A Quality Improvement Journey Using a Communication Ecosystem and Microsystem Approach for Improving Access to Care
What is the problem we needed to solve?
What is the biggest barrier clients face when trying to reach us by phone? Is it the system itself? During the COVID-19 pandemic, our organization was tasked with vaccinating individuals without OHIP coverage. The high demand for services overwhelmed our phone systems, leading to long wait times, frustration, and difficulty accessing appointments. Although we expected these issues to subside after the pandemic, they persisted, even after introducing Ocean, an online booking platform. We realized that the problem extended beyond phone lines and staff availability, highlighting a larger communication issue related to shifting client preferences and technology. This underscored the need for systemic change in how we manage client communications.
Why it matters
This project brought critical insights to the challenges of clients, staff, technological resources, and organizational processes. It shifted us from assumptions about the root causes leading to the challenges and issues experienced by clients and staff to a more fact-based understanding. We can now better allocate resources and make strategic changes that will effectively improve service access and workflow processes for clients and staff.
For example, we had assumed clients were uncomfortable using Ocean online booking due to a lack of skills or access. While skills and access remain an issue for some, we understood from clients that our previous communication efforts were not sufficient to make them aware of this available service. From this project, we have identified numerous changes and have developed an action plan for implementing the findings and recommendations that span not only our phone system and Ocean but also our processes that surround these.
What we did
To tackle these challenges, we initiated a Quality Improvement (QI) project to uncover the root causes of phone system issues. A quality improvement project for improving access to care through a communication ecosystem and microsystem approach. Focusing on phone systems, learn to identify issues, apply data-driven methods including root-cause analysis and Plan-Do-Study-Act cycles, and implement design-thinking solutions to enhance access, streamline call management, and measure ongoing improvements in client service.
Our approach:
- Identify access issues in phone systems or other communication systems through the QI process, utilizing tools such as root cause analysis to pinpoint specific problems, data analysis, conducting experience surveys, gathering client suggestions, etc.
- Use design-thinking approaches to develop solutions to phone tree structures and process optimizations then test solutions using Plan-Do-Study-Act (PDSA) cycles.
- Develop an understanding of how to apply an ‘ecosystem’ perspective to an organization’s total communication structure and the role of ‘microsystems’ in facilitating access to care and information.
The first step involved analyzing phone system data, tracking call volume, answered calls, abandoned calls, queue times, and duration. We also conducted a call log pilot with Secretaries to categorize caller types (e.g., existing vs. new clients), inquiry types, and call-handling efficiency. From these insights, we identified that most callers were existing clients seeking appointments, and that call processes for staff were unclear or not defined.
We then used an Ishikawa diagram (fishbone diagram) for root cause analysis, which highlighted several factors: phone system limitations, communication breakdowns, unclear routing processes, inadequate staff procedures, and client preferences. In addition to phone-related issues, we recognized broader communication challenges with our website and the Ocean platform. We now understand the issues from the phone and the other communication channels are collectively contributing to the challenging call volumes and associated challenges.
Focusing on the phone microsystem initially, we are adopting a design-thinking approach, gathering input from clients and staff. This collaborative effort will help us identify specific changes for improvement and what they would look like. This consultative and holistic approach with individuals using the system on a day-to-day basis ensures that the resulting solutions are client-centered and practical for staff implementation. The next steps involve further designing and testing these solutions through PDSA cycles to identify areas for further improvement and steps towards implementation.
What we learned
While initial improvements focus on the phone microsystem, expanding the approach to encompass broader communication channels ensures overall ecosystem resilience. In the short term, pilot testing and collaboration with clients and staff stakeholders will refine the phone system, making it more intuitive and efficient. The mid-term phase will focus on enhancing alternative communication channels, such as the website and Ocean, to reduce call volume and improve self-service options. These short and mid-term efforts will support long-term goals of creating a scalable, adaptable system that can respond to fluctuating demands and technological changes.
By integrating client and staff feedback, tracking key metrics, and applying design-thinking principles, we aim to build a resilient communication ecosystem. This holistic approach will not only optimize phone systems but also improve all client-facing communication methods across the organization, fostering continuous improvement and better access to care.
What we’re going to do next
We are reshaping our phone system to cut wait times, improve language access, and embed equity into everyday client contact. Our goal is to enhance the client experience and streamline access through an improved phone system. We aim to design a phone tree that efficiently directs calls, such that callers reach their intended recipient and Secretary time is used efficiently for interactions (both phone and in-person). We will assess the success of these changes through key metrics, such as client satisfaction, staff feedback, and phone system data. Continuous monitoring will help us fine-tune the system and improve both its efficiency and client satisfaction.
While the current focus is on optimizing the phone microsystem, we plan to expand our efforts to enhance the entire communication ecosystem. This will involve addressing the volume of incoming calls through quality improvements to the website and Ocean platform usage, which will contribute to a broader strategy aimed at improving client access and satisfaction.
Resources and reports
Dialing Down Barriers: A Quality Improvement Journey to Strengthen Connection and Equity (webinar recording)
This webinar recording provides an overview of our QI methods, real-world data, and actionable next steps. We shared how QI leads, secretaries, and researchers came together with real-world data, plain-language scripts, and workflow analysis that make phone access an equity win for clients. We provided practical ideas for integrating digital tools, tracking key indicators, and fostering cross-team collaboration to turn phone-related frustrations into reliable, inclusive client pathways.
Webinar slides
The Current State and Impact of Digital Literacy and Equity Factors on Newcomers’ Healthcare Access (2024)
The current state and impact of digital literacy and equity factors on newcomer’s healthcare access
This literature review and environmental scan references relevant literature and organizations to understand the digital literacy, access, and impact of technology on newcomers, immigrants, and refugees, particularly concerning their interactions with healthcare and community services. The report highlights the critical need for improved digital literacy and access among immigrants, refugees, newcomers and service providers to enhance their ability to use digital interventions in healthcare and community service settings.