Buncombe County Department of Health and Human Services

From Home-Grown Systems to Cutting-Edge Technology

Background: In Western North Carolina, Buncombe County covers 600 mountainous square miles. Out of the county’s 238,000 citizens, 120,000 utilize the county’s Social Services and Public Health departments. In 2006 Buncombe County identified a major strategic goal: combining its Social Services and Public Health departments into a single, integrated location. This would allow the county to more efficiently utilize their resources and more effectively link clients to the services they needed, and hopefully achieve better outcomes. Improving these outcomes would serve to meet another strategic goal for the county: significantly decreasing public health costs across the whole community.

The Challenge
Statistics showed that 70% of Buncombe County’s client base utilized multiple departments from within the Social Services and Public Health systems. This often resulted in numerous visits with overlapping operations. For instance, a client may need to apply for child care assistance and need access the clinical immunization service or health screening for cancer. What the county needed was a better way to assess client’s needs and reduce the overlap between departments. They needed to diminish redundancy and ensure residents were receiving better access to services.

Integrating the Public Health and Social Services departments could provide a more complete and efficient process for its residents. Administering more comprehensive services for each client’s visit could have a more significant impact on their overall health and reduce public health costs.

Combining the two departments required extensive reshuffling of staff and office layouts. The reorganization involved a major building renovation of the former offices to create a single front waiting room with shared back-o-house amenities. The building renovation began in 2011 and reopened under the new configuration in January 2012.

Opening an integrated human services complex was a major milestone for Buncombe County, but being one of the first integrated service locations in the state also meant being on the front lines of resolving multiple challenges. While they now had beautiful, newly-merged offices, they lacked a way to control customer flow. Together, the two departments served the largest and third largest consumer bases in the county. How could the staff link residents to other services they needed, and route them more efficiently?

As each department’s front desk staff worked together to merge programs and systems, they soon recognized the practicalities and complications of integrating the two departments. Having never operated together, the staff soon realized the need to track clients at the front office and then route them throughout the building in an efficient way. Doing so would also require sharing information between departments to coordinate services and ensure the best use of staff. The county’s old, “home-grown” routing model was no longer sufficient to meet their needs. “It’s great to grow things yourself, but keeping them current is a real challenge,” says Mandy Stone, Buncombe County’s DSS and Assistant County Manager for Human Services.

The challenge was complicated even further when they realized how complex the back-of-house functions between departments were, even with the integrated front desk services. The new system had to meet increased service demand and also streamline the functions of each service beyond the lobby. As the county management liaison responsible for overseeing the budget, Stone and her team set out to identify a company with the necessary technology meet their needs.

The search led them to ACF Technologies’ Q-Flow system. Known for its work in multiple government sectors, Q-Flow’s capacity to track movement of clients in health care settings and create metrics to measure efficiency was ideal. In addition to having a national and international client base, they also discovered that ACF’s corporate offices were just down the street from the new county offices in downtown Asheville.

“Initially we just wanted a straight-forward queuing system,” says Stone. “But upon seeing the potential in the Q-Flow technology, we increased the scope to fully meet our needs.”

Our Solution
With the county’s old, reactive system, clients traveled back and forth between multiple departments sometimes returning to the waiting room several times. The difficulty with staffing and scheduling created significant delays especially on heavy-service days. Not to mention there was also no way to coordinate and organize their many walk-in clients.

The consultation team at ACF Technologies worked closely with Buncombe County to design a Q-Flow system tailored to meet their needs. In the front lobby a greeter directs each client to a kiosk which asks them a series of questions to determine the services needed on their visit. The kiosk generates a ticket for the client to keep throughout their visit. The kiosk directs the client to the front desk where the staff takes a closer look at the client’s needs to determine what, if any, additional services are required. Video monitors in the waiting lobby provide directional signage and information for clients during their visit.

At that point the Q-Flow system lines up the client’s entire route during their visit, and determines the order of services needed. The system directs clients through the entire visit step-by-step without the patient ever having to go back to the waiting room. The necessary staff are prepped and waiting to serve each client in a comprehensive, smoothly-interfaced progression.

Q-Flow identifies peak times for different services and makes adjustments to staffing. In addition to providing wait-time management, Q-Flow sees every aspect of the system, monitoring client load and moving staff around as required. The system tracks wait and service times from front lobby to back-office for every step of the client’s visit. Q-Flow monitors how many clients are waiting in the front lobby and the number of staff serving clients in real-time.

The Q-Flow system optimizes the staff’s scheduling and routing capabilities and enhances the client’s experience beyond the front lobby. Q-Flow allows the departments to share information between services, measure wait times and traffic flow, and provide corresponding staffing metrics.

Q-Flow offers an additional feature which allows off-site social workers to access Q-Flow from remote computers and put clients directly into the system. When the client arrives at the county offices, the staff is ready and waiting for them. How is that for customer service enhancement?

Making Progress
Launched in January 2012, the staff is quickly learning the nuances of the Q-Flow system. As the initial metrics and data pour in, Buncombe County is able to immediately address their service delivery. As a result of these early measurements, the county has added additional kiosks to adjust to the traffic. It’s also allowed the county to measure compliance aspects of their services, including the ability to track dropped phone calls. Q-Flow was instrumental in identifying that non-English speaking clients had a higher incidence of dropped calls. With this information, the county chose to arrange for additional bilingual staff at the front desk.

Another, less-recognized benefit is that the Q-Flow system is an influential part of the county’s disaster plan. The system is cloud-based, enabling the county to operate in emergency conditions. Because client demand can escalate in disaster situations, Q-Flow’s accessibility is instrumental to providing uninterrupted flow of services.

According to Stone, customer feedback is astounding. “We’ve had no negative comments, even in the first hectic days where the staff was learning the system. We survey each client and they report an overwhelmingly positive experience. Even the county commissioners have received positive comments.”

“Q-Flow helped us get away from the way we used to do business. We have more options in how we move people around and organize staff. Now we can be very proactive, which results in a shorter service time with more complete services. When clients come to the back, the staff is ready to take action. Tracking entry to exit is something other social services haven’t done before.”

The staff is now looking for additional opportunities within the Q-Flow system to identify linkages between services, needs, and additional ways to route clients more efficiently. “We’re just scratching the surface,” says Stone.

Final Remarks
Merging two heavy-traffic departments means significant adjustments as even greater numbers of clients come in the door. Q-Flow’s unique combination of technology and human interface is a tremendous asset, giving Buncombe County the ability to provide better customer interface with a significant improvement in delivery. Because these Social Services and Public Health services are among the most expensive to provide, Q-Flow’s ability to show financial prudence and efficiency is critical in managing the county’s investment of public money.

According to Stone, “We feel like Q-Flow was the right choice. ACF has been a great partner, incredibly responsive and adaptive as we made adjustments. Q-Flow is the ‘crown jewel’ example of effectively managing county dollars. Other counties now visit our offices, just to see the system at work.”

Q-Flow® and GreatVisit ™ are trademarks or registered trademarks of Q-nomy Inc., and are used by permission.