| Abstract|| |
Introduction: There is poor penetration of trauma healthcare delivery in rural areas. On the other hand, mobile penetration in India is now averaging 80% with most families having access to mobile phone. Aims and Objectives: The aim of this study was to assess the implementation and socioeconomic impact of a call center in providing healthcare delivery for patients with head and spinal injuries. Materials and Methods: This was a prospective observational study carried out over a 6-month period at a level I trauma Center in New Delhi, India. A nine-seater call center was outsourced to a private company and the hospital's electronic medical records were integrated with the call-center operations. The call center was given responsibility of maintaining appointments and scheduling clinics for the whole hospital as well as ensuring follow-up visits. Trained call-center staff handled simple patient queries and referred the rest via email to concerned doctors. A telephonic survey was done prior to the start of call-center operations and after 3 months to assess for user satisfaction. Results: The initial cost of outsourcing the call center was Rs 1.6 lakhs (US$ 4000), with a recurring cost of Rs 80,000 (US$ 2000) per month. A total of 484 patients were admitted in the department of Neurosurgery during the study period. Of these, 63% (n=305) were from rural areas. Patients' overall experience for clinic visits improved markedly following implementation of call center. Patient satisfaction for follow-up visits increased from a mean of 32-96%. Ninety-five percent patients reported a significant decrease in waiting time in clinics 80.4% reporting improved doctor-patient interaction. A total of 52 visits could be postponed/cancelled for patients living in far flung areas resulting in major socioeconomic benefits to these families. Conclusions: As shown by our case study, call centers have the potential to revolutionize delivery of trauma healthcare to rural areas in an extremely cost-effective manner.
Keywords: Call center, head Injury, healthcare delivery, rural, spinal injury, trauma
|How to cite this article:|
Agrawal D. Transforming trauma healthcare delivery in rural areas by use of an integrated call center. J Emerg Trauma Shock 2012;5:7-10
|How to cite this URL:|
Agrawal D. Transforming trauma healthcare delivery in rural areas by use of an integrated call center. J Emerg Trauma Shock [serial online] 2012 [cited 2013 May 19];5:7-10. Available from: http://www.onlinejets.org/text.asp?2012/5/1/7/93099
| Introduction|| |
It is well known that there is poor penetration of trauma healthcare delivery in rural areas in developing countries like India. Evidently, there is an acute scarcity of super-specialists like neurosurgeons in these areas. The problem is compounded by the fact that head and spinal-injured patients are usually bedridden or wheelchair bound and it extremely difficult for these patients to access specialized services like neurosurgical follow-up on continuing basis.
On the other hand, tremendous growth has occurred in mobile phone use over the last decade with most families having access to mobile phone.  In another first for India and possibly the world, an integrated call center started operations for our hospital on 2 January 2010 (call-center number: +91 11-40401010). Although call centers are common in commercial industries like telecommunications, the concept has been alien to hospitals. ,, Hospitals usually have reception desks which manage general enquiries and appointments. An integrated call center on the other hand manages extensive backend administrative chores and services besides providing a host of patient related activities on a common platform.
In a public-funded hospital like ours, an integrated call center can provide immense cost savings besides revolutionizing healthcare management and delivery. Due to the presence of a mature electronic medical record system (EMR) at our hospital, we were in a unique position to leverage the advantages of a traditional outsourced call center and innovatively wrap a multitude of healthcare services around this model to provide unparalleled benefits in patient care.
The aim of this study was to assess the implementation and socioeconomic impact of a call center in providing healthcare delivery for patients with head and spinal injuries.
| Materials and Methods|| |
Our center is a 152 bedded level I trauma Center (JPN Apex Trauma Centre, All India Institute of Medical Sciences) in New Delhi, India. A nine-seater call-center was outsourced to a private company (SM Telesys limited) in January 2010. The actual call center was located in a different state of India (Noida, Uttar Pradesh). The hospital's electronic medical records were integrated with the call-center operations so that all patient data was accessible by the call-center staff with necessary privileges. As per guidelines in India, healthcare professionals and personnel who are involved in the management of the patient have access to the patient's data. Accordingly a 'nondisclosure agreement' was previously in place between the hospital and the call center so as to ensure confidentiality of patient data. The call-center was given responsibility of maintaining appointments and scheduling clinics for the whole hospital as well as ensuring follow-up visits. Besides this, especially trained call-center staff handled simple patient queries and referred the rest via email to concerned doctors.
Actual scheduling for clinic visits started in June 2010. In this prospective observational study carried out over a 6-month period (May 2010-October 2010), a telephonic survey was done prior to the start of call-center operations and after 3 months to assess for user satisfaction. The survey was limited to the department of Neurosurgery so as to study the impact on head and spinal injury patients who were coming for follow-up. The survey consisted of the following questions to patients:
- How was your experience with the present system for clinic visits? Satisfactory/Dissatisfactory
- How would you rate the interaction with the doctor in the clinic? Satisfactory/Dissatisfactory
At 3-months postimplementation
- Have you been contacted by the call center for appointment/scheduling? Yes/No
- How was your experience for clinic visits with the call center system? Satisfied/ Dissatisfied
- How would you rate the overall experience for clinic visits with the call center system? Markedly improved/Slightly improved/Same/Deteriorated
- Did waiting time decrease markedly following using this system? Yes/No
- Did the interaction with the doctor improve by using this system? Yes/No
The questions were kept deliberately few and simple so that call-center staff could administer them in the patient's language and document the response accurately.
In addition an attempt was made to calculate the cost of implementation of the call-center operations for our hospital.
| Observations and Results|| |
A total of 484 patients were admitted in Neurosurgery department during the study period. Of these, 63% (n=305) were from rural areas. Patients reported markedly improved convenience following implementation of call center and patient satisfaction for follow-up visits increased from a mean of 32% (n=155) to 96.1% (n=465) following implementation of call center operations. Of the patients who became satisfied, 94.2% (n=438) reported 'significant improvement' in the overall experience of their clinic visit. Importantly, a total of 52 visits could be postponed/cancelled for patients living in far flung areas resulting in major socioeconomic benefits to these families. 455 patients (95%) also reported decreased waiting time in clinics with 80.4% (n=388) having improved doctor-patient interaction following implementation of call center for managing the appointments and queries.
The initial cost of outsourcing the call center was Rs 1.6 lakhs (US$4000) with a recurring cost of Rs 80000/(US$ 2000) per month.
| Discussion|| |
Worldwide, head injury is the single largest cause of death and disability following injury. The burden of head injury is greatest in low- and middle income countries (LAMIC), where 85% of the worlds population live.  Delhi with a population of around 15 million has the dubious distinction of having the largest number of road traffic accidents of any city in India.  The main reasons this project was done were twofold: firstly, there is no support structure in place to provide information and continuity of care for trauma patients even in cities like Delhi. Also, patients with trauma usually come from far distances to the hospital for specialized treatment and it is a major socioeconomic burden to come for follow-up visits. Secondly, there is a general lack of accountability in public-funded healthcare delivery systems (including hospitals) in developing countries like India. This has a cascading effect on quality of healthcare delivered to people living in rural areas.
The unique features/objectives of the call center are:
With the main thrust on improving the quality of patient care, the call center can manage all appointments and follow-up of patients for the whole hospital. The call center can also answer queries on all admitted patients and will provide information on all diagnostic and therapeutic services available, the workflow and pricing of getting a specific service or test done and the approximate wait times. This information may help in empowering the patients coming to a hospital and obviate the need to approach anyone physically for information.
Completely outsourced and scalable
This frees up valuable real estate at a hospital besides potentially decreasing the overheads like electricity, parking and toilets which an onsite facility would use. Being completely scalable, the call center can quickly ramp up operations in line with increased demand and in case of disasters.
The call center can provide best-in-class service to clients with quality control at every stage and 100% call recording for auditing and quality purposes.
Research is one of the key mandates of academic medical institutions and a call center can facilitate research by ensuring follow-up of patients, administering surveys and ensuring authenticity of data.
Personnel job responsibility management
In our center, job responsibilities have been defined for all staff in the department of Neurosurgery. The call center can therefore administer a checklist telephonically to the employees at the end of each shift (shift hand off) to ensure compliance and accountability.
Centralized help desk and support
The call center can also take over the responsibility of logging and initial troubleshooting software and hardware problems all over a hospital and thus help in providing professional 24 × 7 support services.
Inventory management and support
It is envisaged that the call center will act as the single window for all civil, mechanical, and equipment-related issues for the hospital. The call center can provide complete audit trail for any breakdown or even and follow-up with the vendor and end user to ensure optimal utilization of resources.
Biometric attendance management
In many hospitals (including ours) employees are under mandatory biometric attendance system and the call center can manage the biometric system remotely to ensure compliance and accountability.
The project from conceptualization to full implementation took less than a year. Integration of various patient, administrative and biometric attendance databases was achieved within a period of 3 months. Interestingly, call volume increased to about 500 calls per day within a span of 5 months.
Integration with the hospital's EMR also ensures that real-time status of any admitted patient can be given by the call-center round the clock and real-time synchronized records of over 100,000 unique patients are available at call center for all patient-related activities.
This study shows that by using the call center for all outpatient appointments can lead to a queue less system for patient clinics drastically decreasing wait-times which is unparalleled in the annals of public-funded hospitals in India.
Acceptability of the concept
Acceptability of the concept of a call center for hospitals was low, especially in its present scope. A major challenge was to convince all stakeholders about the feasibility and potential of the project.
Changing the work culture
In the present form, there was lack of accountability in the system and change management wherein every process step was documented was not easily accepted by people.
Quality of patient databases
As the call center depends on the accuracy and completeness of patient databases, especially in respect to mobile numbers, maintaining consistent quality and accuracy was a major challenge in the implementation of the project. To ensure accuracy, multiple checks were introduced in our system.
Integration of various databases
As our hospitals had various dipartite databases such as EMR database, biometric attendance database, registry database, administrative database, etc, integrating them into a common front-end (for the call center agents) was a major challenge and one which was successfully overcome.
As our study shows, in public-funded hospitals like ours, an integrated call center can provide immense tangible and intangible benefits. This model can be replicated in all public or private hospitals and can revolutionize healthcare management and delivery. Importantly, this model is completely scalable right up to the national level. One central call center can provide all patient-related and back-end activities to a group of hospitals providing huge economies of scale as well-transforming healthcare delivery.
| Conclusions|| |
As shown by our case study, call center has the potential to revolutionize delivery of trauma healthcare in an extremely cost-effective manner. This model is ideal for developing countries like India.
| References|| |
|1.||Shet A, de Costa A. India calling: Harnessing the promise of mobile phones for HIV healthcare. Trop Med Int Health 2011;16:214-6. |
|2.||Batt, R, Moynihan L. The viability of alternative call centre production models. Hum Resour Manage J 2002;12:14-34. |
|3.||Bain P, Watson A, Mulvey G, Taylor P. Taylorism, targets and the pursuit of quantity and quality by call centre management. New Technology, Work and Employment 2002;17:170-85. |
|4.||Knights D, McCabe D. Governing through Teamwork: Reconstituting Subjectivity in a call centre. J Manag Stud 2003;40:1587- 619. |
|5.||De Silva MJ, Roberts I, Perel P, Edwards P, Kenward MG, Fernandes J, et al. Patient outcome after traumatic brain injury in high-, middle- and low-income countries: Analysis of data on 8927 patients in 46 countries. Int J Epidemiol 2009;38:452-8. |
|6.||Dandona R, Kumar GA, Ameer MA, Ahmed GM, Dandona L. Incidence and burden of road traffic injuries in urban India. Inj Prev 2008;14:354-9. |
Department of Neurosurgery and Information Technology, JPN Apex Trauma Centre, AIIMS, New Delhi