Enabling Patients to Receive Appointment Reminders in Their Preferred Language

Betsi Cadwaladr University Health Board (BCUHB) is geographically the largest health organisation in Wales and provides a full range of primary, community, mental health and acute hospital services for a population of over 670,000 people across the six counties of North Wales (Anglesey, Gwynedd, Conwy, Denbighshire, Flintshire and Wrexham) as well as some parts of mid Wales, Cheshire and Shropshire. 44% of the Health Board’s population speak Welsh, well above the national average of 19% (2011 Census)

• BCUHB sent over 600,000 appointment reminder text messages (SMS) during the last financial year; the need to send bilingually doubles the output to over 1,200,000 text messages (and doubles the cost!).
• Over 43,000 appointment reminders were delivered via an agent telephone call; these calls are always made initially in English, with the patient given an option of receiving a follow-up call in Welsh
• The Welsh Language Standards state that BCUHB should be actively asking patients for their preferred language of communication, recording the choice and then using this information to inform future communications.
• As a result of the above, this project aims to improve the patient experience by allowing patients to choose the language in which communications are received; this in turn will make significant cost and efficiency savings for the health board.

The project will enable patients to state their language of choice for appointment reminders (Welsh, English or Bilingual) – this could be:

• when at a GP reception desk.
• during a telephone call with a hospital booking clerk.
• by responding to a text message specifically asking for language choice.
• when visiting the health board’s internet site.

In the long term, the recorded language choice could be used to manage resources, inform patient booking/clinic management and impact on all patient communications.

In 2015-16, over 600,000 text message appointment reminders were sent.

• If just 10% of patients chose to receive appointment reminders in one language, thousands of pounds would be saved by the health board.
• If all patients asked to have their reminders in one language, the cost would be reduced by 50%.

With the future scope to send text reminders for the majority of BCUHB’s 1.1 million outpatient appointments and for nearly 80,000 planned admissions, the potential savings could be massive.

There were also over 43,000 agent telephone calls made in 2015-16. Distressed and concerned patients immediately feel more at ease when contacted in their first or preferred language. The project will allow the appropriate agent to call patients initially without needing a second phone call, improving the quality of the experience for the patient.

Outcomes:

• The language choice intelligence for appointment reminders has been developed by our industry partner Healthcare Communications within their Envoy patient communications This will be available for BCUHB in late January 2017. Furthermore, Healthcare Communications have created a language choice selection feature for online letters accessed via their patient portal (not currently used by BCUHB).
• Within secondary care, language choice can be recorded in the main patient administration systems used within the health board; work with the NHS Wales Informatics Service (NWIS) continues in order to allow the recording of ‘Bilingual – Welsh/English’ as a conscious choice on the national systems. In the meantime, a work around solution will prevent delays in ‘going-live’.
• Adapting the e-referrals process to bring though preferred language from primary care has been deemed too resource heavy, with too many external dependencies, at this point in time. This still remains an integral part of the long term vision (as recording information at the start of the patient journey will be key for long term success) but is out-of-scope for the immediate future.

• It is expected that language choice for appointment reminders will be implemented across the health board in early 2017.

This Project Supports Prudent Healthcare:

The project supports prudent healthcare by encouraging collaboration and co-production within secondary care, primary care, local and national informatics teams and with an industry partner. This is a prudent innovation project, making effective and best use of existing resources, offering both financial and quality benefits: the health board can do this and should do this.