Please hold, caller…

Communicating With Telephones Using Old Technology

 

NHS 111 is in the news again for all the wrong reasons.

Under-staffed, under-skilled, under-experienced, under-performing…all the old recognisable issues.

The report in the Daily Mail says that Ministers are demanding assurances there are enough staff for the service after reports that only one nurse was left to cover an area of 2.3 million people. The Royal College of Nursing warned that a “tragedy” could occur. According to the Sunday papers, tragedies are already occurring.

It is understandable that NHS managers want to protect the performance of the ambulance emergency services. We are all familiar with the business case for providing an alternative service for “urgent” cases, as opposed to the 999 service for “emergency” cases:

-reduce the emergency services time spent on non-emergency calls;

-reduce the response times for emergency calls; and

-make this critical emergency service more affordable.

But is it the concept of how the alternative is provided that is fundamentally flawed?

Would anyone chose a disembodied voice on the end of a telephone to advise at a critical moment in their existence, when at that moment the caller may well be stressed and fearful?

Perceived wisdom may say there is no truth in it, but there is a body of work* that indicates that any communication is made up of:
Body language 55%
Voice 38%
Words 7%

Based on this premise, the NHS 111 service can only ever communicate 45% of the whole, to callers whose anxiety levels are likely to affect their ability to make well-thought out decisions.

Add to this the “remoteness” of the operator (who are they?), which may well contribute to trust issues (are they unaccountable?) and the delays experienced (do they really care?) and you have a complete turmoil of emotions that is not helped by the telephone as a communications medium.

I don’t have any bright ideas for how else the service could be provided, but I’d be pleased to hear any suggestion you might have…

*Mehrabian, Albert, and Ferris, Susan R. “Inference of Attitudes from
 Nonverbal Communication in Two Channels,” Journal of Consulting Psychology,
 Vol. 31, No. 3, June 1967, pp. 248-258
 Mehrabian, A. (1971). Silent messages, Wadsworth, California: Belmont
 Mehrabian, A. (1972). Nonverbal communication. Aldine-Atherton, Illinois: Chicago

Bullseye…or a shot in the foot?

© Andres Rodriguez | Dreamstime Stock Photos

The recent reports of A&E waiting times are an about face worthy of Alice Through The Lookinglass…”Shock 250% rise in patients waiting more than 4 hours in A&E: Six-month total soars by 146,000 – as Labour says crisis is worst in 20 years” from the Daily Mail.

Apparently, since the Government took over the “4 hour wait target” for A&E patients introduced by Labour in 2002, waiting times are supposed to have rocketted.

Not long ago, in the days of Labour, the Press were tutting over the fact that the 4 hour wait target was causing patients to be left in ambulances rather than being brought into A&E departments for the clock to start ticking…now it’s missing the target that is the issue.

The Guardian further explains that “NHS failed to meet four-hour A&E targets for past two months” and that 93.3% of patients have been dealt with under the 4 hours instead of the required 95%…and this is with 1 million patients more being dealt with than in a similar period last year.  Ahhh…that explains it then…there are just too many people presented at A&E…

The Scotsman seems to have it right with their stirring story “A&E patients told: If it’s not an emergency, visit GP” and quite right too. Its the worried well that cause prolems not only in emergency situations at A&E but also with England’s new 111 Service where the volume of call to this urgent number have brought down the systems.

If I was in A&E with a life threatening problem and the guy next to me was being treated for a cut finger as he was nearing the 4 hour wait target I’d be pretty vocal. Surely it’s the triage professionals that should be making the decisions about who is seen first? About who is emergency and who is urgent?

They could always install direct lines to the 111 Service in the A&Es for those who are fed up of waiting.

 

 

 

Legs 11 (1)…thoughts on the NHS lottery

It's a lottery out there...Don’t you just despair over the constant stream of NHS bad news? It’s like a lottery out there if you’re sick…
The main cause of recent Press hysteria is the NHS 111 Service…and yet reading the various articles there is no consensus amongst journalists about what really is the problem. Of course, there is “The Computer System”, that baddie from the sci-fi genre of the 50s and 60s. If you are my age you will recall that computers are violent towards humans and are looking to take over the world.
There is no grasp that today’s services are brought to us through many systems working together (or not) and in the case of the NHS 111 Service I imagine there to be Call Centre Systems, Triage Systems, Patient Record Systems…which has failed us? Or are we blaming them all?
The BBC talks about high call volumes. Is that the Call Centre system causing the long wait? Or is it the staffing levels?
While the Daily Mail sees the Triage System as possibly the main problem…or could it be that staff with only 10 days training, who are so desperate they admit “I don’t know what to do”?
Reports of IT crashes are common in all reports and maybe that was a reference to the Patient record System…or maybe not. Or could it be that as usual a Government project of this size is suffering from flawed planning, know-nothing procurement, poor project management and inadequate testing?
All of the above I suspect, the bigger-is-best policy wreaks havoc again, it never changes and it never will until leaner, meaner, providers are given the chance to prove themselves on Government projects.
I feel a twinge of sympathy for the solution designers as, having worked for years within Government, call volumes have probably been vastly underestimated. The NHS 111 Service is designed for “urgent” calls; the NHS 999 Service for “emergency” calls. However, if you give the public an easy option, they will take it…and hey, who wants to wait two weeks to see a GP?