Board KPI Report Balanced Scorecard October 2002 by s1stem99

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									 Board KPI Report
Balanced Scorecard
   October 2002
   1. Introduction

This report relates to the month of October 2002, and reflects NHS 24 performance as
measured in terms of the key performance indicators (KPIs) that make up the strategic level
balanced scorecard.

Given the newness of the operation, there is still some way to go in terms of completely
populating the balanced scorecard with KPI data, but the following report represents a
significant achievement in the development of performance management for NHS 24.

Where appropriate, more detailed analysis has been supplied in order to provide a fuller
picture of NHS 24 activity and performance.

Explanatory notes are now supplied within an Appendix at the back of the report.


   2. Balanced Scorecard

The table on the following page indicates the Balanced Scorecard for NHS 24 populated with
those KPIs for which data is currently available. Where no information is available, a target
date is indicated for inclusion of KPI data within the scorecard.

At the current time the scorecard cannot be presented in the form of a dashboard, with
‘traffic light’ indicators of performance, as targets for each KPI have yet to be determined.
The setting of targets will take place over the next few months, as NHS 24 experience
becomes sufficiently developed to enable realistic, stretching but achievable, targets to be
set.




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       3. Call Activity & Performance (Impact on KPIs 5, 6 & 7)

The graph below represents the level of call traffic that the contact centre has been handling,
regardless of what action has been necessary in order to process those calls and whether or
not any clinical outcome or the provision of health information has resulted.


                                      Call Activity & Service Level
                            9000                                                    110%
                            8500
                                                                                    100%
                            8000
   Calls Answered




                                                                                    90%




                                                                                           Service Level
                            7500
                            7000                                                    80%
                            6500
                                                                                    70%
                            6000
                                                                                    60%
                            5500
                            5000                                                    50%
                                         Aug                Sep              Oct

                    Calls Answ ered      7490               8511             8778
                    Service Level        98%                97%              98%

                                                Calls Answ ered    Service Level



The last 2 weeks of October have seen a general uplift in answered call volumes, taking the
monthly figure to its highest level since Go-Live. This is despite a dip earlier in the month
due to the schools’ mid-term break. The last week in particular saw a rise in daytime calls,
following the launch of the ‘Not Sure’ campaign.

The Go-Live with MDOCS affected only the last day of the month.

Weekly service levels have been at a stable 98% throughout October, following the slight dip
in September that resulted from the unforeseeable nature of daytime telephony cover
provided for a GP surgery in Aberdeen while their phone system was down. Service levels
were comfortably achieved in each day of the month.


Call Route

The chart below indicates where calls were routed, following initial contact with the NHS 24
service.

The percentage of calls falling into the ‘other’ category increased during October. This
followed an increase in the level of daytime calls, which have historically tended to result in
fewer clinical outcomes.

There was a reduction in the level of health information calls in the month as the public
awareness campaign in Grampian came to a close.




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                                   Call Routing - October 2002


                                                                20.4%
                                6.6% 0.3%




                                                      72.7%



                  Nurse Advisor         HI Advisor    Immediately Life-Threatening     Other


Call Handling Time

                          Call Handler                               Nurse Advisor
                Average     Average       Average             Average    Average    Average    Patient
                 Talk        Wrap           Call               Talk       Wrap        Call      Talk
  Month          Time        Time          Time                Time       Time       Time       Time

      Aug         03:28         00:28        03:56              08:34      04:18      12:52      12:02
      Sep         03:22         00:26        03:48              08:28      04:19      12:47      11:50
      Oct         03:22         00:27        03:50              09:11      05:14      14:25      12:34


Call handling times for Call Handlers have remained stable over the period, while those for
Nurse Advisors have seen some increase.

Nurse Advisor handling times have been impacted by new resource joining the contact
centre, and we would expect to see this settling down over the coming weeks. The nature of
the nurse consultation process means that call times cannot be dictated, but NHS Direct in
both England and Wales are experiencing average talk times of just over 8 minutes, with
wrap times bringing the overall call time to 15 minutes.

Call Backs

                                                                            %
                                              Triaged         Triaged    Triaged
                                                Call          Via Call   Via Call
                                              Volumes          Back       Back

                          Sep                        6142         365        6%
                          Oct                        6407         608        9%


This KPI was newly available for the September report.

There has been an increased requirement for call back activity in October, during periods of
peak demand. These are typically Sunday mornings in particular.


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            4. Call Outcomes (Impact on KPIs 9, 10, 11 & 18)

        This report refers to the final outcomes of all calls that result in a clinical outcome or the
        provision of health information.

        As it is during the out-of-hours period that NHS 24 is integrated with its partners, and
        provides a nurse consultation service on behalf of GDOCS, information relating to call
        outcomes is presented for these periods only.

        ‘Out of hours’ refers to the following periods (for GDOCS currently):
                Monday – Friday 6pm to 8am the following day
                Saturday 11am to 8am Sunday
                Sunday 8am to 8am Monday
                Public and Local Holidays 11am to 8am the following day

        The categories highlighted in bold text relate to those endpoints requiring partner activity out
        of hours. In some instances, where contact with a GP is advised within 12 hours, for
        example, this may not actually require any action to be taken out of hours, but this is our
        best estimate at the current time.


                 Monthly Summary of Outcomes Entered on PRM During Out of Hours Periods

                                                                Aug               Sep               Oct

999 – Ambulance as soon as possible                              150     3%       141      2%       154      3%
A&E as soon as possible                                          195     3%       228      4%       195      3%
A&E within 4 hours                                               136     2%       141      2%       116      2%
Doctor telephone consultation within the hour                    203     3%       118      2%        65      1%
Doctor telephone consultation within 4 hours                     309     5%       228      4%       165      3%
Doctor telephone consultation within 12 hours                     16     0%        23      0%        34      1%
Doctor telephone consultation next working day                    27     0%        31      0%        31      1%
GP face-to-face consultation within 4 hours                     3275    55%      3429     54%      3021     49%
GP face-to-face consultation within 12 hours                     124     2%       190      3%       255      4%
GP face-to-face consultation within 36 hours                     269     5%       293      5%       391      6%
Routine appointment with GP                                      121     2%       134      2%       149      2%
Contact Pharmacist                                                92     2%       126      2%       127      2%
Contact Other Interfaced Service                                  98     2%       114      2%       113      2%
Home Care                                                        498     8%       498      8%       712     12%
Information Provided                                             147     2%       284      4%       231      4%
Other                                                            300     5%       362      6%       364      6%
                                                                5960   100%      6340    100%      6123    100%




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                                  Out-of-Hours Outcomes - October 2002
                                                   12%                4%
                                  4%                                           6%
                            5%
                       3%
                  9%




                                                                         57%
                            GP primary care out-of-hours     GP primary care in-hours
                            SAS                              A&E
                            Interfaced Partners              Home Care
                            Information Provided             Other



What has been evident in October has been a reduction in the percentage of calls for which
a GP face-to-face consultation has been required in the out-of-hours period. In line with the
Quality Improvement Plan, the percentage of calls requiring a consultation within 4-12 hours
has reduced from 57% to 53%.

What is also striking is the significant increase in the percentage of ‘home care’ outcomes,
from 8% to 12%.

   5. HR (KPIs 22 & 23)

The following figures relate to NHS 24 employees on permanent or fixed term contracts.
Numbers are stated in terms of headcount rather than whole-time equivalents (WTE) due to
the number of staff currently in training and, therefore, working in excess of their contracted
hours.

                                           Staff                                       Staff
                                         Numbers                                     Numbers
                                         @ Start of                                  @ End of
                                          Month          Starters     Leavers         Month

             August                                286           42             3          325
             September                             325          186             1          480
             October                               480          168             3          645


West Contact Centre Recruitment

The following figures relate to West Contact Centre recruitment and are expressed in terms
of whole-time equivalents.

                                                            Offers
                                                           Accepted      Target       Variance

                    Nurse Advisors                           201.07            125       76.07   61%
                     Team Leaders                             31.25             30        1.25    4%
                      Call Handlers                          134.84            107       27.84   26%
        Health Information Advisors                           18.57             20       -1.43   -7%
                                                             385.73            282      103.73   37%

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Nurse Advisor recruitment for the west was targeted at 125 WTE based on the numbers
required in order to handle projected call volumes for November. However, with 201 WTE
successful on assessment, it was decided to accelerate recruitment in order to better equip
NHS 24 for the anticipated winter peak. This is the only time the organisation will have the
luxury of staffing to the winter peak, as the "surplus" will level out as more partners are
brought on board in 2003.




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Appendix: Explanatory Notes


Call Activity & Performance:

‘Calls offered’ is the total of calls answered and calls abandoned. This represents the total
number of times someone has attempted to get through to the contact centre, whether that
attempt has been successful or not. This may include individuals trying more than once to
get through and, therefore, should not be taken as a direct indicator of call demand.

‘Calls answered’ represent the successful attempts to get through to the contact centre,
while abandoned calls indicate the number of occasions on which callers have abandoned
the attempt. The important statistic in this respect is, however, the level of calls abandoned
after the 30-second threshold, as calls abandoned prior to this time are assumed not to be
genuine calls.

The service level target is for 90% of calls to be answered within 30 seconds. As in the
threshold for abandoned calls, the 30 seconds does not include the 15 seconds required to
listen to the recorded message relayed to all incoming callers.

The Call Handler passes calls relating to immediately life-threatening conditions to the
Scottish Ambulance Service, without recourse to a nurse triage process.

The category ‘other’ represents calls that are not transferred beyond the Call Handler, and
have not resulted in either a clinical outcome or the provision of health information. This
category includes professional calls, staff calls, repeat calls and calls where the caller has
hung up.

The average talk time indicates the length of time for which the Call Handler or Nurse
Advisor talks to the patient, including the time that the patient is on hold – i.e. the Call
Handler talk time includes the time taken to connect the patient to a Nurse Advisor, where
relevant.

The wrap time indicates that time following their involvement in the call during which the
Call Handler or Nurse Advisor may be completing any post-call processing and is
unavailable to take any other incoming calls.

The patient talk time is the combined talk time for Call Handlers and Nurse Advisors, and
provides an indication of the total length of time that the patient is connected to the NHS 24
service in triaged cases.

The volume of triaged calls represents those calls that have resulted in a clinical outcome
on PRM.


Call Outcomes:

An outcome of ‘999 – ambulance as soon as possible’ can result from a call passed
directly from a Call Handler to the Scottish Ambulance Service, or one that has been
transferred to a Nurse Advisor initially. Accident and Emergency outcomes will also include
some ambulance transport.

Where a ‘doctor telephone consultation’ is required within the out-of-hours period, NHS
24 contacts the doctor to request that they phone the patient within the defined timescale.


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Where the consultation can be delayed to an in-hours period, NHS 24 advises the patient to
phone their doctor within the defined timescale.
Where a ‘GP face-to-face consultation’ is required within the out-of-hours period, NHS 24
arranges for the patient to be seen at either the primary care emergency medical centre or
via a home visit. Patient details will be transferred to the relevant location of care. Where the
consultation can be delayed to an in-hours period, NHS 24 advises the patient to contact
their local surgery within the defined timescale.

‘Other interfaced services’ to which patients may be referred include dentists, district
nurses, family planning clinics, health visitors, mental healthcare and midwives.

A ‘home care’ outcome indicates that the patient has been given advice for self-treatment of
their symptoms.


HR

A Nurse Advisor full-time contract relates to a 37.5-hour working week; for all other staff a
full-time contract relates to a 37-hour working week.

Recruitment numbers are stated in terms of “whole time equivalents”. For example, if a
Nurse Advisor is contracted to work 18 hours, this represents 0.48 of the 37.5-hour full-time
contract.




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