Healthcare trusts keep voice central despite digital shift

Organisations still treat voice as the highest-risk part of workplace communications, and that caution is most visible in healthcare and other public-facing services, according to Gamma Communications.

Voice remains central even as organisations add web chat, bots and collaboration software. Executives at Gamma and Sheffield Teaching Hospitals said the phone still carries the most weight when users need a direct answer, particularly in sensitive situations.

“What we found is that voice is never truly replaced. It is still the most common communication channel across industries. It is particularly useful for those we would probably class as the most vulnerable in society. From that angle, and especially from a healthcare perspective, it is a non-negotiable part of communication strategies when speaking to end users and customers. But because it is so critical, there is a perceived risk around changing the thing that props up everything else. A lot of digital interactions fail back to, ‘We’re terribly sorry, we can’t resolve this issue on web chat. Please call us.’ Well, that is the backup. So if we make any change to that, especially now that it is part of collaboration tools rather than a standalone platform, there are nerves and risks around what we do with it,” said Jack Carr, Teams Leader – Solutions Consultant, Gamma Communications.

That view is echoed in the NHS. At Sheffield Teaching Hospitals, patients and relatives often turn to the telephone first, even where other digital channels are available.

“For an ageing population, there is a real reliance on the telephone. Even now, with all the technology in the world and all the collaboration stacks, if trusts have web chat, live chat or chatbots, people will still default to the telephone. When you are contacting a healthcare organisation, you are often in a vulnerable position. You want to know what is going on with your care or the care of a loved one, or you are waiting for an appointment. You want an interaction with a person. There is nuance in a call that might not be picked up by other technologies. There is such a reliance on the telephone. Historically, it has always worked. Even if you did get through to a department and the booking system was not working, they could at least take your call and let you know. It has always had that importance,” said Tom Boyle, Head of Telecoms, Sheffield Teaching Hospitals.

Rebuild cycle

That dependence makes change difficult. Organisations delay telephony rebuilds for as long as possible because the work is disruptive and often depends on legacy knowledge that may no longer exist inside the business, Carr said.

Technology changes faster than the operating problems around it, he added. Companies still need systems that can cope with demand and remain accessible. Those requirements have stayed largely the same, even as the surrounding tools have shifted from traditional telephony platforms to cloud and unified communications products.

Healthcare providers tend to make such changes even less often, Boyle said. Internal telephony estates can remain in place for decades. Some trusts have changed internal systems separately from external call routing, leaving different parts of the environment moving at different speeds.

“It is the classic ‘if it’s not broke, don’t fix it’. For the PSTN switch-off, it is going to be a once-in-a-lifetime change. But in healthcare, organisations might only change their internal telephony provision every 25 or 30 years. They might change their PBXs or move from copper to IP internally and review it then, but now they are reaching the point where they need to change their external routing. They are probably not going to revisit the internal side because that was already a major project. It is almost as if both are playing catch-up with each other. They never seem to intertwine. And for us, it happens even less often because voice is always working, so we do not want to interfere with it. There is a perception that if you interfere with it, you might break it and make it worse. In healthcare, that impacts people and care. That makes it very different,” said Boyle.

Skills gap

Operational expertise is another issue. Many organisations are reviewing how much telephony infrastructure they should manage themselves and how much they should hand to a provider, Carr said. That question covers both direct spending and the internal cost of using specialist staff on maintenance work.

Yet both speakers said legacy estates still need people who understand voice. Large hospital campuses often run hybrid systems, Boyle said, and some still rely on classic PBX functions and specialist engineering knowledge.

“We are quite fortunate in that, while everything external-facing is IP, internally we have hybrid PBXs as well as an IP PBX. The five hybrid systems are classic telephony PBXs, and all that functionality requires a skilled telecoms engineer to manage it. I am fortunate that I have five skilled telecoms engineers. The difficulty for other healthcare organisations is that over the past 10 or 15 years, telephony has often been absorbed into the network team, collaboration platforms or the EUC team. That is different. But the core functionality of a telephone still needs a skilled telecoms engineer to understand it, especially if you still have parts of a legacy estate. I think there will come a point in the next five to 10 years when those staff and skills start to disappear, and more of this may naturally become part of core IT. But there still needs to be acceptance and understanding that voice expertise matters: how to test, how to probe voice lines and how they work. It is not just a pretend dial tone on an IP phone. There is much more to it. That is a risk looking ahead,” said Boyle.

He also rejected the idea that the move away from the PSTN requires every organisation to replace all internal systems. Large campus sites can keep existing telephony in place if external connections move to SIP-based services, he said.

Different users

The discussion also highlighted a split between the needs of desk-based staff and fixed-location devices. Hospital estates can include thousands of wall phones and emergency lines. Those use cases differ from those of staff who move between sites or work from home and expect a single number across multiple devices.

That divide can push organisations into over-engineered solutions, Boyle said. In some cases, old processes are forced onto newer systems. He argued that this weakens the service and leads users to conclude that the technology itself is at fault.

Decision-making improves when organisations start with business requirements rather than a preferred platform, Carr said. There is no single product that suits every team, and some organisations will continue to run different technology stacks across the same estate.

“That is particularly pertinent for us. If you are going after a specific platform or technology, you must consider how much nuance there is in the business and in the organisation. As we were saying about the split between worker types and departments, we do not have a use case for a large number of collaboration-platform licences when we have eight or ten thousand wall phones serving a simple purpose. Why try to fix that problem when you are trying to solve another? It seems a bit foolish. There is real benefit in splitting it up and simplifying it, rather than trying to chase some ideal end state,” said Boyle.