Princess Alexandra NHS sets the benchmark for patient experience in the UK by transforming the front-line staff experience

About Princess Alexandra NHS

The Princess Alexandra Hospital NHS Trust (PAHT) provides a full range of general acute, outpatient and diagnostic services. It employs 3,700 staff and serves a local population of around 350,000 people living in west Essex and east Hertfordshire, centered on the M11 corridor and the towns of Harlow, Bishop’s Stortford and Epping.

We spoke to Jeffrey Wood, Deputy Director of ICT to understand more about the hospital, their priorities and how IT plays a pivotal role in transforming the patient experience.

A traditional organization takes lead in transforming an industry

Hospitals in general have had a traditional bent when it came to technology. With most of the approaches pertaining to treating patients staying consistent for decades, hospitals didn’t have an incentive to ramp up their technology and transform the patient experience. But, PAHT wanted to change that. The management wanted to lead the transformation for the entire industry in the UK, and in the process elevate the patient experience. This led to bringing in a technology veteran in Jeffrey Wood, who had helped lead such transformations at traditional industrial outfits.

When Jeffrey joined the PAHT, he realized that the institution had a lot to catch up on the technology front.  Looking back on how it all started Jeffrey remarked “When I joined local authorities from the private sector, I felt like I stepped five years back in time. And when I moved from the local authority to the PAHT, it looked like I moved another five years back in time. It was evident that we had a lot to catch up from, but we were forward thinking right from the get go”. One of the key priorities for Jeffrey and his team was to quickly transition from legacy hardware and processes. For context, 85% of the computers at PAHT were desktops, and in addition 65% of computers were 7 years or older, rendering them pretty much obsolete.

Outdated systems significantly impacted its access to frontline staff who were always on the move. The first priority of the ICT team was to do away with the legacy hardware and progressively transition towards more portable computers. While PAHT had a lot of hardware to manage, the lack of a good inventory management system meant they weren’t able to track or monitor these assets, resulting in unnecessary procurement. The challenges though did not end there. PAHT also had a dated telephony system that was installed in the year 1989, and the internet speeds were poor. Considering they had three hospital sites that relied on this infrastructure, the lack of adequate speeds and throughput was bogging down the systems.

The ICT team’s next objective was to migrate its entire technology infrastructure onto the cloud, and modernize processes. This would help the tech teams to work from anywhere, and be better equipped for hybrid work, an approach that helped them tackle the pandemic a lot better. Jeffrey also ensured that the entire ICT team was ITIL certified and they were adept to project management best practices, thereby equipping the team to handle a project of this magnitude within the stipulated time.

Transitioning from phone & email support desk to a comprehensive ITSM tool

Three years ago, Telecom agents at the PAHT would handle about thirty thousand calls a month, and that number quickly snowballed to over 210,000 calls. The ICT Helpdesk handled over 3500 calls per month. With the onset of the pandemic, these calls would have grown at a significant pace, in addition to the number of email queries. Since most of the requests were not documented on a portal, agents had to listen to the concerns either over phone or email, and then document them at their end, resulting in a lot of wasted time and effort.

PAHT needed a tool that would make the entire service request and delivery process seamless. The service desk and a support portal would have to leverage automation, and ensure bulk of the issues were solved by the frontline staff themselves, with only the priority tickets having to be handled by a telephone call to an agent. In addition, the team also looked to bring onboard a cloud telephony platform, to better route conversations directly to the concerned personnel. With the transformation priorities set, the ICT team put down a set of requirements and qualified them into ‘mandatory’ and ‘desirable’ features, serving as the guiding principle for choosing the right tool.

In the process of scouting for the right IT Service Management tool, the team identified 3 tools,  two out of the three being cloud providers, and the third being an on prem platform. After evaluating all the alternatives available, Freshservice was chosen based on its alignment with ITIL best practices, product capabilities and roadmap, cross-device compatibility, clean UI, tool intuitiveness, seamless integration with existing tools, along with having robust asset management capabilities (CMDB) and providing impeccable price to value.

Transforming the patient and staff experience

Prior to the transformation, one of the key observations was that the ICT frontline staff were consistently seen spending a lot of time fixing technical issues. Sometimes, these were as simple as password resets. Such incidents had a far reaching impact to a point where it resulted in a subpar patient and user experience. With the organization being so accustomed to getting issues resolved over phone and email, it was a rather uphill task to get them to switch to the service desk, by articulating how that could make things fast, easy and convenient for the entire organization.

The ICT team realized that one of the fundamental flaws of having siloed service desk experience was having disparate sets of employee data scattered across databases. To address this issue, steps were taken to break data silos and keep them centralized and accessible. Considering most of the details about the employees were already available, storing them centrally and querying them for the right service request category helped drastically reduce the amount of details collected while raising a ticket.

Another challenge with the legacy platform was employees’ lack of visibility to ongoing issues, resulting in several employees reporting the same problem. Unnecessarily tracking and closing innumerable tickets addressing the same issue significantly affected agent productivity. With Freshservice, PAHT looked to mitigate such instances by displaying the list of ongoing issues that the team is already working on, limiting the possibility of such duplicate tickets being raised.

Partnering with Freshservice

While transitioning to Freshservice, the ICT team had decided that it would progressively move from the legacy platform, instead of a big bang rollout. Moving to Freshservice took about three months from start to finish. The team first started off with basic services and then moved the others based on the plans set by the change advisory board, following which the automation and workflows were being configured.

PAHT identified that if their internal teams worked on continual service improvements it would add pressure to these teams. They wanted to update dashboards to allow senior management and team leaders to see where to focus their time. They were also keen to include several automations to improve response times and reduce the workloads of the service department. By using Freshworks Professional Services, they could expedite the necessary work and reap benefits far earlier than they would if they were using their internal teams.

PAHT identified the following Freshservice features that have proved extremely pivotal in transforming the employee experience:

• Workflow Automator: One of the key objectives of using the workflow automator was to make each of the service requests context sensitive. This meant that the service requests were configured to collect just the required information from the end user to get agents to work on it, while leaving most of the fields pre-populated with information that was already available. The requests were also configured in such a way that it would recommend potential subcategories of requests, viz. For a PC request, application access would be recommended as a potential ask, resulting in all supplementary asks tagged to a single ticket. The approach translated to end users spending less time raising a ticket. It also eliminated back-and-forth conversations between employees and agents, while offering transparency and visibility into issue resolution to all stakeholders.
• Asset Management: PAHT manages and tracks every asset in the organization, across its lifetime on Freshservice Asset Management. With asset management built into every service request concerning the entire asset library, any asset procurement or allocation, repair, or potential loss or eventual disposal is registered on the tool. Every asset that is brought in and moved across the organization is tracked using bar codes, without manual updates, resulting in time and cost savings. PAHT is also looking to adopt the automated signature system whereby, whenever an asset is requested by an employee, the entire procurement, shipment and acceptance are executed through electronic contracts, eliminating the need for any paperwork.
• Incident and Change management: From an incident management standpoint, PAHT uses Freshservice to centrally record, track and manage the incidents. Since most issues were managed by predefined automated workflows, fewer tickets reached agents. This freed up agent bandwidth and they could in turn spend time on more challenging and complex problems. From 1308 open tickets out of which 629 of which had breached SLAs in January 2023, incident tickets went down in April to 550 open tickets, 13 of which breached their SLA, in just a matter of 3 months. This has substantially provided a better experience for end users including Clinicians and Nurses who are consequently able to better serve their patients. As for change management, the Change Advisory Board manages the entire change management process through Freshservice. The tool is used to track change requests, and monitor the changes upon implementation and later down the line start to report back on those change requests. 
• Self-Service portal and Knowledge Base: PAHT migrated the knowledge base from the legacy tool to Freshservice. While the old knowledge portal was catering only to the agents, the new tool was made available for end users too. So, whenever an end user starts submitting a service request, the tool automatically brings up a number of knowledge base articles on one side of the screen, suggesting how end users can resolve them on their own, helping deflect a majority of the tickets. In addition, if somebody starts to log a request, the tool would tell them, if such an issue is already being attended to. As highlighted previously, the tool also flashed any major incidents that are being attended to as soon as someone lands on the Freshservice screen. This helped reduce the possibility of logging multiple tickets reporting the same issue. 

Delighting agents, frontline staff and patients

One of the primary pain points of frontline staff with the legacy approach was the endless time spent on the phone with agents, looking to resolve issues. With Freshservice, the process of resolving issues was much more streamlined, delighting agents, frontline staff and in turn the patients. With the benefit far exceeding expectations, the employees were also more receptive to the change in approach, and were reporting issues on the tool, instead of leaning towards traditional channels such as telephone and email. While some of them still reported them over email, the ICT team had set up automated responses guiding employees to report the issue on the service desk, thereby driving org-wide service desk adoption.

The frontline staff definitely see the positives of moving to a centralized support desk.

The support agents too are delighted with how things have changed.

In addition, the ability to gamify the entire experience through Freshservice has helped create a competitive environment, resulting in improved agent involvement and productivity.  Jeffrey uses the native Freshservice analytics dashboard to track agent performance and service desk efficiency.

Looking ahead

For PAHT, the focus will always be about freeing up more time for the clinicians ensuring most of their time is spent treating patients. Therefore, automation is a priority and the ICT team continues to explore processes that can be automated and enable employees sufficiently to ensure they spend less time in reporting issues. Voice alerts also feature as one of the priorities whereby the staff is able to dictate information into the system instead of typing it.

PAHT is also exploring chatbots with Freshservice over the course of the year, and looks to make the service desk experience more context sensitive, so that employees don't have to even login to the portal, and instead do everything over chatbot. Jeffery expects these initiatives to make a big difference to the end user. The institution also plans to onboard other functions onto Freshservice, and in the process streamline service management into one platform.