Health Emergency Assistance Line and Triage Hub (HEALTH) Model

Chapter 3. Methods

The HEALTH model is a conceptualization of a communications system that includes the requirements for people, processes, and technology to meet our public health emergency preparedness goals and objectives. The model is designed to build upon and be consistent with the existing structure and capacities of the DHMIC. A standard system development technique known as the System Development Lifecycle (SDLC) was used to create our model. The steps of SDLC are problem definition, planning, analysis, design, implementation, and testing. Problem definition, planning, and analysis determine the requirements for the model, which ensure that it will meet our objectives. Based on those requirements, a blueprint for the people, processes, and technology necessary to achieve the objectives was designed. Finally, implementation and a test plan allow us to refine the model and verify that our emergency preparedness goal and objectives are met.

System Development Lifecycle

Analysis

The first step in the analysis included conducting research to determine the requirements for the people, processes, and technology of the HEALTH model. The next step in the analysis was to assess our existing resources, processes, and technology; then find commonalties between the needs of the HEALTH model and our current structure. The intention was to use as many of the existing processes within the call center as possible to meet the needs of the HEALTH model. The analysis was completed between November 16, 2002, and March 28, 2003.

Design

Design of the model took place between March 1, 2003, and May 31, 2003. The final report was submitted October 15, 2003.

The Steps in the Model Design

Process

• Define the processes that will suit the requirements of the HEALTH model.
• Identify the levels of service that drive the HEALTH contact process.
• Detail the input and output information flows for the HEALTH Model.
• Develop decision triage trees for routing calls through the process.

People

• Identify the personnel profile required for emergency and surge staffing.
• Determine scheduling requirements for surge capacity.
• Develop training plan for surges and emergency events.
• Develop a management structure for surges and emergency events.
• Identify the steps (change management) that will support the staff in adopting HEALTH, and include call center managers from the beginning.

Technology

• Determine HEALTH systems requirements.
• Determine commonalities between HEALTH and existing systems.
• Determine requirements to integrate HEALTH into the existing systems, staff, and processes.

Design Terms

Several specialized terms will be used throughout the design section. These terms are listed and defined here.

Medical Call Centers

Specialized medical or pharmaceutical call centers offer medical information, medical triage, drug information, or collect information on diverse topics.

Poison control centers offer telephone triage for acute toxic exposures and are, perhaps, the best established of medical call centers. A national body exists, the American Association of Poison Control Centers (AAPCC), which certifies poison control centers and sets forth voluntary industry standards. Other medical call centers, such as nurse advice lines, are more diverse in their objectives and industry standards, and best practices are less uniform.

Process Management

In the realm of contact center operations, the product being delivered is health communication; thus, the processes are the steps taken to deliver that health communication. Applying the principles of process management creates uniformity, consistency, and measurability. It clarifies the responsibilities between departments by identifying transition points within the process. Understanding, step-by-step, the process that each contact undergoes, as well as understanding the interactions between departments and with outside entities, is critical in creating a functional model within the contact center environment. Applying process management to the HEALTH model involves defining the existing processes, creating HEALTH processes based on existing processes, and correcting any shortcomings of the process identified during testing.

Mapping Information Inputs and Outputs

The function of the contact center is to provide and collect information. Mapping of information flows is used to identify the resources needed to meet the contact center's communication and information collection objectives. By diagramming each step taken by a contact to reach all the possible communications sources, the process, systems, and staffing required can be visualized. From mapping these required flows we can determine the needs for software, content, management, staffing, and clinical decision trees. We can determine which databases, internal and external, must be integrated and what technology needs exist (i.e., telephones, interactive voice response [IVR], or automatic number identification [ANI]). Each "user" of the service has a different viewpoint on the desired outcome for the service. The endpoint of each route that the contact takes is one way to visualize the outcomes the process provides. This tool is especially helpful when multiple parties must be brought together in the communication process. By visualizing the process, different parties are able to see where they fit in, and the model can be adjusted to address limitations. A generalized HEALTH input/output flow diagram is available in Appendix B.

Call Metrics

Call metrics are the key performance indicators that must be collected and tabulated for quality control and evaluation purposes. Some of these fields will be determined internally for evaluation purposes, such as average length of calls or hang-up rates. Other fields will be determined by the public health agency that is contracting for the service; these may include information on the callers such as their county of origin or exposure status.

Decision Triage Trees

At each juncture in the routing, a decision tree is used to dictate the route to be taken. A decision tree is a series of questions, established ahead of time, which are used to determine the resources to which to route the contact.

Service Level Agreements

To efficiently meet the communication and data collection needs in the event of a vast assortment of potential bioterrorist events, standardized service level agreements (SLAs) with public health agencies are important. SLAs are service agreements established ahead of time with the Public Health agency that will contract for the service. Offering more than one level of service allows us to tailor service to the different types of agents and events that may be encountered. The SLA clarifies expectations between the contracting agencies, simplifies planning for the event, and reduces response time. SLAs frame the scope of the process. Questions such as, "Does the contact center need to be available 7 days a week and 24 hours per day?" or, "Must the contact center have trained nurses on the phones at all times?" are answered by the level of service opted for.

Operational Management

Operational management describes the management structure and the ratio of management to workers within a business process. The appropriate number and structure of management continues to be the subject of debate among medical call centers Workforce management techniques and formulas have been created for the contact center industry to provide management structures that will improve performance and decrease costs. In creating the operational management structure for the HEALTH model, we looked at these practices and the three existing call centers within DHMIC to come up with possible solutions.

Organizational Change Management

Change management is a process used to help staff accept and adopt new systems. New systems often fail when staff is inadequately primed for adopting the change. To maximize employee satisfaction with the change, to promote efficiency, and to minimize the chance of failure, a change management plan should be drawn up before implementing the model. The plan would describe the change process and include a description of the resources dedicated to implementing the change. The plan should include the following steps:

• Revise management policies to be aligned with the model.
• Assess the costs and benefits to the organization and its employees for making the change.
• Motivate the change.
• Enable people to accept the change by providing the needed skills through training.

Capacity

Following the development of a process, the systems and staffing needs to achieve that process can be determined. Based on our existing technology, we chose a goal of being able to handle 1,000 public or health care provider contacts per hour, in addition to delivering regular services. Determining how to maintain readiness to deal with such surges within our existing staffing profile is an important component of the model. This involves forecasting the skills profile that will be needed, establishing training requirements and scheduling requirements, developing a management structure for surge capacity, and developing a plan to recruit and manage an emergency volunteer workforce.

Implementation

A plan to implement all components of the model is contingent upon funding of the systems upgrades. Parts of the HEALTH model were implemented for the Colorado Smallpox Vaccination Program Support Service (using CO-HELP and CO-PHIL) between January and April of 2003. CO-HELP was implemented again during the summer of 2003 to provide information on West Nile virus. These activities are described in the chapter on implementation.

Testing

Testing and refining components of the HEALTH model has been ongoing with the usage of both CO-HELP and CO-PHIL. In the section on testing, we evaluate our experiences with the CO-HELP and CO-PHIL in 2003. We hope that DHMIC and other agencies will have the chance to further implement, test, and refine the HEALTH model.

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