Performance Improvement Series

AMGA Member Best Practices

One Destination, Two Journeys: Call Center Centralization at Henry Ford Medical Group and The Jackson ClinicThomas Nantais, Chief Operating Officer, and Cyndy Orrys, Contact Center Director, Henry Ford Medical Group; and Mark Allen, Chief Operating Officer, and Amy Smith, Contact Center Manager, The Jackson Clinic

Webinar, September 4, 2014

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“I like to refer to the call center like

a virtual front desk. We’re much

more than an appointment

center—we can handle literally

anything the patient calls for.” — Cyndy Orrys, Contact Center Director,

Henry Ford Medical Group

Detroit-based Henry Ford Medical Group handles 1.2 million clinical visits and $800 million in revenues

across 32 locations. The Jackson Clinic, located in rural Tennessee between Memphis and Nashville, is

an independent specialty group with 750 employees, including physicians. These two organizations

embarked on similar quests—centralizing their call center operations—sharing similarities and

encountering differences.

Henry Ford began its journey eight years ago,

partially to find cost efficiencies in the Detroit

market, where one can find roughly $250 million a

year in uncompensated care. Other drivers included

an inconsistent patient experience across Henry

Ford’s many locations and call abandonment rates

of up to 20 percent. “We look at every call that is

dropped as a missed opportunity,” Orrys said. “If you

can control service levels, the abandonment rate

really takes care of itself.”

For The Jackson Clinic, the quest to achieve a “one-

stop shop” began roughly a year and a half ago. The mission was to address patient complaints—such

as multiple transfers around the world and the feeling of getting stuck on eternal hold—as well as a

lack of measuring capacity. Under the old system, there was no way to track important metrics like the

number of calls coming in or hold times. The new call center’s vision is a central place for patients to ask

questions, request a refill, or schedule an appointment, with employees answering the phone able to

address patients’ issues. “We are not there yet but we are much closer than before,” Allen said.

Setting Up OperationsHenry Ford’s 300-plus person, 32,000-square foot call center handles 260,000 calls and 6,000 e-mails

a month with a 19-second speed to answer and an 88 percent effectiveness rate in answering a call

within 30 seconds or less, a metric based on what callers would typically tolerate before hanging up.

The call center also handles automated appointment reminders, calls into the 1-800 “catch-all” phone

line, and “cross-selling” opportunities (encouraging a patient to schedule an upcoming mammogram

or colonoscopy at the end of a visit, for instance). Within established protocols, RNs in the call center

handle prescription refills at both Henry Ford and Jackson Clinic.

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At Henry Ford, agents, who are referred to as

“advocates,” work in 17 “pods” that answer calls

for multiple care sites or a specific product line,

such as orthopedic health. This gives advocates

a depth of knowledge and skill to address calls

appropriately, Orrys said. RNs, which are staffed

at a 1-to-3 ratio with call center advocates,

handle triage, giving advice and scheduling

appointments when appropriate and refilling

prescriptions in their downtime. This process has

improved first-call resolution and reduced ER

visits. With a call volume 30 percent more than

planned, phone engineers were embedded in the

call center. Managing it all is Orrys, the call center

director and “traffic cop.”

Getting there required intensive coordination

among the CMO, the director of nursing, and

IT staff, as well as strong partnerships between

the front desk and various departments. A

senior leadership group and physician steering

committee met monthly to ensure efforts in

metrics, advocate education, and other areas were

proceeding to plan. For instance, the orthopedics

chair gave call center staff an anatomy lesson,

the CMO and director of nursing helped write

protocols to ensure standardization, and the IT

staff helped move Henry Ford from an antiquated

25-year-old phone system to video IP.

Henry Ford’s ultimate goal is to integrate

specialties and business operations even more

CALL METRICS AT HENRY FORD MEDICAL GROUP

Call Types

Current Metrics

Average Monthly Volume:■ Phone: 260,879■ Email: 6,165

Phone Metrics:■ Speed to Answer: 19 secs■ Average Service level: 88.1% in 30 secs■ Average Handle Time: 3 minutes 11 sec■ After Call Work: 3 minutes 19 sec

Performance Goals:■ Service Level: 80/30■ Abandonment Rate: <6%■ Agent Adherence to Schedule: 95%■ Agent Quality Score: 100%

Other 10%

Rx Re�lls 25%

Inquiries 25%

Appointments 40%

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into a one-stop resource for everything from

scheduling an appointment to paying a bill. Also

on deck are insurer partnerships to, in Orrys’

words, “get patients with bad debt to a good

place.”

Jackson Clinic’s contact center supports 25

full-time employees, each assigned to an

administrative/scheduling group or a nursing

group, and these employees work in staggered

shifts to support calls from 7 a.m.-11 p.m., seven

days a week. Phone nurses are also embedded in

primary and specialty care. Centralization of these

previously scattered employees required physical

relocation of many employees to the new space,

new job descriptions, and additional training.

In terms of IT, Jackson Clinic discovered a capacity

issue that was the opposite of Henry Ford’s: Due

to “spaghetti routing,” the clinic was double-

and triple-counting phone loads, taking in up

to 1,000 fewer calls per day than previously

believed. A new “less is more” call tree now routes

unanswered calls to employees. Patients put on

hold now listen to ads and waiting prompts with

an option to speak to a live person or go to voice

mail. The clinic aims to eventually route calls by

skill set, which will enable customized handling of

calls throughout the clinic during peak times.

Costs for both call center initiatives were charged

under “general and administrative” using

corporate allocation.

Finding and Training the Right People

Every job posting at Henry Ford’s call center

typically attracts around 200 applicants. How

are the right ones chosen? Orrys uses a robust

behavioral interview guide—peppered with

questions like “How did you handle…?” and

“Talk about a time when….” She also looks for

customer service experience—and not necessarily

experienced gained at a call center. In these cases,

“we’re sometimes undoing bad.” However, “you

can’t teach nice, and you have to be nice in order

to handle this job.”

JACKSON CLINIC CALL CENTER ORGANIZATIONAL STRUCTURE

ContactCenterAgents

ContactCenterPhone Nurses

Operators

Primary Care

Appointments

Specialties

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Even after offering pay increases and retention

bonuses to retain employees, the new call center

still needed more staff. The organization originally

used an agency and 90-day temporary terms for

some hires but soon went to a permanent-hire

model, which attracted better candidates and

helped lower turnover to 2-3% per month. Many

of these employees are nurses at the end of their

careers who don’t want to be on their feet all day.

Allen said that he sees many of these applicants as

well, who view the position as a foot in the door

to The Jackson Clinic. The candidate per posting

ratio, however, is lower in Jackson’s less-populated

coverage area—roughly eight to 10 applicants per

opening.

In both organizations, a new hire participates in

several weeks of intensive training between his

or her first day on the job and first day alone on

the phones. Initially, Henry Ford immediately

sent new hires to its 15-seat training center,

which is equipped with a full-time trainer and

adult learning curriculum, to reinforce the

professionalism of the position. But the sudden

classroom immersion proved overwhelming.

Now, new hires first spend a few weeks in the

pod listening in to get a feel for the job. Time

in the classroom is led by trainers educated

themselves through the train-the-trainer method

for standardization purposes. It’s followed by

a “nesting” period back in the pod to reinforce

lessons before taking calls solo.

Training at Jackson Clinic includes a 10- to 12-

week training program, which the clinic is aiming

to shorten when more things are standardized,

and biyearly reviews of protocols, which aid

accountability, Smith said. Due to the complexity

of the training and the position, the clinic looks

for longevity when it hires.

Measuring ResultsThrough standardizing its call center protocols,

Jackson Clinic has empowered its employees to

make decisions while reducing or eliminating

transfers. The ultimate aim, Smith said, is “one-

call resolution,” getting all of a patient’s needs

handled before the end of the call. Jackson also

wants to improve other metrics in areas that

impact the patient experience, such as hold

times and abandonment ratios. An abandoned

call report shows wrong numbers, patients who

waited too long for an answer, and the average

time to answer a call, which is currently around 49

seconds.

Analyzing overall call load also is very important

in defining peak times and forecasting loads for

staffing and other tasks handled during down

time. Jackson bases much of its staff scheduling

on when calls are coming into the clinic and the

defined service level it’s committed to uphold—

answering 80% within 40 seconds. Smith said they

couldn’t find enough industry stats for guidance,

so they use login time to measure who is available

for incoming calls and average talk time to see if

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agents are taking care of calls and not transferring

them elsewhere unnecessarily. Long on-hold or

consultation times can indicate employees in

need of training.

Henry Ford measures many metrics, including

quality, advocate adherence to procedures,

average talk time, and average after-call work

time. “A lot of places buy tools but don’t use them”

due to budget cuts, Orrys said. “We use tools to

the full extent.” These include Verint Systems’

Impact 360 Quality Monitoring. The organization

already measures loyalty and retention and

is looking at Press Ganey for ways to measure

courtesy.

An advocate’s number of calls handled is

compared with his or her peers, mostly to detect

trends, as Henry Ford’s overarching goal is quality,

and the QA score the organization aims for is

100%. Advocate adherence— specifically, how

well advocates mirror what Henry Ford wants

them to be doing—is key to achieving these

goals. Quality coaches and mentors listen in to

advocate calls every two weeks, and an advocate’s

QA score comprises promotions, opportunities,

team membership, and more.

Maintaining MoraleMorale is important in any customer-facing

position, and Jackson Clinic works to boost it

with activities like cubicle decorating, posting

baby pictures, and other activities planned by

employees. Agents also get opportunities for

more responsibility; for instance, one of the

agents was recently named team leader of the

nurse’s call center group.

Similar activities take place at Henry Ford,

including recognition via a regular newsletter

(“The Podville Times”), postings on a bulletin

board, and monthly events planned by the call

center’s WOW advisory committee. Advocates

have opportunities for multiple layers of

advancement—level one, level two, staffing

for the 1-800 line, a QA or workforce role, then

supervisory and managerial roles. Orrys said

that the center has had more than 80 internal

promotions so far. This includes the advancement

of her current call center manager, who started

out as a Level 1 advocate.

Another motivational incentive—and one that

dovetails with the call center’s growth—is the

opportunity to work at home as a Henry Ford call

center advocate. Eligibility criteria include one

year of employment, quality scores of 100 percent,

and excellent attendance. So far, 50 advocates

have met the requirements. The $5,000 “desk-in-

a-box” that enables this includes a laptop that’s

fully loaded with software and a robust firewall.

Because of HIPAA requirements, advocates who

work from home must work from a room with a

door and are not allowed to hook up a printer to

this laptop. The call center has experienced no

breaches, Nantais said.

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From the Audience

Q: Did physicians like the call center idea, or was there pushback to overcome?

A: Physicians at Jackson Clinic thought they were having something taken away from them at

first, Allen said, which was an obstacle. But then they saw that their patients were getting their

problems resolved more quickly, without being passed around, which improved buy-in. At Henry

Ford, pushback came from not bringing all physicians into the call center service at first. “Some clinics

thought they could do better,” Nantais said. “But we showed over time that service levels were better

and won them over.” Putting physicians on the call center steering committee helped as well.

Q: What impact did the one-stop call center have on your patient portal?

A: In the six months that Jackson Clinic’s call center has been live, call volume has increased and the

time spent on portal-related requests has increased, as Allen expected. Henry Ford’s call center also

handles tasks related to its MyChart EPIC EHR, such as general internet requests, activation codes, and

assistance with the technical functions of the portal.

Q: How are nurses triaging calls and passing them on to physicians?

A: Orrys said that nurses at Henry Ford chart every call and let physicians know the outcome,

meaning nurses rarely have to pass calls along. At Jackson Clinic, triage is protocol-driven, with

situations that fall outside of established protocols passed on to physicians.

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