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Expanding New Zealand’s health call lines to cope with COVID-19

Andrew Slater never expected his call centre staff would be delivering babies over the phone on a regular basis. Mr Slater certainly didn’t foresee he would be running around Auckland dairies on the hunt for Ajax Spray n’ Wipe and hand sanitiser for the office.

Nor did he expect an IT system that would normally take five months to develop could be established in just seven days. In the COVID-19 pandemic, the chief executive of Homecare Medical, the organisation that runs Healthline, has found the extraordinary has become ordinary.

“To give some context, normally we would deliver a baby ‘over the phone’ or deal with someone with severe chest pain probably once a year but, in the last week, the number of those presenting to the service has been alarming.”

This is because, says Kristin Good, Homecare Medical’s clinical lead for primary health, New Zealanders under Alert Level 4 lockdown have been reluctant to reach out to their GPs for healthcare as they normally would. “So, as a result, they’re presenting to Healthline much later and are much sicker than usual,” Dr Good says. “It’s added a new layer of complexity.”

Homecare Medical runs the National Telehealth Service, including Healthline, the free mental health line 1737 and the general practice after-hours nurse triage service. COVID-19 has forced a rapid transformation in the past two months.

Staff were already partially prepared. Hard lessons had been learned last year from major health emergencies: the terror attacks in Christchurch, the measles outbreak, and the Whakaari/ White Island eruption.

“This enabled us to establish and strengthen our relationships within the health sector,” Mr Slater says. But, in many ways, COVID-19 has been totally unique, he says. “The increased public need, and for such a sustained length of time, as well as the multicultural dimension…Dealing with international travellers, the Chinese community, our Māori and Pasifika communities, our elderly population… it has affected all communities, all of Aotearoa, in different ways.

“The service has never experienced anything of this magnitude before.” Equity initiatives are of high priority, Mr Slater says. The service is working with New Zealand’s Māori, Pasifika and deaf communities, in particular, towards ensuring they get timely, relevant health advice.

Dr Good and Mr Slater say they are immensely proud of the way their staff  have risen to the challenges presented by COVID-19. The organisation began taking action in late January, and a dedicated public phone service was made available 24/7 for COVID-19 related health advice and information by 7 February.

Three days later, 34 Mandarin speaking health advisers had been recruited and trained. Staff numbers were rapidly increased, from 126 manning the phones at Healthline at the end of January to 426 by the end of March.

When Mr Slater and Dr Good spoke with New Zealand Doctor in mid-April, the number had increased to 500-plus clinical and non-clinical staff delivering the service. Many are working from home, but some staff are still working in Healthline’s contact centres, where they are practising physical distancing, says Mr Slater.

The number of contact centres has increased from three to eight – five in Auckland, two in Wellington, and one in Christchurch. There are also five smaller regional hubs.

Mr Slater says credit needs to be given to the staff who worked closely with telecommunications provider Spark to implement a five-month IT programme in just one week.

“Our infrastructure has got six times bigger. We were developing and deploying virtual desktops, an intranet, so people are able to get the information they need and several phone lines.

“Every staff member needed to have all the right tools, a desk, a computer and they had to be inducted. “We also had to build robust security and privacy frameworks, especially to allow staff to be able to work from home…to make sure nothing was compromised.”

The biggest challenges in facing COVID-19 so far have been the ones Mr Slater least expected. All parts of the organisation have been affected by the virus, he says.

He never predicted global and national supply chain problems that would make it hard to increase server capacity and obtain equipment. “Normally, we would be able to get hundreds of headsets at the drop of a hat. I never thought they’d become as
rare as a hen’s tooth. “We can normally order Ajax Spray n’ Wipe and hand sanitiser for our offices…I never did foresee a world where we’d be running around small dairies in Auckland hunting for them.” Healthline also ran into trouble with the phone lines on 23 March, when it seemed every New Zealander was calling everyone they knew as the lockdown was announced. The organisation has also had to prioritise its work and staff. With bowel screening all but stopped, teams working on that programme have joined the COVID-19 team.

Mr Slater says, since Easter, the aim has been to increase the capacity for the 1737 service, as the number of calls is edging up. For Dr Good, her main challenge has been trying to manage the everchanging COVID-19 disease case definition and maintaining a quick flow of information to staff. “Sometimes we’ve had just 10 minutes’ warning before needing to respond to the public. But we’ve met this challenge head on… “Everything is constantly changing, but we’ve risen to the occasion, and demonstrated our value by coming up with innovative solutions.”

Public health units across the country have been swamped, so Healthline jumped on board, helping out with the likes of welfare checks for those in self-isolation and their close contacts.

“We’ve had to step up and provide those services; I wouldn’t have imagined us doing this three months ago.” The huge demand from the public for non-clinical information saw Healthline quickly engage with both Plunket and House of Travel to redeploy some of their staff.

“There were about 200 House of Travel call centre staff who had no need to respond to travel requests any more, so we trained them, as well as Plunket nurses.” A recruitment process that would normally be done in six months was condensed to about three days, resulting in 200 staff able to provide callers with non-clinical information while under the clinical supervision of the nurses. Mr Slater says staff did an outstanding job, not only building rapport with callers but also satisfying their needs, which freed up clinicians for clinical triage.

“Blueprints for the future have arisen from this innovative thinking. The health system over the last month has done some extraordinary things.” In essence, though, the National Telehealth Service is doing what it was designed to do, says Mr Slater.

Co-designed with the Ministry of Health in 2014 and 2015, it was built with the idea it would be able to scale up and adapt rapidly in health emergencies. “We’ve just had to roll up our sleeves and get stuck in.”

“We've been working day and night with Spark Health to deliver a five-month technology project in just seven days.”
Andrew Slater
CEO, Homecare Medical
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Conversations with international counterparts in Australia, the UK, the US and Canada have provided lessons these countries learned in the fight against COVID-19, says Mr Slater.
“One of the things I’ve been most proud of has been the way we’ve managed
to keep an eye on our clinical quality and safety.” Complaints are fewer than normal: 84 complaints were received in March from 191,995 contacts. The majority of complaints were from callers experiencing long wait times.

In the last week of February, call volumes to Healthline surged, particularly around peak news times and in the evening. By 31 March, the daily number of calls managed by staff each day increased from 1445 to 12,763, with wait times peaking at one hour 52 minutes
in the middle of the month. This is where Mr Slater apologises, saying the service let New Zealanders down.

“The demand was hitting us faster than anticipated, but we’ve managed to bring it down week on week.” Wait times have reduced dramatically: the median is now 20 seconds for
clinical triage calls, and less than 10 for non-clinical. However, with the unpredictability of call volume patterns and many calls – whether related to COVID-19 or not – becoming increasingly complex and requiring more time, longer waits on occasion can be expected.

 

It hasn’t all been complaints; people have complimented the service and acknowledged the pressure and complexity of the work as well as the time taken, thoroughness and compassion received from Healthline staff. Life has certainly not been easy for
call centre staff. “Many of them may have partners who have lost jobs and are having to work from home while educating their children, or having to get to work using limited public transport. COVID-19 has impacted everybody and our staff are not exempt from adversity.” Still, the team has to provide assurance while dealing with unprecedented levels of health anxiety and fear, as well as keep up with the best and most recent advice, such as the current number of available community-based assessment centres. “And sometimes they’ll get people who have been given a response they don’t want – [people] can become
quite evil as humans when this happens, which is to be expected, so they’ve being dealing with that too.” In some cases, Mr Slater has personally called a few of these “evil humans”
to ask them for some understanding and compassion. All in all, though, he says he has found it interesting to see the public’s need and desire for good and consistent
information. Dr Good is proud of the way Healthline staff have dealt with this heightened
degree of alarm from the public. “They’ve managed to provide appropriate responses and an empathetic ear while being extremely busy,” she says.
About 10 per cent of the calls received have been from GPs and primary healthcare professionals. The service has worked with the RNZCGP and other organisations so
the common themes can be covered in resources they provide.

Despite the challenges, the COVID-19 experience has been rewarding: it has provided the service with a huge opportunity to support primary care and public health services.
Dr Good says she has enjoyed seeing relationships strengthened as well as new ones being formed. “I’m very optimistic that we’ll take some positive things out of this. I would like to acknowledge the stellar effort of all of the staff on the front line.”
Mr Slater says it is because of these strong relationships with organisations like Plunket, St John, Spark, Atlantis Health and the college that the service has been able to respond
in the way it has.“I just want to say thank you to the health system and our services, and to all of those who provided us with feedback to allow us to make a bigger impact.” So, what will Healthline and the National Telehealth Service look like post lockdown?
“You know,” says Mr Slater, “I’ve not had two minutes to think about the future. “I just hope that we take on board all of the great things that have come about from this response and use them in our new normal.”

Zahra Shahtahmasebi, NZ Doctor, 22 April.

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