Board KPI Report Balanced Scorecard September 2002 by vow85608

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									 Board KPI Report
Balanced Scorecard
 September 2002
1.     Introduction

This report relates to the month of September 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%
                                               Jul               Aug              Sep

                         Calls Answ ered      7176               7490             8511
                         Service Level        98%                98%              97%

                                                     Calls Answ ered    Service Level



Answered call volumes rose week on week throughout September, with the last full
week in the month (ending Sunday 29th) seeing the highest weekly call volume since
Go-Live. This was due in part to the local Aberdeen holiday on Monday 23rd, but
higher call volumes were evident in each individual day of the week compared with
previous weeks.

The last day of the month saw artificially high call volumes due to calls from a GP
surgery in Aberdeen being diverted to NHS 24 while their phone system was down.
Call volumes were higher than those experienced on the local holiday and, as
resource planning could not anticipate this, service levels suffered as a result.
Performance on this day brought the monthly service level down to 97%; excluding
this day, the monthly figure was 98%, with targets comfortably achieved in each
individual day.

Call Route

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

The volume of health information calls answered during September was double that
experienced in August, following the launch of the public awareness campaign in
Grampian on 26th August. This type of call represented 9% of the total call volume in
the final 2 weeks of September, compared with 4% in August and 5-6% in previous
months.

The percentage of calls falling into the ‘other’ category is artificially high due to the
impact of diverted calls on 30th September, as indicated above.


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                              Call Routing - September 2002


                                     7.8%     0.2%                15.9%




                                              76.1%



                  Nurse Advisor   HI Advisor         Immediately Life-Threatening   Other


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

     Jul          03:40      00:35          04:15              08:21      03:59     12:20       12:02
    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


 A few seconds were taken off the talk time for both Call Handlers and Nurse Advisors
 during September, to take the average patient talk time for triage calls (the sum of
 the two) below 12 minutes for the month.

 While a reducing trend in the call handling times for Call Handlers is evident, for
 Nurse Advisors a pattern has been less clear. 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.

 Overall, there has been a reduction of more than 1 minute since June in the time for
 which triaged patients are connected to the NHS 24 service.

 Call Backs

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

                      September                     6142         365        6%


 This KPI is newly available for the September report, although no history can be
 provided for comparison purposes.


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           After a low reliance on call back procedures early in the month, the last weekend saw
           an increased requirement for call back activity, particularly due to Nurse Advisor
           sickness absence.


           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

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

                                                           Jul             Aug                    Sep

999 - Ambulance as soon as possible                         153   3%           150   3%              141   2%
A&E as soon as possible                                     196   3%           195   3%              228   4%
A&E within 4 hours                                          126   2%           136   2%              141   2%
Doctor telephone consultation within the hour               303   5%           203   3%              118   2%
Doctor telephone consultation within 4 hours                324   6%           309   5%              228   4%
Doctor telephone consultation within 12 hours                20   0%            16   0%               23   0%
Doctor telephone consultation next working day               20   0%            27   0%               31   0%
GP face-to-face consultation within 4 hours                3114 54%           3275 55%              3429 54%
GP face-to-face consultation within 12 hours                201   3%           124   2%              190   3%
GP face-to-face consultation within 36 hours                241   4%           269   5%              293   5%
Routine appointment with GP                                  90   2%           121   2%              134   2%
Contact Pharmacist                                           73   1%            92   2%              126   2%
Contact Other Interfaced Service                             77   1%            98   2%              114   2%
Home Care                                                   383   7%           498   8%              498   8%
Information Provided                                        156   3%           147   2%              284   4%
Other                                                       316   5%           300   5%              362   6%
                                                           5793 100%          5960 100%             6340 100%




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                              Out-of-Hours Outcomes - September 2002


                                                4%       8%          4%
                                         6%                               6%
                                    2%
                                  7%




                                                                    63%



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



There has been a further reduction over September, in the percentage of calls with a
‘doctor telephone consultation’ outcome – from 8% to 6% (11% in July). This is in line
with current developments between G-DOCS and NHS 24.

The increased percentage of ‘home care’ outcomes that was evident in July and
August has been sustained in September.

The out-of-hours periods reflect to a lesser extent the increase in health information
calls that is evident for the month as a whole.

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

               July                                   172           117           3        286
               August                                 286            42           3        325
               September                              325

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                 199.72              125      74.72         60%
                  Team Leaders                   30.77               30       0.77          3%
                   Call Handlers                 138.3              107       31.3         29%
     Health Information Advisors                 19.43               20      -0.57         -3%
                                                388.22              282     106.22         38%
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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 200 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. Where the consultation can be delayed to an in-hours period, NHS 24
advises the patient to phone their doctor within the defined timescale.

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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.

The number and percentage of endpoints requiring partner activity out of
hours is a sum of those categories highlighted in bold text. 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.

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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