The city of London in southwestern Ontario, Canada is home to over 530,000 residents and is a leading centre for higher education, medical research, manufacturing, and technology, and is the regional health care hub for over 1 million people. Providing top-tier health care to the city and surrounding region are London Health Sciences Center, one of Canada’s largest acute-care teaching hospitals; St. Joseph’s Health Care London, renowned for compassionate care and for contributing to the advancement of health care education; and the Lawson Health Research Institute, a top ten health research institute in Canada.

IT Support for the Organization

The ITS Department is an integrated citywide department that supports these hospitals and institute, and the regional healthcare hub of 11 local partner hospitals. The ITS Help Desk is the single point of contact for all ITS related requests across the organization. There are 357 full time ITS Staff and they support 21,527 employees and affiliates. Approximately 15,000 corporate desktops, laptops, thin clients, and tablets, along with almost 3000 printers are also supported and the IT infrastructure accommodates roughly 25,000 active directory accounts, 20,000 email accounts, roughly 1200 corporate & clinical applications. In addition, they support 5,633 regional hospital electronic record users, 15,000 South Western Ontario Diagnostic Imaging Repository users and 1,050 provincial Emergency Neuro Imaging Transfer System users. The integrated service support provides offsite desktop support at 28 satellite locations, and on-site desktop support at 7 primary locations.

The Support Challenges

In the early days of the ITS Help Desk, only one full time employee was dedicated to transcribing email from clients into the ticketing system, respond with request numbers, and update existing requests. An average monthly email volume was greater than 4000, and the biggest nuisance was the inefficiency of email:

• Clients didn’t know what information to provide.
• Information was often missing.
• Requests were vague or missing context.
• A lot of back and forth was required to determine the true nature of requests.
• Delays getting requests to appropriate Support Teams were encountered.

There was no existing, robust intake method for service requests available, which resulted in many common, repeatable service requests being made by phone. This would tie up highly skilled Help Desk phone consultants whose time was better utilized in dealing with break/fix issues that impact patient care.

Additionally, ITS was made up of more than 40 support teams specializing in an array of operational, technical, security and patient care services. Many ITS staff reside within multiple teams, and while these are logical to the ITS department, it was not evident to clients. But what was evident to all was that a single, generic self-service form would never meet the needs of the clients or the ITS department supporting them.

Working Towards a Solution

In June of 2018, the ITS department acquired and began implementing Marval MSM software and ITSM processes including Incident Management, Request Fulfillment, Problem Management, Change Management, Service Level Management, Service Catalog Management, Knowledge Management, and Configuration and Asset Management. Prior to using MSM, the service management tool in place was Service Desk Express (SDE). SDE had not seen significant upgrades in many years and its self-service capabilities were limited to only allowing clients to raise a generic ticket. Self-service in SDE was made available but offered no benefit to clients and no process improvement for ITS. The primary support channels prior to MSM were phone and email, and a handful of web-based forms that generated a preformatted email. Overall use of self-service was less than 1% of all requests.

With Marval MSM as the Service Desk foundation and self-service eForms as the digital form solution, ITS rolled out the new 4-HELP client portal in June 2019.

Rethinking Service Delivery

MSM Self Service is designed to allow clients to raise and view their own request for service or get assistance for incidents, search and view knowledgebase help, view service status and Service Catalog offerings, respond to surveys, launch a chat session with a Service Desk technician, and more. Within the MSM Self Service portal branded as ITS “4-HELP”, request forms are organized by service groups, and the groups are designed to align with the way the clients think about the services delivered, not the way they align as ITS Support Teams. For example, a “Communication Services” group encompasses Beep, the in-house paging system, Jabber messaging, physical phones, mobile phones, MS Outlook shared mailboxes, resources and distribution lists, directory updates and cable pulls.

From a client perspective, these systems and services all have to do with how they communicate across the organization, while from an IT perspective these services are supported by Technology Solutions, Network and Telecom Analysts, Facilities, Telecom Field Support, Telecom Directory Support and Account Administration. Grouping request forms in this manner makes it easier for clients to connect with support, without needing to know who does the work making service delivery more streamlined and comprehensible.

Where the Journey with Self-Service Truly Begins

Another example of effective service delivery via the 4-HELP self-service portal is OneChart: the branding of the electronic health record, Cerner Millennium. OneChart is made up of over 100 solutions and solution families containing millions of records. It is the single largest and most critical application suite and represents one of Help Desk’s largest generators of service requests.

The ITS Help Desk had a problem when they received multiple emails (sometimes 10-15 each day) for OneChart Lab Change requests. Often accompanied by an attachment or a link to a file on a shared drive, these requests were time consuming to log manually. ITS Help Desk was not adding any value to the process, other than it fit the Single Point of Contact model they were struggling to promote. Giving up and telling people to just email PathNet was not an option, but a better solution was needed. ITS reached out to the PathNet Team and asked “What about a self-service form specifically for Lab Change Control? And from that discussion, the first self-service form targeted to a specific task was born.

In its simplest design, the form allowed clients to choose the type of request, enter the path to the change document and submit. With input fields for comments and attachments, if necessary, the form had the potential to eliminate hundreds of emails from flowing through Help Desk. Fast forward several weeks, and other forms had been developed for OneChart where Teams were struggling with a lack of information in requests. Today, the service catalogue of self-serve forms streamlines the intake of OneChart requests, with more on the drawing board.

If You Build It, Will They Come?

Once the self-service portal was configured and forms built, it was time to launch. At the time of the go live, the organization was still heavily reliant on email as the primary communication tool with ITS and there were no collaboration tools that were widely used at that time (i.e., M365, WebEx, Teams, SharePoint, etc.) Moreover, the limited self-service tools and self-help services in the organization in the past, combined with processes that were still heavily “paper based” for many requests (expenses, HR, payroll, procurement, privacy, etc.) it was evident that by simply announcing the launch, it was not enough to drive adoption of the new portal.

The PathNet team was consulted, and they were asked to engage with their clients to promote the use of self-service and its benefits, which included:

• Immediate request confirmation with reference number.
• A means to gather all the required information to resolve a request without multiple emails back and forth.
• Requests that were automatically routed directly to the ITS Team best able to complete the request.
• The ability to view and track request details and their history securely online.
• Easily update the request or provide additional information and attachments.
• Faster service.

The ITS Help Desk also got the approval of the PathNet team to begin to reject requests received via email. Clients were advised that the ITS Help Desk had launched a self-service portal that would allow them to streamline request intake, automate many manual processes, and provide their clients with better insight into their recent ITS requests, and that to be more efficient, the Lab/PathNet teams were no longer accepting requests by email but encouraged clients to use the 4-HELP Self Service portal. Within a few weeks, all PathNet requests were coming through self-service. Gradually, they also started to see more and more use of the portal and other teams within ITS began asking for forms and more clients began updating their own requests online.

Monitoring Success and Uptake

To date, the ITS Help Desk has seen a reduction of support requests from inbound email by about 60%. For some requests, for example PathNet, the time from New to WIP has been reduced to under one (1) hour during regular business hours. The FCR for break/fix at the ITS Help Desk is now between 61-65%, which is up from an average of 56% because of less time being spent logging Service Requests over the phone or providing status updates.

Propagating and Moving Forward

Today with the support of their partners at Marval North America, the ITS Department have recently launched their first forms with an approval workflow. Because of the integrated nature of the ITS Department – a single Help Desk supporting multiple hospitals, affiliates, and researchers – there isn’t always a clear or delineated reporting or approval structure. As a result, the organization created a ‘JobLevel’ field in the client record in the Organisational Structure to identify VPs, Directors, Managers and Coordinators. The self-service forms are then integrated with the MSM database to populate a picklist and clients can choose the relevant approving leader for requests that require authorization. Approvers can respond to the request with an approval or rejection decision via email or the 4-HELP Self Service portal.

Plans for the Future

The ITS Department hopes to expand the self-service to support a variety of other requests that have costs or privacy and security considerations and may require leadership oversight. There are also plans to duplicate this functionality when they implement a Project Management engagement process within both Self Service and MSM. While administration of MSM servers, as well as all backend services and databases is managed by the Corporate Solutions Team, eForms are developed, built and maintained by the Help Desk. This allows them to:

• Modify or change forms in the moment or ‘on the fly’ without the need to go through a formal change control process.
• Ensure forms are always current for both content and the information they gather.
• Tweak the form parameters immediately if they are unclear, are being answered incorrectly, or not generating the desired result.

Plans are also underway to make 4-HELP available externally from anywhere, at any time, with the corporate Multi-Factor Authentication service, DUO Mobile. Through an education campaign that raises client awareness of the differences between a Service Request and an Incident, it is the hope of the ITS Department to all but eliminate email as a support channel in the next 18 months. This will continue efforts to free up valuable Help Desk resources, so they are devoted to first call resolution of break/fix issues, resulting in better service for staff, clinicians, and physicians, and ultimately, the patients they all serve.