We are never too busy to answer the call bell

Kōrero Mai: South Cross Hospital Christchurch case study


Our Southern Cross Hospital in Christchurch was asked by the Health Quality & Safety Commission patient deterioration programme to develop a patient, family and whānau ‘escalation of care’ system. Also known as known as Kōrero Mai/Talk to me, the system gives patients and their families a voice when they feel their loved one’s health is deteriorating.

The aim of the project was to work with patients and staff to gain a detailed understanding of the barriers and osbtacles, and then work together to develop solutions to enable the escalation of concerns within our hospital. By implementing these solutions, our hope is to improve patient care and enhance the patient experience. 

We were eager for our nurses to be more aware of patients/whānau concerns, act on those concerns in a timely manner and escalate accordingly.  In addition, our aim was to understand the varied requirements of different patients and their whānau. 

The co-design process we used fundamentally aimed to involve the people who deliver and receive care, seeking their experiences to establish views and create a full picture, then work together to develop solutions.

We used focus groups of patients and clinical teams to establish some key themes including:

  • the notion of ‘busyness’ and how this impacted patients and their whanau
  • that staff really did want patients and whanau to alert them if there were any concerns.

Suggested solutions to address these issues included display charts, information brochures, cards and badges that could inform patients that our clinical teams were there to help at any time and they could ask for assistance at any stage during their stay. These solutions were worked through with patients from the focus groups who confirmed that these ideas were relevant and would be beneficial to provide them with reassurance that it was okay to ring the bell. 

Improve / Implementation

  1. Display charts were placed in patient rooms, located either at the wall facing, or at the side of their bed. 

  2. Information leaflets were included in the patient admission packs, a larger version of this was also placed in different areas around the ward; in the patient lounge, at the nurse’s station and several were also placed on walls in other areas of the ward.

  3. A small card is handed to patients on admission by the Health Care Assistant.


As we are still in the process of implementing changes outcomes are yet to be revealed.  Some of our patient feedback thus far includes:

  “Have always been reluctant to ring the bell but would have no issue ringing now”

“ The poster was enough to ring”

“Within the first 10 minutes it was impressed on me to ring the bell”

After seeing poster… 

“I talked to the anaesthetist about my breathing concern when intubated, I wouldn’t have told him otherwise”

Working as a co-design team

How we found working as a co-design team:

  • The co-design team have maximised individual strengths to give diversity to the project
  • We had the advantage of being able to readily connect due to our close proximity
  • As time is a rare commodity, if full attendance was not able to be achieved at every meeting we were able to keep everyone in the loop to ensure we had continuous momentum.
  • Engaging the wider team and making change purposeful requires all areas of the hospital to be involved. Only then can we sustain improved quality of care.

For future planning we would consider using the co-design framework for any improvements and would hope that it would be supported by enthusiasm and motivation from all stakeholders no matter what department they work in, working towards the same goal.

There is ongoing engagement with patients and whānau following our initial trial period and looking to sustainability we will continue to seek involvement for ongoing feedback and redevelopment as needed.

Project team members’ contacts

Names of team members Role Email address Organisation DHB
Pippin Morrison Project Lead Southern Cross Hospital Christchurch
Fiona Ryder Project Sponsor Southern Cross Hospital Christchurch
Lorraine Proffit Safety Quality Risk Facilitator Southern Cross Hospital Christchurch
Nadeane Spriggs Clinical Nurse Educator Southern Cross Hospital Christchurch
Rachel McCaskill Clinical Nurse Specialist Southern Cross Hospital Christchurch
Kim MacFarlane Ward Team Leader Southern Cross Hospital Christchurch
Michelle Grenfell Ward Team Leader Southern Cross Hospital Christchurch
Belinda Clark Patient

Download Full Case Study

To read this case study in detail and find more information about this project, download a full case study in a printer-friendly PDF format here.