfied/satisfiedvery satisfied/satisfied with with Health Connection service Health Connection service

87% said they would use HC service again87% said they would use HC service again

89% would recommend service to family and friends89% would recommend service to family and friends

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Key Findings: Service Quality & ImpactKey Findings: Service Quality & ImpactClient Perceptions of Quality of Interaction with Health Connection Staff

(Strongly Agree / Agree responses)

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Provide the information that was requested

Was well explained

Fully understood the problem

The information was helpful

Staff were knowledgeable

Was prepared for the appointment

The information was easy to understand

Provided appropriate information and choices

Staff demonstrated sensitivity

Spoke to me in a courteous manner

Percent

1515



Client Perceptions of Quality of Information Provided by Health Connection Staff (Strongly Agree / Agree responses)

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Staff able to assist me in accessing resources

The action recommended was effective in solvingthe problem

Information helpful to seek out other communityresources

The information will help me to better deal withthe issue/similar issues in the future

Staff able to assist me in setting up anappointment

Information helped me to better understand theissue

The information helped me to better deal with theissue

Percent

1616



Client perception of the helpfulness of the service

Themes Examples of responses/subthemesFrequency of responses for

this theme

Supportive staff

staff very knowledgeable staff very supportive and provide reassurance staff professional, felt very comfortable speaking with staff staff provided good advice and resources

59 %

Knowledge gained

linked to additional resourcesquestions were answered, issues addressed , second opinion very helpful mailed out additional information after call

25%

Service convenience

access to appointments 12%

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65% of respondents indicated they followed up with the recommendations 65% of respondents indicated they followed up with the recommendations made by staffmade by staff

Overall Ability to Meet Needs of Client

0%

10%

20%

30%

40%

50%

60%

70%

Very Unsatisfied Unsatisfied Neutral Satisfied Very Satisfied

Level of Satisfaction

Per

ce

nt

1818



Most respondents reported accessing the service had a Most respondents reported accessing the service had a positive impactpositive impact

57 % obtained new information57 % obtained new information

11% changed their behavior11% changed their behavior

4% had either increased confidence in dealing with issue, 4% had either increased confidence in dealing with issue, decreased stress and were reassured by the support decreased stress and were reassured by the support

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HC services currently being provided are meeting or exceeding client HC services currently being provided are meeting or exceeding client expectationsexpectations

Client perception of Desired Features of a Health Information Service as Compared to Actual Experience with Health Connection

(Bars = Level of Importance)

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Adequate time spent discussing the natureof the call

Ability to call from any location

Timely access to a health unit service

Quick access

Opportunity to speak directly with staff

Receive helpful advice

Obtain accurate information about theproblem/issue

Percent

Actual Experience

Desirability

2020



reported challenges/barriers to utilizing the service were reported challenges/barriers to utilizing the service were around call management (56%) and unmet needs (24%)around call management (56%) and unmet needs (24%)

long wait times before reaching staff (42 % waited 2-5 mins.)long wait times before reaching staff (42 % waited 2-5 mins.)

clarity of voicemail instructions (being unsure of what information clarity of voicemail instructions (being unsure of what information to provide)to provide)

limited access to a live person limited access to a live person

advice/information provided did not meet need advice/information provided did not meet need

limited appointment timeslimited appointment times

staff unable to answer questionstaff unable to answer question

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RecommendationsRecommendations

Call Management: increase the ability of clients to self-Call Management: increase the ability of clients to self-direct through the system and minimize number of direct through the system and minimize number of transferstransfers

Implementation:Implementation: self-direct options provided off main menuself-direct options provided off main menu

• direct access to specific linedirect access to specific line

• access to pre-recorded informationaccess to pre-recorded information

• ability to leave requested information by voicemailability to leave requested information by voicemail

call routing algorithms developed for call routing algorithms developed for switchboard staffswitchboard staff

2222



Service Access: improve access to live answer by Service Access: improve access to live answer by staff, service and timely responsesstaff, service and timely responses

Implementation:Implementation: Increase call response capacityIncrease call response capacity

• CSR positionsCSR positions• VPD/OH pilotVPD/OH pilot• Back-up staffBack-up staff

Electronic SchedulerElectronic Scheduler

2323



Web-services: increase availability of web-based Web-services: increase availability of web-based servicesservices

Implementation:Implementation: website redesignwebsite redesign secure submission of personal health information secure submission of personal health information

i.e. immunization recordsi.e. immunization records

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Implementation enablersImplementation enablers fit with agency strategic prioritiesfit with agency strategic priorities Executive sponsorship and endorsementExecutive sponsorship and endorsement broader benefit impactbroader benefit impact

Implementation barriersImplementation barriers competing prioritiescompeting priorities current economic climatecurrent economic climate stakeholder fatiguestakeholder fatigue

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Presenter Contact InformationPresenter Contact Information

Reina BarkerReina Barker Joyce Fox Joyce FoxSimcoe Muskoka District Health UnitSimcoe Muskoka District Health Unit Simcoe Muskoka District Health UnitSimcoe Muskoka District Health Unit

15 Sperling Drive15 Sperling Drive 15 Sperling Drive15 Sperling Drive

Barrie, On L4M 6K9Barrie, On L4M 6K9 Barrie, On L4M 6K9Barrie, On L4M 6K9

(705) 721-7520 ext 7359(705) 721-7520 ext 7359 (705) 721-7520 ext 7210(705) 721-7520 ext 7210

[email protected]@smdhu.org [email protected]@smdhu.org

Documents

Health Connection: Evaluating the quality and impact of a public health telephone response service CHNC Conference: Knowledge to Action - June 17 th, 2010