The American Cancer Society (ACS) is the largest cancer-related charitable organization in the United States, and probably the world. It is one of the United States' two largest healthcare charitable organizations, along with the American Heart Association. It receives millions of dollars a year in donations and provides funding for research, information, and programs for cancer patients throughout the United States. One of the programs it runs is the cancer information center, a call-center where specially trained cancer information specialists handle calls about cancer. These cancer-information specialists (CIS) are college-educated, highly trained individuals with access to a database with extensive information about cancer. Most of them have backgrounds in the social sciences, such as psychology, sociology, and social work, and many of them have experience and training in crises counseling. In addition, the ACS employs nurses in the call-center to handle specific-questions that may require additional expertise. The goal of the hotline is to disseminate information to callers, not to provide individual healthcare advice. CIS are prohibited from answering patient-specific questions and are to serve in an information-only basis.
In addition to being prohibited from answering patient-specific questions, CIS are prohibited from providing any type of counseling to a caller, even though it is not unusual for the CIS to receive calls from people who express suicidal ideations linked to a cancer diagnosis. The policy is for the CIS to attempt to transfer the caller to a national suicide hotline, or, if that is impossible to find a supervisor or nurse to take the call. However, the majority of suicidal callers contact the ACS during evening or night shifts, when nurses are not available and coverage by supervisors is sparse. Furthermore, even supervisors and nurses are urged not to engage in anything that could be considered counseling. The result is that CIS are placed in a position of telling callers who have already expressed significant depression or suicidal ideation that the CIS cannot help them but can give them referrals to other numbers. When the call ends, the CIS is left to wonder if the caller is safe. If a CIS does provide any type of counseling, then the CIS is given a written warning; accumulating three warnings is grounds for termination. The policy should be changed; not only should CIS not be punished if they provide counseling to a suicidal caller, but CIS who work evening and overnight shifts should be given training to handle suicidal callers, and day-shift staffing should ensure that at least one crisis-trained CIS is on-staff at all times.
Reasons for Change
The first reason that this change is important is to improve customer services; customers calling the hotline of the nation's largest cancer charity expect to find answers and resources at the other end of the line and depression is very common with cancer diagnoses. The second reason is that it is inhumane to hire people who come from helping profession backgrounds and ask them to ignore those instincts when a person is asking for their help. The third reason is that these calls are going to continue and CIS are going to continue to try to provide help to suicidal callers; giving them the training and tools to do so would limit liability for the company and make things easier for the CIS.
Currently, the ACS policy is not to provide counseling of any type to any caller. The policy should be changed. All CIS who will work evening or overnight shifts, as well as additional CIS who volunteer for training should receive training to be a crises counselor in Texas, the location of the call-center. Texas allows people who have been trained as crises counselors, but who are not otherwise certified as mental health professionals, to handle incoming crises calls for the purposes of suicide hotlines and protects them from liability for those calls. These CIS who have also been trained counselors could then deal with suicidal callers, helping to save lives and provide better customer service for distraught people who have turned to the ACS for help.
The change strategy will be based on Kotter's 8-step model, which continues to be recommendable model (Applebaum et al., 2012). Because calls are frequently recorded for coaching purposes, using a recorded call with a suicidal caller and playing it for supervisors from outside of the call-center on one of the scheduled visits to the call center should help establish urgency. Because many of these supervisors have never worked in the call center, they may have no understanding of the content of these calls. Moreover, CIS should be asked to log all suicidal callers, so that the frequency of the problem can be presented at the same time as an example call. Coalition creation is not a significant problem in the call center; all in-house management has come from the floor and all CIS and local supervisors are aware of the problem and want a solution. Developing the vision and strategy could be accomplished by asking CIS what they would want from such additional training and using that input to help shape the training program. Communicating the vision would be easy because of an established monthly team-meeting system, which allows for and encourages open communication by all team-members. The CIS have been successful in implementing call-center wide changes in the past, so reminding them of those successes would help empower broad-based action. In this scenario, one short-term win has already occurred; a CIS with a third-strike for providing counseling to suicidal caller was not terminated after the call center supervisors spoke up for her to upper management. Currently, CIS need to work on that gain and work for change to the policy, not just an exception to the policy for a particular worker; the time to do that is in the wake of the organization almost losing a valuable employee because of the policy. Anchoring new approaches into the culture should be relatively easy. The ACS already has one of the best-trained call-centers in the United States. New employees receive extensive training on all databases, attending a full week of comprehensive training prior to working on the floor, and additional training and coaching while on the floor. Incoming employees could receive the counseling training as a component of their regular training, while current employees could attend on-going training sessions for the counseling, as they do for other job-related continuing education.
Dealing with Resistance
The primary resistance has been from management, which is concerned about liability if the ACS engages in counseling and the cost of the program. The Texas location is key to helping deal with this management, since Texas law specifically provides an exemption from liability. Moreover, the call center is located in the same city as the national suicide prevention hotline, and they have already offered to provide training that would meet the state's requirements, at no cost, to ACS employees.
Communicating this change would need to happen on multiple levels, and would, therefore, require multiple communication strategies. The call center itself is designed to promote communication between CIS employees in their teams. Teams are seated near each other, have similar break times, and have regular meetings for communication and for recreation. Therefore, communicating with CIS can occur within the natural environment. Communicating with call-center management would utilize existing team meeting opportunities; a CIS from each team could be designated to discuss the issue at a team meeting, which would ensure contact with their immediate manager (team leader) and upper management at the center. Moreover, one of the dangers pointed out by Cameron and Green was that teams would be so task-oriented that they would fail to "look at where they [are] as a team, and how they [are] performing and interrelating" (2012). Finally, communication with management from outside of the call-center could be accomplished in a two-prong strategy: (1) upper management already has regular meeting with call-center management and call-center management can help establish the agenda and present speakers, and (2) upper management encourages contact from individual CIS without requiring adherence to a hierarchy, so that all CIS who promote such change could contact all members of the executive-level management team to promote the change.
ACS already has one diagnostic tool; it randomly monitors phone calls for the purposes of teaching and training, and the scores on those calls can be used to help highlight problem areas. The current CIS who already try to counsel suicidal patients receive very low scores and the scoring can be changed to reflect changes in the scripts and procedures. However, suicidal callers are a small portion of all callers, so those calls may not be monitored. Using interview or surveys are two ways to obtain diagnostic information (Cummings & Worley, 2009). CIS could be surveyed or interviewed to find out: 1) if they had ever received a caller who expressed suicidal thoughts or ideations; 2) if they handled that call…