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Case Study: Frequent Callers

Case Study: Frequent Callers

| On 16, Dec 2018

Darrell Mann


This is the story of NHS paramedic, Rhian Monteith. She was concerned about small numbers of Accident & Emergency ward patients who seemed to keep coming back to the hospital she worked in. So called ‘frequent callers’. Frequent callers are classed as those who call at least five times a month or at least 12 times in three months. The paramedic’s idea, now a year-old scheme called the High Intensity User programme, identified 23 patients in Blackpool who had visited A&E 703 times in the previous three months.

Here’s what the problem to be solved looks like from a Contradiction perspective:

What we’re trying to improve: Supply Cost (i.e. we’re trying to reduce the cost of A&E service provision)

What stops us: ‘frequent callers’ sensing a lack of Autonomy

And then, here’s how others have successfully challenged that conflict pair, according to the new Business Matrix (3.0):

And here’s Rhian Monteith’s solution:

“Frequent caller patients offered a coffee and a chat, personal mentoring and one-to-one coaching, became involved in community activities and encouraged to phone her and not 999.”

Respectively, Principles 1 (Segmentation), 24 (Intermediary) and 7 (Nested Doll). Not to mention the overall concept of (Principle 13) turning the whole A&E model around 180degrees by pro-actively (Principle 10, Prior Action) approaching the patients rather than waiting for them to turn up at the hospital doors.

Notice, too, how Principle 6, Universality (6B in the business version of the Principles, ‘make use of universal behavioural traits (ABC-M)’) is an integral part of the story: Ms Monteith’s solution is all about teaching frequent callers how to take control (A), how to get involved in the community (B) and to feel competent (C).

The story continues:

“Through the scheme Rhian helped A&E attendances, emergency calls and hospital admissions drop by around 90% among the group. The programme was then scaled up to cover around 300 patients in Blackpool over the next three years, saving the NHS more than £2 million, and has now been rolled out to around a fifth of the country. NHS England now wants all remaining clinical commissioning groups to take on the idea to make the NHS more efficient. Around 5,000 people visit A&E units more than 20 times each year, costing the NHS £53 million. Ms Monteith, who now works as the High Intensity User lead with the RightCare programme, said: ‘This scheme is about making sure people are not left behind in society and not medicalised or criminalised.

‘Every individual is put in contact with a person in their lives who cares about them, and stands with them in their time of need. ‘I’m incredibly proud to see how my idea has grown and it shows how, if you are armed with a phone and a high level of emotional intelligence, and ask people “what matters to them” instead of “what’s the matter” (Principle 13 again), the difference you can have to people who need a hand up in life.’ Tessa Walton, director of NHS Delivery, said: ‘The High Intensity User programme is a fantastic example of what we are trying to achieve – improving patient care while reducing some of the pressure on NHS services through new ways of working. ‘We really want to see all local NHS areas using this idea to benefit their patients and services. ‘The fact that it was an advanced paramedic working on the front line of patient care that spotted the potential demonstrates that, regardless of where in the health service someone works, a good idea can have a huge impact across the whole NHS.’

Rhian Monteith’s amazingly simple – ‘if it’s a great solution, it should very quickly look obvious’ – innovative idea is now being rolled out across the country and looks set to save the NHS tens of millions of pounds a year.

There’s always ‘the next contradiction’ to be solved, of course, and I imagine it won’t take long for the new problems to emerge. Perhaps by way of anticipating one of the likely scaling problems (‘we don’t have enough people with high EQ like Rhian Monteith’), might we suggest Inventive Principle 25 as a long term strategy: frequent callers often call because they’re lonely, so why not connect them to other frequent callers. Somewhat like the Alcoholics Anonymous model. We could call it Frequent Callers Anonymous.