Control Centre Improvement Project Every second … ccip project-bfa1960f...Queensland Ambulance Service –Queensland (QAS) StJohnSt John –NZ Toronto Emergency Medical Services

Control Centre Improvement Project

Every second counts for the patientAmbulance Service of NSWOctober 2010

Project Summary Report

About thAbout th

This report has been prepared by the Ambulance Service of NSWThis report has been prepared by the Ambulance Service of NSW, the objective, approach and outcomes of the Control Centre Improv

Ambulance Service of NSW • Control Centre Improvement ProjectProject Summary Report

1159

his reporthis report

with support from PricewaterhouseCoopers (PwC) to summarisewith support from PricewaterhouseCoopers (PwC), to summarise vement Project (CCIP) and outline the recommended next steps.

October 20109

Table of Contents

1 Executive Summary

2 Program Overview

3 Program Highlights

4 Next Steps

5 Learnings for future projects

AppendixAppendix

Page Number

4

7

23

47

49

5353

Section 1Executive SummaryExecutive Summary

Section 1 – Executive Summary

ForewordThe Control Centre Improvement Project has successfully imModel for Control Centres

During 2010 Ambulance undertook a major improvement program to transform the culture, structure, processes, systems and education of Ambulance Control Centres. The key objective of this program was to improve the patient journey and, as the i l t ti h f thi j t d t l I d t t th t thimplementation phase of this project draws to a close, I am very proud to report that the project has achieved this outcome.

By focusing on improving the journey of our patients, we have improved the experience of our staff and improved our performance in managing and responding to Triple Zero calls. Over a period of 10 months we have implemented:

One virtual Control Centre at four locations with clear and consistent business rules One virtual Control Centre at four locations with clear and consistent business rules and protocols and procedures

New training curriculums for call-taking and dispatching

Dedicated Control Centre educators and training for Control Centre staff

A model for coaching and performance feedback – to let our staff know what we expect of them and how well we think they are doing it

A protocol and procedures manual for Control Centres

Enhanced systems functionality to improve call taking, dispatching and communications

Improved access to email and intranet for Control Centre staff and improvedImproved access to email and intranet for Control Centre staff and improved communication with staff

A shared culture consistent with Ambulance that values and recognises good performance

Increased use of the Ambulance Electronic Booking System for non-emergency transport requests – which has reduced the number of non-emergency calls comingtransport requests which has reduced the number of non emergency calls coming to Ambulance Control Centres

Separate management of non-emergency calls to put the focus on managing Triple Zero calls


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plemented its recommendations to deliver the Optimal

A program of this magnitude cannot be accomplished without expertise and resources. Throughout this program Ambulance has worked closely with NSW Health and with a team from PricewaterhouseCoopers (PwC). The expertise that PwC has b ht t thi j t i d i i th h d ki th h ti kbrought to this project in designing the change program and making the change stick, has been invaluable.

PwC has also helped us to engage and collaborate with Control Centre staff and managers to develop solutions that are effective and sustainable. All of the initiatives that have been delivered were designed and implemented in collaboration with Control Centre staff and managers. g

This program represents a significant investment for Ambulance and reflects the growing recognition of the specialised skills of Control Centre staff and the integral role that Control Centres play in the patient journey.

I am proud of this program of work and the staff in our Control Centres who have embraced and supported these changes. Every second counts for our patients: Control Centre staff understand this better than anyone else.

Thank you to all of those who worked hard to change Ambulance Control Centres during 2010 and who will continue to work hard to improve Control Centres now and into the future.

Mike WillisGeneral Manager, OperationsOctober 2010

October 2010

Section 1 – Executive Summary

Executive SummaryThe Control Centre Improvement Project has delivered its plaas-Usual

Background & ObjectivesThe Ambulance Service of NSW (Ambulance) has a vision of “Excellence in Care”. Key to achieving this vision is effectively and efficiently receiving requests for support fromto achieving this vision is effectively and efficiently receiving requests for support from the public, health professionals and other emergency services organisations and identifying, prioritising and coordinating the most appropriate and timely response. These critical functions are the accountability of the Control Centres.

In May 2009, Ambulance, supported by NSW Health and PwC, undertook a project to assess their Control Centres and design a model and implementation roadmap to improve the patient journey and employee experience. This was undertaken through a patient and caller survey, global research of Ambulance Operations Centres and staff consultations to facilitate the development of the Optimal Model for Control Centres.

In January 2010, Ambulance began a 9 month program to construct and implement the change with the assistance of PwC.

A hApproachCCIP leveraged the Ambulance Service Improvement Office, PwC and NSW Health Redesign School methodology to assess the current model, design the target operating model, manage an integrated program to deliver the benefits and provide a focus to monitor and review the outcomes.

This was underpinned by the principles of patient-centric redesign, high staff engagement and involvement, evidence based analysis and bringing the whole organisation into the change effort.


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anned outcomes and is now being transitioned to Business-

What the CCIP deliveredChanges have been implemented across the Control Centre’s strategy, structure, people process and technology to enhance and improve call taking dispatchingpeople, process and technology to enhance and improve call taking, dispatching, supervision, teaming and governance.

Highlights include:

Record call taking performance for all telephone queues including Triple Zero, Urgent Medical Bookings and calls from other Emergency Service Organisations. These benefits have been sustained above performance targets without additionalThese benefits have been sustained above performance targets without additional resources.

Separated Non-Emergency Call Taking and migrated a significant number of calls from hospitals and medical practitioners to the Electronic Booking System (EBS)

Real time visibility of performance of Call Taking

I l t d d l d b i f i t t di t hi Implemented or developed business cases for improvements to dispatching processes and technology to reduce workload and improve quality

Standardised, communicated and enhanced Protocols and Procedures

Improved training and centralised recruitment of staff

Development of a model for coaching and teamingp g g

New uniforms, improved communications, the development of a knowledge base and the implementation of pre-shift briefings.

Next StepsAn interim Control Centre Director has been appointed and has primary responsibility to t iti th i i ti iti d l d hi i t “b i l” H d thtransition the remaining activities and leadership into “business as usual”. He and the team will finalise the implementation of the remaining activities and build upon the achievements of the CCIP through identifying additional continuous improvements.

October 2010

Section 2Program OverviewProgram Overview

Section 2 – Program Overview

Program ObjectivesThe Control Centre Improvement Project set out to deliver deAmbulance staff

Objectives Improve the patient journey by transitioning from the ‘as is’ model to the Optimal

Model for Ambulance Control CentresModel for Ambulance Control Centres.

Improve patient care, service quality and reliability within Control Centres.

Implement the separation of emergency and non-emergency requests in Ambulance Control Centres and improve the patient journey by prioritising Triple Zero and emergency patient transport.

Provide detailed project planning and support to guide Ambulance in the successful implementation of a complex program of work that requires consistent and comprehensive consultation with staff and managers to assist Ambulance in realising the anticipated returns on investment to improve service delivery, operational and financial performance.

Implement best practice call taking and dispatching that provides safe andImplement best practice call taking and dispatching that provides safe and appropriate patient care and workforce conditions that meet international performance benchmarks.


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emonstrable benefits for patients, callers, stakeholders and

Overview of scope Four Control Centres (previously Operations Centres):

– Sydney Control Centre, Everleigh

– Northern Control Centre, Charlestown

– Southern Control Centre, Warrilla

– Western Control Centre, Dubbo

Interactions with support functions including:

– IT

– System Support Unit

– State Comms

W kf i l di it t– Workforce including recruitment

– Education

– Clinical

– Procurement and Health Shared Services

Ser ice Impro ement Office– Service Improvement Office

October 2010


ApproachThe Control Centre Improvement Project followed a structureengagement of staff and evidence based analysis

Principles of the approach Ongoing provision of a safe and appropriate service (patients, callers, related

workforces and agencies)workforces and agencies)

Continually consider the voice of callers and patients

Deliver sustainable and effective change: shift focus from performing analysis and diagnosing issues to implementing change

Engage staff and appropriate stakeholders early in the project and project stages

Manage interdependencies through an integrated program of work that sequences activities and interdependencies

Measure and clearly articulate operational and financial costs and benefits

Construct a cost tracking and benefits realisation framework

M i k d i b id tif i i k d i l d idi iti ti Manage risks and issues by identifying risks and issues early and providing mitigation strategies

Remain mindful of other initiatives Ambulance may be seeking to overlay with the Optimal Model

Regular engagement and collaboration with the executive team and the Control Centre Managers to maintain project o ersight and access to decision makingCentre Managers to maintain project oversight and access to decision making.


8

d approach that was underpinned by the principles of high

Overview of Program PhasesThe program was structured around three main phases of work:

Phase 1: Develop the Optimal Model

Phase 2: Implementation

Phase 3: Business as Usual

May – June 2009 December 2009 –September 2010

Future

The following pages outline the activities of each phase

October 2010


Impact on the Patient JourneyThe primary aim of the Control Centre Improvement Project w

Activation time -Call response

Mobilisation time - reduced

Response time -

Benefits along the Patient Journey

Reduced time to answer call due to removal of non-emergency call taking

Non-emergency clinical advice and support available

Activation time reduced

Call response time -

reduced

Improved quality of call taking through: Screening of applicants Increased training, mentoring and

coaching Increased availability of call taking

supervision KPIs based on quality and time

R d d f ti f i t

Specavail

Reduced fatigue from resourcing to meet demand including correct relief ratios

Reduced time to dthrough an automa Initial assignmen Automated alert

mobile phones a Updates of local


9

was to improve the patient journey

reduced

Automated “fluid deployment” to increase on-road coverage

Improved quality of dispatching through Increased training, mentoring and

coaching Reduced non-core functions (i.e.

rostering, MDT sign on / sign off) Duplicate incident warnings

cialist clinical skills lable when required

ispatch resources ated CAD system using:nt of on-road resourcests to paramedic pagers, nd stationsl names

October 2010


Phase 1: Develop the “Optimal Model”The first phase of the program assessed the present organisaintegrated research approach

Overview of Research ApproachThe first phase drew insight from a number of sources:

Voice of Control

Voice of the Control

Centre Staff

Voice of External

Patient

“Voice of the possible”

Global ScanExternal Stakeholders

Global Scan of Good Practice

Overview of Global Good Practice ScanIn order to gain an understanding of different Control Centre models, seven Ambulance Services from Australia, New Zealand, Canada and the United Kingdom were identified for inclusion in project consultations. These Services were chosen because they were p j ydelivering operations in a similar environment and the service was being delivered on a comparable scale to that in New South Wales.


10


Phase 3: BAU

Phase 1: Developthe Optimal Model

ation and developed the “Optimal Model” drawing from an

The seven Ambulance Services were:

North East Ambulance Service – UK (NEAS)

Metropolitan Ambulance Service – Victoria (MAS)

Queensland Ambulance Service – Queensland (QAS)

St John – NZSt John NZ

Toronto Emergency Medical Services – Canada (TEMS)

London Ambulance Service – UK (LAS)

Key Control Centre staff were interviewed to gain an understanding of their operations. Data requests were also sent to six of the Services to cover additional volumetric, structural and performance elements.

Scottish Ambulance Service – UK (SAS)

Overview of Voice of the customer researchThe program undertook voice of the customer research with approximately 400 respondents through an online survey. Overview of staff consultationsSt ff d d lt d th h t th j t St ff t d dStaff were engaged and consulted throughout the project. Staff were represented and extensively consulted during key project programs such as “Standardisation”. In Centre “expression sessions” provided staff with opportunities to be updated and ask questions regarding the progress and impacts related to the CCIP. Quarterly Pulse Surveys provided staff with an avenue to provide their feedback regarding project and non project activities.

October 20100


Phase 1: Develop the Optimal ModelThe research captured elements of good practice that Ambulajourney

StratSupport a world best practice patient journey by providing efficient and effectiv

emergency and non emergency requeemergency and non-emergency reque

Shared Values Structure ResouShared Values

Staff will wear uniforms that reflect their role in the patient journey and within the Service. The Control Centres will be

Structure

The Control Centres Director provides strategic leadership, financial and operational responsibility for all Control Centres, and

Resou

Staff will be rthrough a twostructured proan initial screeidentify candid The Control Centres will be

actively promoted with internal and external stakeholders as a specialised area of the Service, with expert staff providing a critical element

a Co t o Ce t es, a dreports to the General Manager, Operations. The Control Centres will

use standardised policies and processes to consistently process and

de t y ca d dappropriate cacarried out byservice provid Control Cent

(CCO’s) will fuTaking Dispaproviding a critical element

in the overall patient journey. Control Centre staff will be

encouraged to develop and maintain their skills through a structured training and

consistently process and deliver services. Policy and procedure

changes require consultation with the Director who will consider the impact on Operations

Taking, DispaSupervision, Csome trainingwithin Control Control Cent

resourced to padequate stafa structured training and

development program that emphasises the positive working relations, the specialist role and valuable contribution in a high performance culture

the impact on Operations, and any subsequent impact on the patient journey, prior to implementation

adequate stafduring all shiftsufficient relieand interventi


11

performance culture.


Phase 3: BAU


ance staff and leadership identified as beneficial to patient

tegye call taking, triage, prioritised dispatch and advisory functions in response to

ests for Ambulance services in NSWests for Ambulance services in NSW.

Systems Trainingurcing Systems Trainingurcing

recruited o stage, ocess including ening to dates with

Common system platforms will be used for CAD, AMPDS, rostering, secondary triage and administrative functions.

All new staff will receive training that follows a specialised and standardised Control Centre curriculum. Initial training dates t

apabilities y an external der. re Officers ulfil Call

atching

ad st at e u ct o s Automation will be used to

expedite common processes, including the initial assignment of on-road resources; on-road resource MDT sign on and sign off;

cu cu u t a t a gwill be conducted centrally and will include both classroom based and simulation learning. Ongoing training will be

provided to all staff duringatching, Coaching and functions l. res will be provide ff to meet KPIs

MDT sign on and sign off; rostering of on-road and Control Centre resources; internet portals and menu driven telephony for NEPT requests; desktop access to email and intranet

provided to all staff during working hours to address identified gaps, system issues, and ongoing development needs. Staff will be required to complete a minimum number offf to meet KPIs

ts, allowing ef for coaching ions.

email and intranet a minimum number of training hours annually. Quality Support

Coordinators, and Education will provide additional expertise to support ongoing quality

October 2010

support ongoing quality improvement.


Phase 1: Develop the Optimal ModelThe components of systems, resourcing, training, structure anControl Centre model

Components of the Optimal Model

Systems

ComponentObjective

Resourcing

TrainingThe Optimal

ControlCentre Model

Structure

Shared Values


12


Phase 3: BAU


nd shared values were aligned to develop the optimal

Leveraging technology to improve the Patient journey and the

Vision

experience of Ambulance staff

Develop positions and processes to enhance the depth of the workforce

and create career pathsp

Skills and support required to deliver high quality service to Ambulance

Patients and enhance the employee experience

Four Control Centre locations performing consistently as one with

clear goals and protocols

s Underpinned by a consistent and collaborative working environment

October 20102


Phase 1: Develop the Optimal ModelThe Optimal Model is aligned to the “Excellence in Care” visio

Optimal Model Conceptual FrameworkThe project developed a best practice Control Centre model aligned to the vision and strategy o

Patient centric redesign; Single Control Centre in four locations Patients

Visio

Strateg

four locationsImproved opportunities and environment for staff

Patientsand users

Guidinprincip

A single state-wide structure for Control Centres and clearer

Standardise and

Interaction

Business Control Centres and clearer demarcation between Emergency and NEPT

enhance policies, protocols and procedures

Organisation

Call taking process

Dispatchproces

Better leverage technology

Get the right

people

System

Develop the right skills and

behaviours

Supervcoach arecogn


13

System


Phase 3: BAU


on of the Service

of the Service which would support the implementation of a Production and Distribution model

Control Centre model moving toward a stronger production

“Excellence in Care”

Emergenc

n

gy

Enhancements to the interactions with Control Centre support

toward a stronger production and distribution model

Emergency and NEPT

ng ples

with Control Centre support functions including education,

systems support,workforce and recruitment

model

model

structure

Supervision process

ing s

ms

vise, and

nise

Keep the right

people

Providea clearer

career path

Transform our people’s experience

October 20103

ms


Phase 2: ImplementationPhase 2 ran from January 2010 to September 2010 and manof the components of the Optimal Model

OverviewThe program was implemented in an integrated program of work.

Quick Wins M

AB

Map ref. Phase 2 Stream Name

A MDT Sign on/off

B CAD Recommend function

C Dynamic Dispatch research & briefSystems

Training

B

H IJ

K

Sys

C Dynamic Dispatch research & brief

D Duplicate telephone number alert

E Notebooks

F Pager Bus Case & Trial Plan (cont)Training

Structure

G Electronic Booking System (cont.)

H Integrated Voice Response

I Control Centre Knowledge Base

J F di f li i “M h B d”

Resourcing

A

J Funding for splitting “Munch Board”

K Additional CAD functionality brief

Tra

A Curriculum – Call Taking

B Curriculum - Dispatch

Sh

Tra p

CTraining Needs Assessment Plan (awaiting Award)


14


Phase 3: BAU


aged the implementation of the quick wins and the majority

Optimal

Mar – Jul 10 Jul –Sep10

C DEF


Str

A Control Centre Director

B NEPT CC Separation

Optimal Model

EE

B

AA

C

C

D

CD

C Standardise Protocols & Proc

D Predict research and briefing

Res

A Program Director

B De elop & Agree Ne PDBC

BA

B

D

E

Res B Develop & Agree New PD

C Centralised Recruitment

A Uniforms

B Recognition

C

Sha

B Recognition

C Pre-shift Briefings

D High Performing Teams

E Paramedic Observation Shifts

ared Values Program & Change Management

ProA Program Management

B Change and Communications

October 20104


Phase 2: ImplementationThe CCIP made significant improvements to the operations astakeholders

Summary

Record performance: ex

Improve Call Taking

Record performance: exresources; best ever 13 Dedicated Non-Emerge

and medical practitioner Consistent, communica Improved training and re

Improve Dispatching

Improved effectiveness explored Consistent, communica Improved training and re

OUTCOMES

Improve Patient Journey

Improve Supervision, Support & Teaming

Enhanced coaching and Enhanced communicati Implemented pre-shift b

Si l if C

Journey Operate a single

Control Centre in four locations Improve opportunities

& environment for t ff

Improve Structure & G

Single uniform across C

Centralised Leadership I l t d C t l C

staff

& Governance Implemented Control Ce


15


Phase 3: BAU


and to the Ambulance Service of NSW’s patients, staff and

xceeded target of 90% of Triple Zero calls answered in 10 seconds without additionalxceeded target of 90% of Triple Zero calls answered in 10 seconds without additional 31233 performanceency Patient Transport Call Taking & migrated a significant number of calls from hospitals rs to the Electronic Booking System (EBS)ted and enhanced Protocols and Proceduresecruitment of staff

and efficiency through process improvements and enhanced technology delivered and

ted and enhanced Protocols and Proceduresecruitment of staff

d supervision through delivery of High Performing Teams model, plan and phase 1on – access to intranet and email at desks and development of the knowledge base

briefingsC ll T k d Di h i i h d P diCall Takers and Dispatch consistent with on-road Paramedics

of Control Centres under single Directort P t l C itt d P li P t l & P d W ki Gentre Protocols Committee and Policy, Protocol & Procedure Working Group

October 20105



Deliverable Summary


A MDT Sign on/off Reduced Dispatc

B CAD Recommend functionEnhanced Dispatin CAD

C Dynamic Dispatch research & brief Organisational un

Improve Call Tak

Systems

D Duplicate telephone number alertImprove Call Takplace

E NotebooksImproved accessinformation

F Pager Bus Case & Trial Plan (cont) Presentation of a

G Electronic Booking System (cont.)EBS bookings nocalls per month

H Integrated Voice Response Split NEPT calls a

I Control Centre Knowledge Base Improve KnowledI Control Centre Knowledge Base Improve Knowled

J Funding for splitting “Munch Board” Funding has allow

K Additional CAD functionality brief Access CAD func

8 newly recruited

Training A Curriculum – Call Taking and Dispatching

and inductees arelevel and confide

Dispatch course d

BTraining Needs Assessment Plan (awaiting Award) Engagement with


16

B (awaiting Award) Engagement with


Phase 3: BAU



Deliverables

cher effort: All Paramedics and PTOs signing on and off via the MDT

tcher quality: Implemented an automated recommendation of the most appropriate vehicle

nderstanding of benefits and funding requirements

king: Technical and operational requirements agreed with CCMs; implementation plan inking: Technical and operational requirements agreed with CCMs; implementation plan in

s to communications and resources to assist in providing patient care and accessing

alternative communications with on road staff to improve turn out times

ow achieving ~9,100 a month from ~1,500 in January, reducing NEPT calls by over 8,000

and direct calls to most appropriate Call Taker

dge: Central repository for knowledge documents and reference materials onlinedge: Central repository for knowledge, documents and reference materials online

wed the recruitment process to be initiated

ctionality not previously implemented during CADIUP

Call Takers trained in the new call taking curriculum: Call Taking skills are more advanced e better equipped to carry out their core skills effectively and noted to have a higher skill nce that the previous Call Taking course.

developed and scheduled.

h Education Workforce and Control Centres to develop and agree TNA project plan

October 20106

h Education, Workforce and Control Centres to develop and agree TNA project plan



Deliverable Summary


The Control Cent

Structure

A Control Centre Director Centres

B NEPT CC SeparationSeparated NEPTemergency perfo

C Standardise Protocols & ProceduresStandardised 319Procedures and iC Standardise Protocols & Procedures Procedures and i

D Predict research and briefing

Analysed technolbetter understandvehicles

A Program Director The Project Direc

Resourcing

A Program Director The Project Direc

BDevelop & agree new position description for Call Taking and Dispatching A clear and struc

Reduce the dupliC Centralised Recruitment

pControl Centres


17


Phase 3: BAU



Deliverables

tres Director provides strategic leadership and operational responsibility for all Control

T Call Taking and enhanced NEPT Dispatching: improving focus, Triple Zero and rmance and reducing NEPT bookings undertaken in emergency vehicles

9 LOPs (Sydney’113, Northern 109, Western 67, Southern 30) to 28 Protocols and 140 improved and aligned processesimproved and aligned processes

logy to improve service planning through evaluation of resourcing strategies and changes, ding the performance impact of varying and shifting Paramedic resources, skill sets and

ctor was a dedicated resourcector was a dedicated resource

ctured career path and development program for Control Centre Officers

cation of effort and lack of coordination of recruitment activities that were undertaken in all

October 20107



Deliverable Summary


Shared

A Uniforms The new uniform

B Recognition Improved staff un

C Pre-shift Briefings Regular and cons

Values

D High Performing Teams (HPT)

Triple Zero GoS hsecond counts foFull coaching moHit Call Taking G

Feedback from PE Paramedic Observation Shifts

Feedback from Pdemands, commu

Program & Change Management

A Program Management Clear Executive le

B Change and Communications 3 Pulse surveys,


18


Phase 3: BAU



Deliverables

m has improved cultural and organisational alignment with Control Centre and on road staff.

nderstanding and belier in their contribution in the patient journey and value to the Service

sistent communication of macro-level organisational and operational information

has remained higher than the GoS prior to the launch of the HPT initiative “90/10, Every r the patientdel and roadmap developedOS KPIs

Paramedics and Station Managers indicates improved understanding or workplaceParamedics and Station Managers indicates improved understanding or workplace unications and working relationships between themselves and Control Centres

eadership, ownership and decision making.

delivery against the communications plan

October 20108


Phase 3: Transition to BAUPost September 2010 the CCIP transitioned into Business Asa Control Centre Director

OverviewAn external secondee has been appointed as interim Control Centre Director to oversee the transition to Business as Usual and to manage the remaining elements ofthe transition to Business as Usual and to manage the remaining elements of implementation. This will require additional support and ongoing ownership from stream leads.

A CCIP planning workshop was held on the 28 August with the Project Director and Director, Service Improvement Office to develop the CCIP Transition Plan in order to ensure that the momentum of the CCIP was maintained and the additional phases of some streams were implemented.

Embedding the stream ownership and sustainability of changeThe design of the CCIP and appointment of Service employees as stream leads assists in embedding stream ownership and sustainability of change into the CCIP. To assist in providing insights into activities to assist reviewing key streams.

Final reports have been compiled by stream leaders for individual streams to provide the Control Centre Director and Project Director with oversight of key activities to be undertaken in Phase 3 “Operate and review” (Transition to BAU). These key activities, activity owners and timeframes for review assist in embedding and sustaining change while allowing focus areas for continual improvement.


19


Phase 3: BAU


s Usual with the end of PwC support and the introduction of

Making change stickTo enable changes and benefits of the transformation to be sustained, it is important that the appropriate change management activities and conditions are built into all stagesthe appropriate change management activities and conditions are built into all stages, including the Operate and Review stage. In planning for this phase, the principles of PwC’s 'making change stick' methodology were applied.

The figure below provides and overview of the key change management considerations of involvement, benefits and sustainability in the Operate and Review stage of a transformation programme

Making

Benefits

change stick

Involvement

Sustainability

October 20109


Program ManagementProgram Management was established across all streams to manage interdependencies, risks, and timeframes

Program Structure and GovernanceThe program was structured as a “whole of business initiative” with broad representation of functional areas as stream leads, allow functional leaders to maintain ongoingof functional areas as stream leads, allow functional leaders to maintain ongoing oversight of project progress and remain abreast of project and stream risks.

AmbulanceService of NSW executive steering committee

Sponsor: Mike Willis, General Manager, Operations (Chair)Jamie Vernon, Project Director

Julie Morgan, Governance: Service Improvement Office

PwCJonathan Lunn – PartnerAdam Lai – Project DirectorMichael Wann – Snr ConsultantRachel Linton – ConsultantAmy Plowman Director

Ambulance Working Group Alan Morrison (Education) Phil Keene (Workforce)Roger Hanseen (IT)Max Stonestreet, Core Ambulance Team

Control Centre Managers

Amy Plowman – Director

Stream Leads


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manage toward the outcome of the Optimal Model and

Program Management MethodologyThe CCIP leveraged two main sources for the Program Management methodology, tools and templates:and templates:

the Ambulance Service Improvement Methodology that has been developed and refined under Julie Morgan, Director Service Improvement Office.

PwC Program Management methodology and templates

Role of the Executive Steering CommitteeThe role of the Steering Committee is to improve organisational involvement and maintain ultimate responsibility for signing off deliverables and the successful delivery of the project. The Steering Committee was decisive and provided robust support for the Control Centres Working Group (CCWG). The Steering Committee was chaired by the Chief Executive Greg Rochford.

St i C itt b l d d t A b l k tSteering Committee members lead and represent Ambulance work streams.

Role of the Working GroupThe Control Centres Working Group (CCWG) is responsible for scoping projects, reporting on project progress, communicating and rolling out the processes and change for their respective work streams. The CCWG met weekly and prepared the Steering Committee with up to date progress reports, risks and information for Steering Committee communications. The recalibration of stream time frames and key deliverables was elevated the Steering Committee.

October 20100


Change ManagementThe CCIP leveraged best practice change management princbuy in to the solution

OverviewThe principles behind the change management approach were:

Best fit change approach: The change approach that best fits the Ambulance Service of NSW was one that involved broad consultation to understand opportunities, issues, risks, and directive decision making from leaders.

Involvement: The executive team, managers, staff, patients and NSW Health representatives were all involved at some point throughout the program as required. They were engaged through a number of different forums including surveysThey were engaged through a number of different forums including surveys, workshops, interviews and continual email feedback.

Benefits at the heart of change: a key principle of the program was to keep the patient and staff experience at the heart of the change – and manage to the outcomes and not the task

Sustainability: A measured and careful approach was taken to continue to facilitate Sustainability: A measured and careful approach was taken to continue to facilitate the sustainability of many of the recommendations implemented. As well as having deep engagement with managers and staff in the implementation planning the program also received valuable feedback which allowed the program to be adjusted and recalibrated where necessary.

Change managementg gA detailed Change Management plan was developed at a program level to manage all activities. The change management plan delivered:

Work plan summary outlining the situation, complication, risks, next steps, timeline and funding requirements for each stream.

Communications plan Communications plan

Stream project plans

Staff engagement and satisfaction (Pulse Surveys)


21

ciples to effectively take staff on the journey and engender

Work plan summaryPwC hit the ground running with a draft preliminary work plan summary outlining the situation, complication, risks, next steps, timeline and funding requirements for eachsituation, complication, risks, next steps, timeline and funding requirements for each stream. The work plan was then developed further in collaboration with the Service to assess the priority, ease of implementation and interdependencies for each stream and remained a live document.

Communications plansA broad array of communications mediums were leveraged including monthly circulars y g g y(Sirens), posters in centres, fact sheets, Control Centre expression sessions, weekly CCM meetings, Supervisor workshops as well as significant engagement at a stream level through representative or consultative arrangements.

A Communications stream was developed and incorporated into the full length of the project. A review of this stream is provided in the Program Achievements, Program B Change and CommunicationsChange and Communications.

Due to expansive geographic area covered by the Service and constrained means of staff access to electronic communications was a key component in informing staff, patients and customers of changes, improvements and CCIP updates and successes.

Stream project plansStream project plans were constructed in collaboration with stream leads. Project plans assisted in aligning project outcomes to the CCIP outcomes. Project plans outlined the stream objectives, key activities, activity time lines, stakeholders, benefits and measures, issues and funding requirements.

Pulse SurveysA key components was the “Pulse Survey” – a blend of regular cultural assessments, employee satisfaction and project progress survey with a change readiness tool. Surveys where completed quarterly in February, July and September. Electronic Pulse Survey’s have been developed and can be implemented once all notebooks are deployed into Control Centres.

October 2010

Section 3Program HighlightsProgram Highlights

Section 3 – Program Highlights

Performance improvement The CCIP made significant improvement in Call Taking perforOctober 2010, performance has been sustained above 90% o

Emergency Grade of Service Performance Summary

100%

85%

90%

95%

70%

75%

80%

85%

%

60%

65%

70%

50%

55%

0100

101

0100

112

0100

123

0100

203

0100

214

0100

225

0100

308

0100

319

0100

330

0100

410

0100

421

0100

502

0100

513

0100

524

0100

604

0100

615

0100

626

0100

707

0100

718

0100

729

Actual % calls answered in 10 secs

20 20 20 20 20 20 20 20 20 20 20 20 20 20 20 20 20 20 20 20

Actual % calls ans

Target % calls answered in 10 secs Target % calls ans

Estimate: no data recorded in Genesys


23

rmance measures: since the shift to Global Routing on 5 of calls answered in 10 seconds

y Emergency Average % calls answered in 10 secs

%82%

93%

72% 75%

Beginning of year to NEPT

Separation (5/7/10)

NEPT Separation

(5/7/10) to HPT Ph1 (25/8/10)

HPT Ph1 (26/8/10) to

before global routing

Global Routing (3/10/10) to

13/10/10(5/7/10) Ph1 (25/8/10) routing

(2/10/10)

High Performing

Global Routing

Emergency Average % calls answered in 45 secs99.7%

0100

809

0100

820

0100

831

0100

911

0100

922

0101

003

0101

013

Teams

91% 92%94%

20 20 20 20 20 20 20

swered in 45 secs

swered in 45 secs


Separation (5/7/10)

NEPT Separation

(5/7/10) to HPT Ph1 (25/8/10)

HPT Ph1 (26/8/10) to

before global routing

(2/10/10)


13/10/10

October 20103

(2/10/10)


Performance improvement The CCIP made significant improvement in Call Taking perforhas improved by over two seconds

Emergency Average Speed of Answer Performance Sum

12

8

10

4

6

0

2

101

111

121

131

210

220

302

312

322

401

411

421

501

511

521

531

610

620

630

710

720

730

2010

01

2010

01

2010

01

2010

01

2010

02

2010

02

2010

03

2010

03

2010

03

2010

04

2010

04

2010

04

2010

05

2010

05

2010

05

2010

05

2010

06

2010

06

2010

06

2010

07

2010

07

2010

07

ASA

Estimate: no data recorded in Genesys


24

y

rmance measures: Triple Zero Average Speed of Answer

mmary

Emergency Average Speed of Answer (secs)

8.3 8.1

7.0

Hi h

5.4

809

819

829

908

918

928

003

013

High Performing

TeamsGlobal Routing


NEPT Separation

HPT Ph1 (26/8/10) to


2010

08

2010

08

2010

08

2010

09

2010

09

2010

0920

1010

2010

10

year to NEPT Separation

(5/7/10)

Separation (5/7/10) to HPT Ph1 (25/8/10)

(26/8/10) to before global

routing (2/10/10)

(3/10/10) to 13/10/10

October 20104


Performance improvement The CCIP made significant improvement in Call Taking perforAverage Speed of Answer has improved and importantly the

131233 Average Speed of Answer Performance Summa

300

150

200

250

0

50

100

2 3 3 4 5 8 9 0 0 2 3 4 4 5 6 7 8 9 9 00

2010

0101

2010

0112

2010

0123

2010

0203

2010

0214

2010

0225

2010

0308

2010

0319

2010

0330

2010

0410

2010

0421

2010

0502

2010

0513

2010

0524

2010

0604

2010

0615

2010

0626

2010

0707

2010

0718

2010

0729

2010

0809

2010

0820

ASA

Note: 131233 is the Urgent Medical Booking number used by predominantly b


25

rmance measures: 131233 Urgent Medical Bookings’ historical variation in performance has reduced

ary 131233 Average Speed of Answer g p(secs)

50

3533

2 3

2010

0831

2010

0911

2010

0922

2010

1003

Beginning of year toNEPT Sep (5/7/10)

NEPT Sep (5/7/10) –HPT Ph1 (25/8/10)

HPT Ph1 (26/8/10) today before globalrouting (2/10/10)

by health professionals and their representatives

October 20105


Stream: Systems A MDT Sign on/offDispatching workload has been reduced by moving all ParamTerminal sign on and sign off

Stream Lead: Max Stonestreet

Overview & achievementsWhy we did it

Mobile data terminal (MDT) sign on / off functionality is supported by CAD and Patient Transport Officers in Sydney were already using this MDT functionality effectively.

MDT sign on / off was not in use by all on road staff, resulting in unnecessary radio communications between on-road crews and Control Centrescommunications between on road crews and Control Centres.

Control Centres were undertaking station by station radio roll calls to sign on Paramedics, which was time consuming and inefficient.

What we did

Designed, developed and delivered a MDT sign on/ sign off field trial in Tamworth to d t d t d t i i i tunderstand system and training requirements.

Refined training materials, communications, roll out time frames and resourcing requirements to undertake a state wide roll out of MDT sign on / off.

Implemented a prompt identification and escalation process to improve on road compliance and ensure divisional ownership in addressing compliance.

Benefits (quantified)

Reduction of non core activities and work pressures on Dispatchers at shift change.

Improved availability and visibility of on road resources as stations/vehicles initiated sign on as opposed for waiting for roll call.

Increased the efficiency of Dispatch staff by utilising existing technology and Increased the efficiency of Dispatch staff by utilising existing technology and functionality to reduce the time taken to sign on/off Paramedics and PTOs.


26

medics and Patient Transport Officers to vehicle Mobile Data

Proposed next stepsAmbulance has begun implementing further improvements to the current process under the project “MDT Sign on/off Phase II” This includes reducing the reliance on role callsthe project MDT Sign on/off Phase II . This includes reducing the reliance on role calls and making some important technology improvements.

October 20106


Stream: Systems A MDT Sign on/offPlanning, communications and training materials played a keyof MDT sign on / off

On road MDT train

Stream Lead: Max Stonestreet

Benefits (photographed)

Tamworth daily trial report


27

y role in rolling out, tracking and completing the first phase

ning materials g

Sydney training roll out plan

October 20107

Source: “Sirens” July 2010


Stream: Systems E Notebooks Control Centre staff have access to service communications a

Stream Lead: Gerard Azar


Control Centre staff previously only had access to email, intranet and the internet at shared workstations and these could only be accessed during breaks: many staff had not accessed their email for months

It was important to provide access to electronic materials and communications atIt was important to provide access to electronic materials and communications at work stations in order to improve communications with Control Centre staff

What we did

Investigated a desktop and wireless notebook solution for providing access to organisational communications and operational information

D l d i l t b k i S th N th d S d Deployed wireless notebooks in Southern, Northern and Sydney

Implemented wireless access points in Control Centres that will facilitate the use of other wireless functions


Rolling out desktop notebooks with email and intranet capability to all workstations g p p ywithin Control Centres has allowed staff more efficient and effective access to organisational communications.

Control Centre staff can access Control Centre specific information on intranet (e.g. Protocols and Procedures, and knowledge base)

Internet access is provided to web based mapping information and this has assisted Control Centre staff in guiding Paramedics to locations (Southern – Godding)


28

and additional operational and clinical resources

Benefits (photographed)

Northern Control Centre Officer tilising notebooks for Ser ice comm nicationsNorthern Control Centre Officer utilising notebooks for Service communications

Proposed next steps Continue to provide project oversight, management and support for IT so that the roll

out of notebooks is completed in Western

October 20108


Stream: Systems G Electronic Booking SysDuring the CCIP EBS usage grew to more than 50% of all NE

Stream Lead: Joel Bardsley and David Pennington

O er ie & achie ementsOverview & achievementsWhy we did it

Reduce calls to Control Centres by utilising and promoting an existing online platform for submitting NEPT bookings

Promote an online efficient alternative to customers which would reduce the number o ote a o e e c e t a te at e to custo e s c ou d educe t e u beof callers to 131 233

What we did

Assigned dedicated resources (Archie Salinas and David Pennington) to promoting EBS and providing support for users

Analysed EBS and non EBS data to identify and target high volume non EBS Analysed EBS and non EBS data to identify and target high volume non EBS customers

Developed EBS customer lists, user guides and training materials to provide training and support

Worked with NSW Health to communicate the benefits of EBS to key customers (Patient Transport Units and Patient Flow Units)(Patient Transport Units and Patient Flow Units)

In response to customer requests the Service designed, developed and implemented EBS enhancements to improve the functionality and performance of the EBS

Developed and implemented EBS specific internet content for the Service web site to assist in communicating NEPT eligibility and EBS requirements


29

stem (EBS) EPT bookings


The increase in EBS usage and proportional of EBS requests over non EBS requests is outlined in the table below. The CCIP campaign to increase EBS access and usage targeted existing and potential customers from March

R5 to R7 EBS and Non EBS usage (January to August 2010)

12,000th

6,000

8,000

10,000

12,000

ques

ts p

er m

ont

0

2,000

4,000

Jan Feb Mar Apr May Jun Jul AugR

eq

EBS bookings Non EBS bookings

October 20109


Stream: Systems G Electronic Booking SysDuring the CCIP EBS usage grew to approximately 50% of al


The table below provides an overview of the improvements and benefits realised during th CCIPthe CCIP.

Measure Number Explanation of benefit

EBS usage ~50% Approximately 50% of R5 to R7 bookings were submitted using EBS in Septemberwere submitted using EBS in September

Growth in EBS usage

500%+ growth to 9,100 per

Month

9,100 EBS bookings in September 2010

Total number of EBS Since March 2010 43k requests for NEPTTotal number of EBS requests ~43k Since March 2010, ~43k requests for NEPT

have been submitted via EBS

Call Taker hours saved Over 2,000

Over 2,000 Call Taker hours have been saved allowing Control Centres to priortise Triple Zero calls (based on 1.9 minutes handling time)g )

Growth in EBS access ~400%During the CCIP, EBS access increased by 673 new accounts (up from 138 accounts) to over 800

N f iliti id dThe increase in new facilities has increased th t b Thi i l d 3 jNew facilities provided

EBS access Over 50 the customer base. This includes 3 major Patient Transport Units (Dubbo, Port MacQuarie and Wollongong)


30

stem (EBS) ll NEPT bookings.

Proposed next steps Target internal customers who continue to fax NEPT requests (e.g. R4/ MRU and

R8/Sector offices)R8/Sector offices)

Develop and load EBS e learning module

Continue to identify and target new EBS customers

Continue to work with NSW Health to maintain relationships with Patient Transport Unit and Patient Flow Managers

EBS internet content

EBS pamphlet to promote EBS to Health Services andHealth Services and Aged Care facilities

October 20100


Stream: Systems I Control Centre knowledDevelop and implement a knowledge sharing resource file to

Stream Lead: Mel Willis & Skye McKenzie

Overview & achievementsOverview & achievementsWhy we did it

Previously there was no database or knowledge sharing platform for Call Taking and Dispatch staff to gain an understanding of Service information and situations

Knowledge and information sharing platforms exist to provide Clinical and Operational f P di d P ti t T t Offiresources for Paramedics and Patient Transport Officers.

What we did

Designed an intranet site specific to Control Centres

This knowledge sharing resource file will enable Ambulance and staff to develop, retain and share knowledge on how to coordinate, respond and manage specialised g p g psituations.

The launch of the intranet content was communicated to Control Centre staff via an email to the Control Centre Manager.

Each time new content was placed on the site, another email was sent to the Control Centre Managers to inform their staff.

The implementation of the knowledge base is dependent on workstations being available in all Control Centres.


31

ge basesupport Call Taking and Dispatching functions

Benefits (quantified)(q )

Improved accessibility to Call Taking and Dispatch Reference Materials as acknowledged by Call Takers and Dispatchers

Proposed next steps Continue to expand and refresh the content relevant to Control Centre functions to

i t i lidit d l f k l d b t tmaintain validity and relevance of knowledge base content

Seek to include any suggested additions from staff are considered and added to the knowledge base to maintain staff involvement and ownership

Include information to assist Control Centre staff in obtaining insights into on road working environments (i.e. SBS Ambulance series)

Knowledge base for Control Centre staff on Service intranet

October 2010


Stream: Training A Call Taking and DispatcPlan, design and produce a structured curriculum specific to Ctraining process, Control Centre requirement and inductee ca

Stream Lead: Karl Pirchmoser and Steven Matheson


The training for call takers and dispatchers did not meet patient or Control Centre needs

Gaps existed within the training process, there was no structured or formal follow up training available and minimal resources to support trainees following their initialtraining available and minimal resources to support trainees following their initial Control Centre training at Rozelle.

No mentoring information was available to Trainers on how to train/assist staff and what level should be achieved at specific timelines

What we did

R it d Ed t ith C t l C t i t d i d l d ll Recruited seven Educators with Control Centre experience to design, develop and roll out Call Taking curriculum and training.

Reviewed current training practices, identified core skills requirements and addressed gaps in current Education program.

Acquired and implemented a Dispatching simulator

Involved stakeholders in all processes

Developed a new comprehensive six week Call Taking course followed by structured mentoring and skill development assessment

Developed a new comprehensive three week Dispatching course followed by structured mentoring and skill development assessment

Developed session plans, facilitator notes, student notes, training resources, assessment tools, trainers material and practicum report

AQTF mapping for Certificate III accreditation (Call Taking)

AQTF mapping for Certificate IV accreditation (Dispatcing)


32

ching Curriculum Call Taking and Dispatching to address gaps within the

apabilities

Benefits

Training resources are available ensuring all courses delivered contain identical content and all students receive identical current information

Assessments are competency based and address the skills required within the Control CentresControl Centres

Regular stakeholder involvement ensures currency

Resources are stored on a Quality Management System and audited ensuring currency

Specialist Control Centre Educators are located within all Control Centres to address th ifi d f t ffthe specific needs of staff

A structured training pathway exists progressing students from Certificate III progressing to Certificate IV

Call Takers are equipped to carry out their core skills effectively

Proposed next stepsp p Develop ongoing resources and tools addressing the training needs of stakeholders.

Workshop stakeholders regarding effectiveness of new training practices

Develop mentor package.

Identify skill gap with existing staff. y g p g

Develop RPL package for existing staff.

Develop Supervisor’s Package supporting the mentoring process.

Develop a ‘Certificate to Dispatch’ to assess currency of all current staff

October 20102


Stream: Structure B NEPT Control Centre sSeparating NEPT Call Taking and Dispatching has contributeperformance

Stream Lead: Mike Willis

Overview & achievements

Why we did it

A number of reviews of the Ambulance Service of NSW have identified the need to fully separate the emergency and non-emergency tiers.

Using emergency call-takers to process non-emergency bookings was having a negative impact on call taking performancenegative impact on call-taking performance.

Ambulance was in the process of implementing an enhancement of the Patient Transport Service and it was important that non-emergency patients in Sydney were dispatched centrally to ensure that non-emergency patients were not being carried on emergency vehicles.

.


33

separationed to improving the patient journey and Control Centre

What we did

The Project Director and CCIP team regularly attended all relevant NEPT Working Group meetings to represent and present the interests of Control Centres. Separated Triple Zero/131 and NEPT Call Taking functions within Control Centres

Collaborated with CCMs and the PPP Working Group to design develop and agree Collaborated with CCMs and the PPP Working Group to design, develop and agree NEPT specific Protocols and Procedures

Created dedicated NEPT Call Taking skill sets to support requests for NEPT

Redirected 131 233 calls to dedicated NEPT Call Taking functions in Sydney and Northern.

R i d l t i d th b f d di t d NEPT di t hi Received approval to increased the number of dedicated NEPT dispatching resources for SYCC NEPT dispatch

Implemented dedicated rostering patterns from 0700 to 1900 Monday to Friday and 0700 to 1500 Saturday to respond to NEPT requests and prioritise Triple Zero calls

Revised the 131 233 IVR to assist in directing and processing NEPT calls

Designed, developed and implemented NEPT / EBS specific internet content to provide consistent information to patients, Health Services and the community


Utilisation of emergency vehicles to move non emergency patients has reduced

Proposed next stepsProposed next steps Undertake roster reforms to improve the alignment of the supply and availability

NEPT on road resources to match the patient demand for non emergency transport

Promptly progress the tendering process to select, develop and implement a scheduling tool to improve the utilisation of NEPT resources and reduce NEPT dispatching resources requirements

October 20103

dispatching resources requirements


Stream: Structure B NEPT Control Centre sThe initial resourcing profile was designed to match call arrivamaterials

Initial State wide resourcing profile for the NEPT queue

Approximate Dedicated NEPT Queue Rostered Resourcing Monday to FridayApproximate Dedicated NEPT Queue Rostered Resourcing Monday to Friday

Initial Monday to Friday state wide resourcing profile for the NEPT queue

3

4

5

3

4

5

Mixed queues as per present process out of these hours


0

1

2

5:00 6:00 7:00 8:00 9:00 10:00 11:00 12:00 13:00 14:00 15:00 16:00 17:00 18:00 19:00 20:000

1

2

5:00 6:00 7:00 8:00 9:00 10:00 11:00 12:00 13:00 14:00 15:00 16:00 17:00 18:00 19:00 20:00

these hours these hours

SYCC NCCSYCC NCC

Approximate Dedicated NEPT Queue Rostered Resourcing SaturdayApproximate Dedicated NEPT Queue Rostered Resourcing Saturday

Initial Saturday state wide resourcing profile for the NEPT queue

3

4

5

3

4

5



0

1

2

5:00 6:00 7:00 8:00 9:00 10:00 11:00 12:00 13:00 14:00 15:00 16:00 17:00 18:00 19:00 20:000

1

2

5:00 6:00 7:00 8:00 9:00 10:00 11:00 12:00 13:00 14:00 15:00 16:00 17:00 18:00 19:00 20:00


34

SYCC NCCSYCC NCC

separational patterns and supported with significant communication

Dedicated Intranet location for NEPT procedures and resources

9 NEPT procedures to standardise and guide NEPT Call Taking and Dispatching

October 20104


Stream: Structure C Standardisation of ProCollaborated with Control Centre stakeholders to develop a cand Procedures which will assist in reducing operational erro

Stream Lead: Mel Willis


Historically Control Centres developed ad hoc Local Operating Procedures (LOPs) to respond to gaps in staff knowledge, local conditions or adverse events

The 330 LOPs (SYCC 113; NCC 109; WCC 67; SCC 30) supported silos and did not support the “one Control Centre in four locations” vision for Control Centressupport the one Control Centre in four locations vision for Control Centres

These LOPs overlapped in relation to more than 57 areas of duplication (e.g. mobile phone use) and were inconsistent in many areas (e.g. Sydney versus rural procedures for extension of shift overtime)

None of the local procedures were written, managed, reviewed or approved centrally by the General Manager Operations or the Chief Executive.by the General Manager Operations or the Chief Executive.

This reactive approach to policy making biases outputs toward operational problems rather than normal operations and results in inconsistent practices between Control Centres, confused expectations for staff, duplication of effort as Control Centresdevelop separate procedures on the same topic, lack of communication and oversight, and training problems

The implementation of a virtual CAD to deliver “one Control Centre in four locations” has made standardisation of Protocols and Procedures necessary to ensure consistency between the four centres


35

otocols and Proceduresclear and consistent set of Control Centre Policies, Protocols rs and improve patient outcomes

What we did

Reviewed and mapped over 330 LOPS that identified 57 areas of duplication

Established the Policies, Protocols and Procedures framework to guide the development and agreement of Call Taking and Dispatching Protocols and ProceduresProcedures

Developed a governance process and structure that represents all key stakeholders throughout the Service to continually maintain Clinical, Operational and Educational oversight

Frequently collaborated with CCMs and SOCOs,to develop, assess and agree PPP

Mapped protocols

The PPP infrastructure to standardise the multiple procedures exist for every protocol, and multiple protocols exist for every SOP.

Standard Operating

Policy What it is …A rule; a governing policy

What it isn’t …A process; a set of instructions

Protocols

Procedures

What it is …High level process steps

Wh t it i

What it isn’t …A process; a set of instructions

What it isn’t …

October 20105

What it is …Detailed instructions High level or

vague


Stream: Structure C Standardisation of ProCollaborated with Control Centre stakeholders to develop a cand Procedures which will assist in reducing operational erro

Overview & achievements


Reviewed, translated, incorporated and consolidated 319 LOPs (Sydney’113, Northern 109, Western 67, Southern 30) to 28 Protocols and 140 Procedures.

– Call Taking protocols: 10 Procedures: 45

– Dispatching protocols: 10 Procedures: 56

Supervisor protocols: 8 Procedures: 30– Supervisor protocols: 8 Procedures: 30

– NEPT procedures: 9

Standardisation will reduce operational errors and improved patient outcomes as Control Centre Officers have clear guidance and instructions for undertaking their activities .

Like the application of patient care protocols and procedures, Control Centre protocols provide consistent, effective and demonstrative command and control of any situation

Provide a framework for the seamless handover of responsibility throughout the patient journey across the virtual Control Centres operating in four locations

Standardisation provides a solid foundation for state-wide call routing, allowing a call f ffrom any location to be answered and processed in the same manner, regardless of which Control Centre receives the call

Delivered printed copies to each Control Centre staff member

New PPP are available on the intranet for easy of access and updating improving the certainty and consistency in performing Control Centre functions


36

otocols and Proceduresclear and consistent set of Control Centre Policies, Protocols rs and improve patient outcomes

Proposed next steps Develop and finalise Supervisor protocols & procedures, and track under the High

Performing Teams streamPerforming Teams stream

Receive feedback from Control Centre Staff via email

Amend documents as required and re-issue and educate staff of changes

Produce final manual & personally issue to staff

Regular Protocol Committee meetings & ongoing review Regular Protocol Committee meetings & ongoing review

Form and operate PPP Working Group

Finalise escalation Protocol and Procedure

October 20106


Stream: Structure C Standardisation of ProProcess for reviewing, developing and agreeing to the standa

Mapping LOPs and SOPs

Mapping of existing 319 LOPs and SOPs against the new structure (Sydney’113, Northern 109, Western 67, Southern 30)Northern 109, Western 67, Southern 30)


37

otocols and Proceduresardised Control Centre Policies, Protocols and Procedures

Membership of PPP Committee and Working Group

The PPP Committee is responsible for (a) providing in principle support for suggested changes and (b) recommending draft PPPs for final sign off.suggested changes and (b) recommending draft PPPs for final sign off.

The PPP Working Group is responsible for researching and writing new policies, protocols and procedures in a timely manner and to a high standard

PPP Committee

Membership NomineeMembership Nominee

Control Centre Director (Acting) – Chair Jamie Vernon

Divisional Manager Mark Beesley

Control Centre Manager Nicole Fletcher

Clinical Services (Patient Safety/MDRC /NIC) Graham McCarthy

Education representative Alan Morrison

Secretariat Melissa Willis

PPP Working Group

Membership Nominee

Control Centre Manager (group leader) Nicole Fletcher

Communications Educator Mark Moreau

On-road standby staff representative Ric Jones (WCC)

SOCO David Drysdale (NCC)

DOCO Sharmaine Cohen (SYCC)

QSC Gabrielle Nicholls (WCC)

Call Taker Kylie Crebert (NCC)

Dispatcher Anna Walton (SCC)

SSU R Ch i Aik

October 20107

SSU Rep Chris Aiken

Secretariat Mel Willis


Stream: Shared Values A Uniforms Control Centre staff are wearing a new uniform which reflectsControl Centre staff play in the patient journey.

Stream Lead: Max Stonestreet and Skye McKenzie


Staff in the Control Centres in the Ambulance Service of NSW did not wear a common uniform.

Staff with paramedic qualifications wore the Service’s dress uniform while non-paramedic staff wore a different uniformparamedic staff wore a different uniform.

The research with other Ambulance Control Centres identified that a single uniform was important for building a shared culture.

To better reflect the important role Control Centre staff play in the patient journey the current paramedic working uniform was chosen as the Control Centre uniform.

All t ff i th C t l C t th if d l tt th t fl t All staff in the Control Centres now wear the same uniform and epaulettes that reflect each persons role within the Service.

What we did

Engaged with the Uniform design team and Bisley (uniform provider) to develop uniform options.

Recommended sizes and volume in order to issue the base uniform to staff.

Circulated samples and sizing packs to each Control Centre

Uniform design team agreed changes.

Uniform orders were sent to Health Support Services to be entered into the system for stock picking and issuingstock picking and issuing.


38

s the values of a shared culture and the important role that

Benefits (to be quantified)

The new uniform has improved cultural and organisational alignment with Control Centre and on road staff.

Increased perceived value of Control Centres to the Service and patient journey.

Proposed next steps Include a Control Centre representative on future Uniform design teams and Working

Groups to maintain oversight of Control Centre staff requirements and requests.

New Control Centre uniform

October 20108


Stream: Shared Values D High PerformingControl Centres can achieve organisational performance objeteaming & performance framework

Stream Lead: Jamie Vernon


A lack of focus on motivating and supporting Control Centre staff is contributing to “under performance.

There is a need to reinforce organisational performance objectives and motivate and support our staff to achieve themsupport our staff to achieve them.

What we did

Developed a hypothesis that we can motivate and support our team to achieve organisational performance objectives by:

– Reinforcing clear performance objectives through revitalising the SWITCH dscorecards

– Motivating and supporting staff through:

> effective coaching

> teaming to create a supportive team environment

Held a HPT workshop with SOCOs which resulted in agreement about the benefits of Held a HPT workshop with SOCOs which resulted in agreement about the benefits of High Performing Teams, the role of SOCOs in actively supporting the project, agreement on coaching and teaming principles, and development of key performance measures for cascading scorecards

Held a HPT workshop with CCMs to provide feedback from SOCO workshop and seek responses to SOCO HPT recommendations resulted in the endorsement and expansion of most recommendations.

On August 26, the revised the CC Pulse and “90/10, Every second counts for the patient” initiative was launched to communicate and improve the relevance of key performance and Control Centre measures to staff.


39

Teams (HPT)ectives through High Performing Teams – a coaching,


Triple Zero Grade of Service (GoS) improved by 10% on the day of the “90/10, Every second counts for the patient”.

Triple Zero GoS has remained higher than the GoS prior to the launch of “90/10, Every second counts for the patient”Every second counts for the patient .

Development of individual scorecards to be distributed to email accounts to motivate staff and support staff to achieve the performance objectives.

Proposed next steps Appoint HPT stream leadpp

Reconsider and commit to phased implementation plan and targets

Develop and upgrade LMS to allow coachee comments to be included in LMS coaching portal

October 20109


Stream: Shared Values D High PerformingThrough the first phase of HPT, the Average Call Ringing Timimproved by a full second on average. This has significantly i

On 26 August 2010, the CCIP simultaneously launched the “90/10, Every second counts for the patient” campaign in all Control Centres

It provided posters, quick reference cards and coaching conversations to reinforce theIt provided posters, quick reference cards and coaching conversations to reinforce the importance of the critical performance measures of Call Taking: answering the phone quickly when it rings and remaining in ready status on the telephone system.

State-wide Average

8

7

8

6

Seco

nds

4

5

2010

0101

2010

0112

2010

0123

2010

0203

2010

0214

2010

0225

2010

0308

2010

0319

2010

0330

2010

0410

2010

0421

2010

0502


40

Data errors to be investigated

Teams (HPT)me (average time the phone rings at a Call Takers desk) has mpacted performance.

Triple Zero Grade of Service (GoS) improved by 10% on the day of the “90/10, Every second counts for the patient”.

Triple Zero GoS has remained higher than the GoS prior to the launch of “90/10, EveryTriple Zero GoS has remained higher than the GoS prior to the launch of 90/10, Every second counts for the patient”.

Call Ringing Time (secs)

HPT

2010

0513

2010

0524

2010

0604

2010

0615

2010

0626

2010

0707

2010

0718

2010

0729

2010

0809

2010

0820

2010

0831

2010

0911

2010

0922

2010

1003

Average Call Ringing Time (secs)

October 20100

Average Call Ringing Time (secs)


Stream: Shared Values D High PerformingThe revised CC Pulse now provides Control Centre staff with minutes assisting in communicating the Grade of Service and

“Before” CC Pulse

Staff did not understand the purpose or measures of the previous CC Pulse.

C i t d f f id i ht ki it diffi lt t d t d Communicated performance from midnight making it difficult to understand performance the further from midnight.

Three dimensional columns and no clear number made it difficult to assess performance and volumes.


41

Teams (HPT)real time performance information relating to the last 15

d queue volumes to all staff

“After” CC Pulse

Communications packs were explained and distributed to Call Takers to inform them of the purpose and measures of the new CC Pulse.of the purpose and measures of the new CC Pulse.

The new CC Pulse provides staff with a call to action by communicating availability, grade of service performance, queue volumes and max waiting times for all queues.

The new CC Pulse reports and continually updates key performance measures over the last 15 minutes.

Supervisors have access to all Call Taker performance measures in real time: Supervisors have access to all Call Taker performance measures in real time: including average call ringing time, average time not ready over their shift and the number of time the phone rings for longer than 15 seconds.

7592 556

October 2010


Stream: Program B Change and CommuniExamples of CCIP communications

CCIP Pulse Survey posters to communicate results and employee highligh

Fact sheetsSirens ArticlesPosters / desk cardsCCM meetingsExpression Sessions


42

SOCO DOCO workshops

cations

hts

October 20102



CCIP Fact Sheets to communicate the implementation of streams and provide updates on projCCIP Fact Sheets to communicate the implementation of streams and provide updates on proj


43

cations

oject progressoject progress

October 20103



Sirens articles assisted in communicating CCIP progress and raising the profile of Control Cen

Source: “Sirens” May 2010


44

Source: “Sirens” August 2010

cations

tres in delivering excellence in care to improve the patient journey

Source: “Sirens” July 2010Source: Sirens July 2010

October 20104


Additional highlights and benefitsThe CCIP undertook call routing initiatives to assist in improvanswered in 10 seconds) by improving the utilisation of availa

Queue thresholdsWhy we did it

Triple Zero were presented to individual an Control Centre for 45 seconds and if unanswered were withdrawn by the Telstra Triple Zero operator and re-presented to an available Call Taker state wide.

This effectively trapped the call if all Call T\akers in the centre were busy regardless of the availability of other Call Takers state wide and impacted Ambulance’s ability to meet their performance target of 90% of calls answered in 10 secondsmeet their performance target of 90% of calls answered in 10 seconds.

The Genesys telephone system was able to apply “queue thresholds” specific to each Control Centre: this would in effect re-route calls to other centres if there were more than a certain number of calls waiting in the Triple Zero queue.

What we did

C lt d ith C t l C t M IT SSU St t C i ti d I t Consulted with Control Centre Managers, IT, SSU, State Communications and Integto develop and implement call routing strategy

On 1 July 2010, implemented the “queue thresholds” for each Control Centre including the following actions:

– test and integrate the operational and technical requirements

– further develop protocol and procedures

– understand and manage risks

– understand and communicate benefits of global routing.

Since 1 July, queue thresholds have been systematically reduced for each Control Centre to assist in answering Triple Zero calls as soon as possibleCentre to assist in answering Triple Zero calls as soon as possible


45

ing the Triple Zero Grade of Service (90% of calls to be able Call Takers in other Control Centres

Global routingWhy we did it

Triple Zero were presented to individual an Control Centre for 45 seconds and if unanswered were withdrawn by the Telstra Triple Zero operator and re-presented to an available Call Taker state wide.

This effectively trapped the call if all Call Takers in the centre were busy regardless of the availability of other Call Takers state wide and impacted Ambulance’s ability to meet their performance target of 90% of calls answered in 10 secondsmeet their performance target of 90% of calls answered in 10 seconds.

What we did

Implemented “gl\obal routing”: the process by which calls are automatically routed to the first Call Taker available state wide if a call has waited in any local queue for more than 2 seconds.

I l t it i l d Implementaiton involved:

– Bringing together CCMs, Comms, IT and Integ to design the technical specification

– Ran risk workshops with the CCMs

– Developed and rolled out Geo location training, and CAD mapping upgradep g, pp g pg

Global routing went live on 4/10/10.

Benefits

The results have been summarised at the beginning of this section: but include record call taking performance across all emergency queues.

This performance has been sustained.

October 20105

Section 4Next StepsNext Steps

Section 4 – Next steps

Next stepsIt is important to continue communicating with stream leads tostrategies for continual improvement

Finish project Business

Next month Next 3 m

PurposeContinue to provide overall project leadership to complete existing streams to build on and drive Control Centre performance improvements and efficiencies.

The transition to business asactivities assists in sustainingrealise additional performancbeyond the CCIP.

The transition business as ufocuses on embedding the ctransformed Control Centre delivering sustainable benefculture of continuous improvement

Streams that require ongoing oversight and involvement from the CCIP team to assist in driving stream activities and monitoring completeness are: High Performing Teams –

Implementation Plan

Key streams

and

continuous improvement.While all streams present opcontinual improvement, the assessment for Control Ceninitiatives include: Workforce plan Award changes: includin

Implementation Plan- Step 1 of 9- Step 2 of 9

Notebooks - Continue to monitor and report roll

out of SYCC and WCC notebooks Curriculum

activities Additional CAD bandwiduplink and downlink CADimprove activation times

- Monitor Dispatching course progress Centralised recruitment

- Understand Control Centre recruitment requirements for 2009 and early 2010

- Monitor Recruitment appointment position is in place on 11 October andposition is in place on 11 October and undertaking and fulfilling Control Centre recruitment requirements

Duplicate telephone number alerts- Monitor technical developments

and operational requirements for implementation.


47

o continue oversight, make change sustainable and develop

s as usual Recommended next steps

months Next 12 months

s usual of stream g the change to ce improvements

The close proximity of the CCIP team and understanding of what is required to deliver excellence in care, the CCIP has developed future considerations to assist the Service in continually delivering on the vision.

usual stage of change of the functions,

fits, and building a

In addition to the continual improvement strategy for streams that have transitioned to business as usual, the CCIP has outlined below the considerations for future improvement. These are: Undertake tendering process, purchase and

implement NEPT scheduling toolpportunities for areas for

ntre improvement

ng TNA

implement NEPT scheduling tool Consider on-road dynamic

deployment technology Consider on-road resource analysis tools

(eg Predict) Construct a future state MDT Working Group to

research development in MDTs and assess dth to increase D processing and s.

patient and organisational benefits Centralised rostering.

October 20107

Section 5Learnings for future projecLearnings for future projecctscts

Section 5 – Learnings for the future

Learnings for future programsCapturing key learnings is important to improve execution of f

OverviewThe Control Centre Improvement Program proactively and continuously sought out ways to improve and documented lessons learned in stream project closure reports There is ato improve and documented lessons learned in stream project closure reports. There is a significant opportunity for the Service to leverage these learnings in future programs and to continue to build the Service Improvement methodology.

The key success factors for the project were:

A truly whole-of-business program: the program involved collaboration and support of Control Centre operations and all the functions that support them there was strongControl Centre operations and all the functions that support them, there was strong engagement of all responsible areas in the program at all levels from the Executive Steering Committee through to individual stream leads.

Strong Program Management & Governance: Strong, dedicated and aligned Executive Steering Committee, Program Sponsor, Program Manager, Service Improvement Office and Program team.

Managing as an integrated program of work: Managing an integrated program office through a single Program Working Group

The Program Management methodology: The PM methodology, tools and forums supported the management of complexity and change.

The transformation methodology: Assessment of the as-is designing the to-be and The transformation methodology: Assessment of the as-is, designing the to-be and then moving into detailed design, construction and implementation with post implementation review and tracking.

Collaborative approach: Starting problem solving and solution design with a hypothesis, or “point of view”, and strengthening with high stakeholder collaboration.

Hypothesis driven and evidenced based: Develop an early hypothesis and seek Hypothesis driven and evidenced based: Develop an early hypothesis and seek evidence to support proposed changes and review solution post-implementation.

Patient Centric and looking outside: the patient journey was the focus of the project


49

future service improvement programs

Communications: a well planned, targetted and continuous communication campaign was undertaken throughout the life of the program at all levels of the organisation.

Continual learning: seeking feedback and continuously improving the projectContinual learning: seeking feedback and continuously improving the project

A truly whole-of-business programThe CCIP, unlike past performance improvement programs with in the Control Centre, sought to improve the support of the Control Centres rather than limiting the scope for change to Control Centre operations. This was a clear mandate from the Chief Executive at the beginning of the program and ensured that Workforce and Recruitment IT SSUat the beginning of the program and ensured that Workforce and Recruitment, IT, SSU, Comms and Education were deeply involved in changes. These groups were engaged throughout the life of the projects through a number of levels: (1) Stream leads were allocated from the support functions to engender ownership and get the right people to run the stream, (2) Working Group membership included key senior leaders who could make decisions and remain accountable and (3) the program reported into the Executive Steering CommitteeSteering Committee.

Strong Program Management & GovernanceProgram Sponsor: Mike Willis, GM Operations, was very active throughout the program and chaired weekly Working Group meetings. An active and present Sponsor providing strong and consistent leadership allowed decisions with critical implications to be made quickly and risks to be mitigated as requiredquickly and risks to be mitigated as required.

Service Improvement Director: Julie Morgan, played a role of significant importance in establishing and framing the program, overseeing the program through Working Groups and weekly Service Improvement meetings and playing the important role of linking the CCIP to other programs across the Service.

Program Director: Jamie Vernon provided strong and capable leadership and broughtProgram Director: Jamie Vernon provided strong and capable leadership and brought deep business knowledge, leadership skills, understanding of the stakeholders and an ability to drive change and “get things done”.

October 20109


Learnings for future programs Capturing key learnings is important to improve execution of f

Strong Program Management continuedStream Leads: Stream leads were accountable for delivery and were drawn from across the Service from their respective functional areas This strategy employed ensured thatthe Service from their respective functional areas. This strategy employed ensured that stream projects were owned and managed, were aligned to the functional strategy and kept other functions involved and accountable.

Core project team: the dedicated team, including Max Stonestreet, Mel Willis and Karl Pirchmoser were drawn from Control Centre operations and brought deep subject matter expertise, a passion for improvements and full time dedicated project resources.

Weekly Working Group meetings, chaired by the Sponsor, were of significant importance. These were well attended, especially by the Sponsor, SIO Director and Program Director. Decisions were made regularly and communication was constant.

Managing as an integrated program of workThe improvement effort focussed on the Control Centres over the past year has beenThe improvement effort focussed on the Control Centres over the past year has been immense – managing interdependent changes, their timing, their communication and change management efforts was complex. Managing change as an integrated program of work under a single Program Director and Program Working Group allowed delivery of a complex set of changes.

The program management methodologyp g g gyLeveraging the Service Improvement Office methodology, PwC’s best practice PMO methodology and learnings from our previous projects, the PM methodology allowed a focus on delivering the quality, cost and time of program activities. Importantly, the program tools – project planning templates, program reporting templates, Working Group standing agendas, communications plan templates, project closure documents – assisted in a consistent approach Scope was managed tightly through escalation to the Workingin a consistent approach. Scope was managed tightly through escalation to the Working Group and decisions made to expand the program or make others accountable where appropriate. As the program grew through these changes, the PMO began reporting on their progress immediately.


50


The transformation methodologyLeveraging NSW Health’s Redesign School methodology and PwC’s best practice transformation methodology the program followed a structured assessment of the as istransformation methodology, the program followed a structured assessment of the as-is, design of the to-be and the development of an integrated program of work to construct and implement the change. Streams were reviewed post project closure for a time agreed at the Working Group.

Collaborative approachThe program as highl collaborati e and in ol ed Control Centre staff and managementThe program was highly collaborative and involved Control Centre staff and management and stakeholders throughout the program. This included regular meetings (for example weekly Control Centre Management meetings) and ad hoc meetings required at Program or Stream levels (eg NEPT workshop, Global Routing workshops, Protocol and Procedure working sessions). Workshops were held through all phases of the project: from understanding the current state, to solution design, to implementation and risk mitigation planningmitigation planning.

Two-way communication forums (including open “Expression Sessions” with Control Centre staff and DOCO/SOCO workshops) were held to keep staff engaged and receive feedback.

The program may have benefited from greater ownership of change at the supervisor level It is worth considering engaging this group further in future – particularly around thelevel. It is worth considering engaging this group further in future – particularly around the next wave of the High Performing Teams stream.

Hypothesis-drivenDuring the problem solving, solution design, implementation planning and risk planning phases, a hypothesis driven approach was employed. This involved the central program office often involving a small number of other staff identified a hypothesis to be testedoffice, often involving a small number of other staff, identified a hypothesis to be tested through workshop consultations and detailed analysis. This often involved the early development of “point of view” or an answer that was “80% right” rather than starting from scratch. This accelerated design, focussed analysis and effort.

October 20100


Learnings for future programs Capturing key learnings is important to improve execution of f

Evidence basedThe program made a particular effort to identify an evidence base to substantiate perspectives test and validate hypotheses and review project post implementationperspectives, test and validate hypotheses and review project post implementation. Identifying and gathering evidence helped with the change management effort.

Patient centric and looking outsideKeeping the patient at the centre of change was a key principle of the program. This resulted in Voice of the Customer research during the initial design phase. It also manifested itself in man of the changes and comm nications to staffmanifested itself in many of the changes and communications to staff.

The program also took an external viewpoint to understand global good practice to be leveraged during the design phase. This proved to be of value for showing the “voice of the possible” and assisting in the change management effort.

CommunicationA structured communication plan was developed at a Program level at the beginning of the project. This was a “live” document and the communication efforts became a stream reported on weekly to the Working Group.

It included Fact Sheets, Sirens Articles, Posters in Centres, Desk cards, Expression Sessions and manager workshops. The intranet was used to communicate to Control Centre staff for the first time greatl assisted b the a ailabilit of notebooks on desksCentre staff for the first time – greatly assisted by the availability of notebooks on desks.

Communication extended beyond Control Centre staff – to the whole organisation.

Feedback was regularly sought through forums and importantly a “Pulse Survey” that tested both understanding of staff and morale. Each survey was presented and discussed with the Working Group and actions were agreed in response to the feedback.


51


Continual learningThe project sought feedback continuously to improve its operation and interaction with stakeholders This took place regularly at Working Group meetings CCM meetings andstakeholders. This took place regularly at Working Group meetings, CCM meetings and stream meetings.

Learning were also recorded in the Project Stream Closure reports – which are outlined on the following pages.

Investment in implementation supportAmbulance focussed more investment into implementation support rather than merely diagnostic and design support. PwC was engaged throughout the end-to-end journey rather than “designing and running”.

This allowed the team to have independence throughout the program, deep expertise in transformation management and change management and technical knowledge in areas such as call routing strategies coaching contact centres etcsuch as call routing strategies, coaching, contact centres etc.

Focus on skills and knowledge transferPwC transferred the skills and knowledge of project management, change management and more technical areas of support through out the program to the core project team.

Letting leaders leadLetting leaders leadThe program has learnt that engendering ownership of the leaders and supervisors for changes is of significant importance in transferring the accountability for implementation from the project to the Business.

October 2010

Appendix AOverview of initial staff woOverview of initial staff woorkshops and site visitsorkshops and site visits

Appendix A – Overview of initial staff workshop and site visits

Workshop with Control Centre and HAC MA workshop with the Control Centre and HAC Managers was discussed current challenges in supervision, structures, Metro

Supervision of Control CentresThe Control Centre Managers are concerned that there has been a reduction in oversight of the Control Centres since the removal of the Strategic Communications Manager roleof the Control Centres since the removal of the Strategic Communications Manager role. There is concern that under the current structure Control Centre Managers have limited ability and opportunity to develop co-ordinated approaches to common issues. For example:

Different supervision structures are used in the different Control Centres, with actual roles of individuals in the same positions varying across Centres

Workarounds are developing at an Control Centre level in areas such as rostering, coaching, payroll, performance management and training

There is no standardised methodology for determining threshold levels

In addition, the Control Centre Managers do not feel that they have adequate representation to IT and Communications equipment support, Clinical development andrepresentation to IT and Communications equipment support, Clinical development and Training. The Control Centre Managers have contact with these areas, but they believe that the Control Centres would receive increased support through a single State wide Control Centre Manager. In turn a single Manager would enable support functions to approach issues in Control Centres as a whole rather than being required to address issues within four separate structures.

C d d C t l t tCommand and Control structureControl Centre Managers reported that responsibility and accountability between the Centres and Road resources are not clearly defined. Control Centres are currently using the Paramedic resources made available to them by Operational staff, but they take the blame when the resources are not adequate to meet demand.

L k f i t d i l lti i th d tLack of appropriate on-road resources is also resulting in the need to move crews between towns to create coverage. This is resulting in high costs, as crews may be asked to drive to a different town and back again during their shift to meet coverage needs.


53

anagers held on 12 May 2009. During the workshop the Managers

o / Rural differences and HAC …

Differences between Metro and Rural areasThe Operation Managers discussed the different issues faced by Rural and Metro Centres These include:Centres. These include:

Rural call takers need to capture different information than Metro call takers. Rural call takers may need clear directions to a site, rather than a street address, and UHF radio contact details

Metro call takers may need more specific location details than the street address that would be adequate for rural towns For example a CBD street address may alsowould be adequate for rural towns. For example, a CBD street address may also need to be supplemented by a building name, cross street and floor level

Rural and Metro dispatching requires a judgement of time for a vehicle to cover the distance to an incident. This may be impacted by the terrain and distance to a rural incident, and the traffic flows in a metro area. Similarly, there is judgement required in determining what vehicle should be dispatched (i.e. Off road vehicle, rapid response

t l )motorcycle)

HACThe Control Centre Managers consider the HAC to be a useful addition to the emergency call taking process. The Control Centre Managers are concerned that insufficient work has been done to understand the level of demand for HAC services under CADIUP, and whether HAC will be sufficiently resourced to meet the additional demand created when the Control Centres are linked.

The potential to use Health Direct for HAC functions was discussed as an option for future secondary triage delivery.

HAC is currently available to the Sydney Control Centre, but there is a lack of visibility of ll di t d t HAC C t l C t t ff d t h i ibilit f h th ll di t dcalls directed to HAC. Control Centre staff do not have visibility of whether a call directed

to HAC is being answered. They also do not know whether a caller has hung up or whether the call has been adequately dealt with when the call disappears from the queue. As a result Paramedic resources are being dispatched to respond to incidents, only to find that the caller has received assistance from HAC.

October 20103


Workshop with Control Centre and HAC M… as well as system and Patient Transport systems …

VisiCAD FunctionalityVisiCAD has been in use by the Control Centres for ten years. It was noted that some of the original functionality of the system has yet to be implemented For example the MDTthe original functionality of the system has yet to be implemented. For example, the MDT sign on- sign off functions have yet to be enabled for Paramedics.

Call BacksThere is currently no visibility of callers that are calling back to the Control Centre. As a result, one caller who needs to call the Control Centre back needs to go through the same process each time the call and ill not necessaril speak to the same Call takersame process each time they call, and will not necessarily speak to the same Call taker. The Operation Managers discussed the potential for system changes to automatically recognise and load information from previous calls from the same number. The issues of identification of call backs was also raised in the State Coroner’s inquest into the death of David Iredale.


54

anagers (continued)

Patient TransportThere is concern amongst the Control Centre Managers about the delivery of Patient Transport functions The issues raised were as follows:Transport functions. The issues raised were as follows:

Some hospitals are making Patient Transport bookings in bulk which is causing spikes in demand for Call takers and scheduling of vehicles

Electronic booking of Patient Transport has had a low uptake, with only 8% of PTS booked online. Hospitals that have received additional engagement have shown higher uptake levelshigher uptake levels

Emergency calls follow a scripted process. Patient Transport bookings can be more difficult as they require significant judgement and are more complex interactions

There have been some issues with rural Patient Transport services not meeting deadlines. As specialists in rural areas may fly in for short periods, delays in Patient Transport can cause patients to have their appointments to be rescheduled until theTransport can cause patients to have their appointments to be rescheduled until the next time the specialist visits. This has a severe impact on the patient journey, as well as requiring additional Ambulance Service resources to organise and deliver additional Patient Transport services.

October 20104


Workshop with Control Centre and HAC M… and resourcing issues …

ResourcingThe Control Centre Managers discussed the lack of resources in the Control Centres. This is impacting on:This is impacting on:

the potential ability of the Western Control Centre to cope with major event

Overtime levels – in the Western Control Centre, overtime levels are sufficiently high that staff can pick and choose which extra shifts they work. This has led to an inability to adequately resource some shifts due to a lack of staff

Supervision of staff in Western and Southern, as SOCO’s are not rostered for every overnight shift, and in Western the DOCO moves to the Dispatch board from 1am

Call taking KPIs

Coaching, mentoring and training of staff, as there is inadequate time during shifts to allow for these activities

Multiskilling of staffStaff in different Control Centres have different skill sets. For example:

Sydney staff are trained to be multiskilled across Call taking and Dispatching, but there is limited opportunity for staff to maintain skills in both

Staff in the Western Control Centre rotate through both Call taking and Dispatch functions on an eight week roster. This enables them to maintain skills in both areas.

Communications with staffStaff do not have ongoing access to email, which is impacting on the ability of Control Centre Managers to distribute information.


55

anagers (continued)

Sustainability of previous recommendationsPrevious projects have made positive recommendations for improvement. The Control Centre Managers were concerned that they had been unable to sustain these initiativesCentre Managers were concerned that they had been unable to sustain these initiatives. Key factors were:

Resource constraints – competing demands for resources to meet core operational requirements has impacted on the sustainability of coaching, performance management and training recommendations

Lack of ongoing support at an Executive and Divisional Manager level for the Lack of ongoing support at an Executive and Divisional Manager level for the continuation of change initiatives

There is no structured ongoing training in place to support change initiatives. As a result, staff fall back on old habits rather than embed new practices.

Quick winsThe Managers recognised that the success of some SWITCH and PIPNOC changes could provide opportunities for quick wins if these initiatives were rolled out to the other Control Centres.

October 20105

Appendix BOverview of the Optimal MOverview of the Optimal MModelModel

Appendix B – Overview of the Optimal Model

Overview of findings from the Global Scan The Service identified a number of key similarities and differe

Strategy and structure Services are using a command and control approach to direct on road resources

Operations Centre positions are viewed as specialist roles

Production and distribution models are in place for some Services

A single Senior Management position is responsible for all Centres in each Service

Virtual environments are employed where more than one Operations Centre is used in a Servicein a Service

Multiple Operations Centre sites are in use by most Services

Resourcing, training and education There are differences in the recruitment of Call taking roles, with some Services

preferring medical experience, while others prefer staff with call centre experiencepreferring medical experience, while others prefer staff with call centre experience without medical knowledge

Dispatch roles are recruited from experienced Call taking roles

All Services provide extensive initial training, with up to 14 weeks being provided to new recruits in some centres

Some Services are offering recognised qualifications for staff

All Services have an ongoing training and development program

Staff development aligns to career progression


57

of Good Practicesences between the Control Centres analysed

Role and Responsibilities The majority of Services contacted have removed non-core functions from

Operations Centre staff through systems processes or splitting of rolesOperations Centre staff through systems, processes or splitting of roles

Some call taking is being done through ACD systems to increase the call taking speed.

Patient transport There has been a move away from Services providing non emergency patient y p g g y p

transport

Patient transport bookings have been split or removed from most Operations Centres contacted

Automation Services are using automation to streamline dispatch and on road communications

Email, intranet and internet access are being provided at workstations for some Services with strict security protection

Behavioural elements All Services require Operations Centre staff to wear uniforms All Services require Operations Centre staff to wear uniforms

Interaction with on road staff is encouraged through on road shifts for Operations Centre staff, as well as site visits by on road staff.

October 20107


Overview of the Optimal ModelThe Optimal Model incorporates elements from consultationsimprovement within the current model …

Overall Strategic directionNSW Ambulance Control Centres will support a world best practice patient journey by providing efficient and effective call taking triage prioritised dispatch and advisoryproviding efficient and effective call taking, triage, prioritised dispatch and advisory functions in response to emergency and non-emergency requests for Ambulance services.

Shared ValuesThe Control Centres will be actively promoted with internal and external stakeholders as a specialised area of the Amb lance Ser ice ith e pert staff pro iding a critical element inspecialised area of the Ambulance Service, with expert staff providing a critical element in the overall patient journey.

Control Centre staff will be encouraged to develop and maintain their skills through a structured training and development program that emphasises the specialist role and valuable contribution of Control Centre staff.

Control Centre staff will wear uniforms that reflect their rank and specialist role within theControl Centre staff will wear uniforms that reflect their rank and specialist role within the Service.


58

and analysis to address identified opportunities for

StructureThe Ambulance Control Centres Director provides strategic leadership, financial and operational responsibility for all Control Centres and reports to the General Manageroperational responsibility for all Control Centres, and reports to the General Manager, Operations. The Director is of the same level as Divisional Managers, and will be required to work collaboratively with Divisional Managers in order to optimise the co-ordination and delivery of on-road resources. Additionally, the Director will work closely with senior staff in Clinical Development, Corporate Services, Finance and Data Services, and other Emergency Service providers to achieve a best practice patient journey.

The Control Centres are managed by Control Centre Managers who report to the Director, Control Centres, and work closely with Divisional Managers on local supply and demand issues. Control Centre Managers are also responsible for specific performance improvement project portfolios to operationalise strategic initiatives.

Control Centres co-ordinate the deployment of Paramedic resources to incidents through prioritised dispatching of emergency and non-emergency calls. Operational Divisions areprioritised dispatching of emergency and non emergency calls. Operational Divisions are responsible for providing agreed resource levels to meet predicted demand.

Each Control Centre provides clinical specialists for emergency advice, and secondary triage services for non-critical service requests. Patient transport is co-ordinated through each Control Centre, with separate Call Taking stations, and, where sufficient demand exists, separate Dispatch stations.

Each Control Centre will be linked through state wide IT systems, standardised policies, procedures and processes, and a unified high performance culture.

October 20108


Overview of the Optimal Model (continued)Training and education programs are designed to meet specicomplemented by behavioural elements that promote team w

Behavioural ElementsPositive working relations and a high quality, professional service delivery culture will be promoted within Control Centres and with Divisional Staffpromoted within Control Centres and with Divisional Staff.

Internally this will be achieved through:

providing all staff with regular coaching by appropriately trained senior staff

Pre shift briefings of Call Taking and Dispatch teams

Control Centre employee recognition programs Control Centre employee recognition programs

Positive working relationships with other Operational staff, the Executive, other Ambulance staff and external stakeholders will be promoted through:

the ongoing championing by senior Control Centre staff of Control Centres as a specialised area of the Ambulance Service

C t l C t t ff d t d t k l id l hift ith d Control Centre staff encouraged to undertake annual ride along shifts with on-road staff

on-road staff actively encouraged to undertake observation shifts at Control Centres

Rotational positions for experienced Paramedics to provide specialised advisory functions within Control Centres

Ambulance Service and public recognition of the contribution of Control Centre staff in major incidents

on-road staff will receive radio communications only for incidents that they have been assigned to


59

)fic capability needs and develop staff career paths,

work and recognition …

A Performance Management Framework will be established to reward high performance and investigate complaints regarding Control Centre or Operational staff. Investigations will be carried out collaboratively by senior management staff from both Divisional and C t l C t ith i t i t l t dControl Centres, with appropriate internal management redress.

Training and EducationAll new staff will receive training that follows a specialised and standardised Control Centre curriculum. Initial training will be conducted centrally and will include both classroom based and simulation learning. Key training areas will be specialised systems, including CAD and AMPDS simulations, medical terminology, first aid, customer service, audit processes, cultural awareness and stress management. New staff will be required to pass evaluations in all areas prior to continuing to on site training.

On site training of new staff will be conducted by Control Centre training staff, providing both a structured training program and specialised remedial training as required. New staff will be required to pass additional evaluations on site during their probation, and alsostaff will be required to pass additional evaluations on site during their probation, and also undertake a Certificate II in Ambulance Communications within their first year of employment.

Ongoing training will be provided to all staff during working hours to address identified gaps, system issues, and ongoing development needs. Staff will be required to complete a minimum number of training hours annually. Additionally, specific training programs will be req ired to be completed b staff prior to being considered for progression andbe required to be completed by staff prior to being considered for progression and promotion.

October 20109


Overview of the Optimal Model (continued)Revised recruitment and Ambulance Control roles, coupled wongoing quality and performance improvement initiatives …

ResourcingStaff will be recruited through a two stage, structured process. An initial screening to identify candidates with appropriate capabilities will be carried out by an external serviceidentify candidates with appropriate capabilities will be carried out by an external service provider. Screening will include sighting of qualifications, telephone interviews and testing to identify appropriate psychometric, communication, comprehension and physical capabilities. The second stage will involve face to face interviews of remaining candidates by Ambulance Service staff.

Control Centre Officers (CCO’s) will fulfil call taking, dispatch, supervision, coaching and some training functions within Ambulance Control.

Control Centres will be resourced to provide adequate staff to meet KPIs during all shifts, allowing sufficient relief for coaching and interventions. Separate supervision for call taking and dispatch functions will be provided for the duration of each shift. In addition to supervision staff, Quality Support, Paramedic Specialist and Health Access Coordination will provide additional expertise to support ongoing quality improvement.will provide additional expertise to support ongoing quality improvement.

Systems Support Unit (SSU) and Education resources will be based within each Control Centre. These staff will report to management within Corporate Services and Clinical Development, and have dotted line reporting to the Ambulance Control Centre Manager. Additionally, they will be tasked to work in conjunction with Control management to deliver services within the Control Centre, operating within a state wide delivery frame ork to facilitate consistenc across all Amb lance Control Centresframework to facilitate consistency across all Ambulance Control Centres.


60

) with process and system improvements, will underpin

Processes and Systems alignmentThe Control Centres will use standardised policies, processes and systems to maximise the efficient delivery of services Common systems platforms will used for CAD AMPDSthe efficient delivery of services. Common systems platforms will used for CAD, AMPDS, Rostering, secondary triage and administrative functions.

Automation will be used to expedite common processes, including the following:

Initial assignment and fluid deployment of on-road resources

On-road resource sign on and sign off functions

Rostering of on-road and Control Centre resources

Automated pager, announcement and mobile phone alerts for Ambulance stations and on-road staff

Internet portals and menu driven telephony for Patient Transport requests

E h k t ti ill b i d ithEach workstation will be equipped with:

Email

Intranet, including operating procedures and wiki style databases of updateable special case handling information

Limited internet connectivity (for work related content such as mapping, medical y ( pp g,terminology, drug information and meteorology).

Policy and procedure changes will require consultation with the Control Centres Director who will consider the impact on Control Centre operations, and any subsequent impact on the patient journey, prior to implementation.

Ongoing process and system improvement initiatives will be overseen by the Director, with special improvement initiatives assigned to Control Centre Managers to coordinate across the State.

October 20100

Documents

Control Centre Improvement Project Every second … ccip project-bfa1960f...Queensland Ambulance Service –Queensland (QAS) StJohnSt John –NZ Toronto Emergency Medical Services