Health Connection:
Evaluating the quality and impact of
a public health telephone response service
CHNC Conference: Knowledge to Action - June 17 th, 2010
Presenters: Reina Barker, RN, BSc.N
Joyce Fox, RN, BSc.N, MHS
Simcoe Muskoka District Health UnitSimcoe Muskoka District Health Unit
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OutlineOutline
Overview of Health ConnectionOverview of Health Connection
Review Health Connection Client SurveyReview Health Connection Client Survey
Purpose & ObjectivePurpose & Objective
MethodologyMethodology
Survey limitationsSurvey limitations
FindingsFindings
RecommendationsRecommendations
Implementation enablers & barriersImplementation enablers & barriers
Simcoe Muskoka District Health UnitSimcoe Muskoka District Health Unit
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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 seekingaccess to public health information and the services,programs and resourcesserves as the first point of contact for the public seekingaccess to public health information and the services,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 andcustomer service representativesstaffed by public health nurses, public health inspectors andcustomer 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 theinformation, knowledge and skills required to make choicesthat support healthhealth promotion approach used to help clients get theinformation, knowledge and skills required to make choicesthat support health
Simcoe Muskoka District Health UnitSimcoe Muskoka District Health Unit
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Client SurveyClient Survey
conducted as part the data gathering activities of a largerHealth Connection reviewconducted as part the data gathering activities of a largerHealth Connection review
external researcher hired to conduct the survey of clients whoaccess HCexternal researcher hired to conduct the survey of clients whoaccess HC
to identify changes to improve the client experience andservice deliveryto identify changes to improve the client experience andservice delivery
undertaken as a way of obtaining information directly fromusers with respect to:undertaken as a way of obtaining information directly fromusers with respect to:
client characteristicsclient characteristics
client satisfactionclient 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 expectationsclient needs and expectations
barriers to using and accessing the servicebarriers to using and accessing the service
Simcoe Muskoka District Health UnitSimcoe Muskoka District Health Unit
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Research QuestionsResearch Questions
Does Health Connection provide information and servicethat meets the needs and expectations of its users?Does Health Connection provide information and servicethat meets the needs and expectations of its users?
How satisfied are users with the information and serviceprovided?How satisfied are users with the information and serviceprovided?
What are the barriers to using and accessing theservice?What are the barriers to using and accessing theservice?
What changes are needed to improve the effectivenessand the quality of the service?What changes are needed to improve the effectivenessand the quality of the service?
Simcoe Muskoka District Health UnitSimcoe Muskoka District Health Unit
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MethodologyMethodology
telephone surveytelephone survey
eligible clients solicited by staff between October 9 –November 16, 2007eligible clients solicited by staff between October 9 –November 16, 2007
clients contacted 2-3 weeks later by independent surveyorsclients contacted 2-3 weeks later by independent surveyors
sample size = 290sample size = 290
data analyzed using SPSS software and descriptive statisticscomplied for each itemdata analyzed using SPSS software and descriptive statisticscomplied for each item
Simcoe Muskoka District Health UnitSimcoe Muskoka District Health Unit
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SampleSample
60% of clients solicited to participate actually completed the survey60% of clients solicited to participate actually completed the survey
Simcoe Muskoka District Health UnitSimcoe Muskoka District Health Unit
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LimitationsLimitations
Reliance on human reporting as the primary data sourceReliance on human reporting as the primary data source
Potential respondent bias related to social desirability ofresponsesPotential respondent bias related to social desirability ofresponses
Potential selection bias related to staff soliciting clients toparticipatePotential selection bias related to staff soliciting clients toparticipate
Small sample size and resulting sensitivity torespondents responses.Small sample size and resulting sensitivity torespondents responses.
Simcoe Muskoka District Health UnitSimcoe Muskoka District Health Unit
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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 inSimcoe and Muskokageographical breakdown of respondents close to population distribution inSimcoe and Muskoka
Simcoe Muskoka District Health UnitSimcoe Muskoka District Health Unit
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Key Findings: Access to ServiceKey Findings: Access to Service
service was accessed equally throughout the dayservice was accessed equally throughout the day
Simcoe Muskoka District Health UnitSimcoe Muskoka District Health Unit
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Key Findings: Access to ServiceKey Findings: Access to Service
majority of respondents heard about the service through a notice tocallmajority of respondents heard about the service through a notice tocall
most were seeking informationmost were seeking information
Simcoe Muskoka District Health UnitSimcoe Muskoka District Health Unit
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Key Findings: Access to ServiceKey Findings: Access to Service
86% of respondents reported being satisfied to very satisfied withtheir overall experience of how their call was directed86% of respondents reported being satisfied to very satisfied withtheir overall experience of how their call was directed
most respondents who went to voicemail reported feelingcomfortable doing somost respondents who went to voicemail reported feelingcomfortable doing so
Simcoe Muskoka District Health UnitSimcoe Muskoka District Health Unit
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Key Findings: Service Quality & ImpactKey Findings: Service Quality & Impact
Respondents reported a high level of satisfaction withthe service, information and recommendations providedby staffRespondents reported a high level of satisfaction withthe service, information and recommendations providedby staff
92% indicated they were very satisfied/satisfied withHealth Connection service92% indicated they were very satisfied/satisfied withHealth 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
Simcoe Muskoka District Health UnitSimcoe Muskoka District Health Unit
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Key Findings: Service Quality & ImpactKey Findings: Service Quality & Impact
Simcoe Muskoka District Health UnitSimcoe Muskoka District Health Unit
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Key Findings: Service Quality & ImpactKey Findings: Service Quality & Impact
Simcoe Muskoka District Health UnitSimcoe Muskoka District Health Unit
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Key Findings: Service Quality & ImpactKey Findings: Service Quality & Impact
Client perception of the helpfulness of the service
Themes
Examples of responses/subthemes
Frequency of responses forthis 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 %
Knowledgegained
linked to additional resources
questions were answered, issues addressed , secondopinion very helpful
mailed out additional information after call
25%
Serviceconvenience
access to appointments
12%
Simcoe Muskoka District Health UnitSimcoe Muskoka District Health Unit
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Key Findings: Service Quality & ImpactKey Findings: Service Quality & Impact
65% of respondents indicated they followed up with the recommendationsmade by staff65% of respondents indicated they followed up with the recommendationsmade by staff
Simcoe Muskoka District Health UnitSimcoe Muskoka District Health Unit
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Key Findings: Service Quality & ImpactKey Findings: Service Quality & Impact
Most respondents reported accessing the service had apositive impactMost respondents reported accessing the service had apositive impact
57 % obtained new information57 % obtained new information
11% changed their behavior11% changed their behavior
4% had either increased confidence in dealing with issue,decreased stress and were reassured by the support4% had either increased confidence in dealing with issue,decreased stress and were reassured by the support
Simcoe Muskoka District Health UnitSimcoe Muskoka District Health Unit
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Key Findings: Service Quality & ImpactKey Findings: Service Quality & Impact
HC services currently being provided are meeting or exceeding clientexpectationsHC services currently being provided are meeting or exceeding clientexpectations
Simcoe Muskoka District Health UnitSimcoe Muskoka District Health Unit
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Key Findings: Service Quality & ImpactKey Findings: Service Quality & Impact
reported challenges/barriers to utilizing the service werearound call management (56%) and unmet needs (24%)reported challenges/barriers to utilizing the service werearound 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 informationto provide)clarity of voicemail instructions (being unsure of what informationto provide)
limited access to a live personlimited access to a live person
advice/information provided did not meet needadvice/information provided did not meet need
limited appointment timeslimited appointment times
staff unable to answer questionstaff unable to answer question
Simcoe Muskoka District Health UnitSimcoe Muskoka District Health Unit
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RecommendationsRecommendations
Call Management: increase the ability of clients to self-direct through the system and minimize number oftransfersCall Management: increase the ability of clients to self-direct through the system and minimize number oftransfers
Implementation:Implementation:
self-direct options provided off main menuself-direct options provided off main menu
•direct access to specific line•direct access to specific line
•access to pre-recorded information•access to pre-recorded information
•ability to leave requested information by voicemail•ability to leave requested information by voicemail
call routing algorithms developed forswitchboard staffcall routing algorithms developed forswitchboard staff
Simcoe Muskoka District Health UnitSimcoe Muskoka District Health Unit
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RecommendationsRecommendations
Service Access: improve access to live answer bystaff, service and timely responsesService Access: improve access to live answer bystaff, service and timely responses
Implementation:Implementation:
Increase call response capacityIncrease call response capacity
•CSR positions•CSR positions
•VPD/OH pilot•VPD/OH pilot
•Back-up staff•Back-up staff
Electronic SchedulerElectronic Scheduler
Simcoe Muskoka District Health UnitSimcoe Muskoka District Health Unit
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RecommendationsRecommendations
Web-services: increase availability of web-basedservicesWeb-services: increase availability of web-basedservices
Implementation:Implementation:
website redesignwebsite redesign
secure submission of personal health informationi.e. immunization recordssecure submission of personal health informationi.e. immunization records
Simcoe Muskoka District Health UnitSimcoe Muskoka District Health Unit
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RecommendationsRecommendations
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
Simcoe Muskoka District Health UnitSimcoe Muskoka District Health Unit
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Presenter Contact InformationPresenter Contact Information
Reina Barker Joyce FoxReina Barker Joyce Fox
Simcoe Muskoka District Health UnitSimcoe Muskoka District Health UnitSimcoe Muskoka District Health UnitSimcoe Muskoka District Health Unit
15 Sperling Drive15 Sperling Drive15 Sperling Drive15 Sperling Drive
Barrie, On L4M 6K9Barrie, On L4M 6K9Barrie, On L4M 6K9Barrie, On L4M 6K9
(705) 721-7520 ext 7359(705) 721-7520 ext 7210(705) 721-7520 ext 7359(705) 721-7520 ext 7210