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Registered Nurse Average Speed to
Answer Project
Improvement Advisor: Becky Sheely RN, BSN
Colorado Region, Highlands Ranch MOB
August 2012
2
Goal Statement - What Are We Trying to
Accomplish?: Improve the member’s phone experience with
Registered Nurses by increasing their average speed
to answer calls in 60 seconds from 13% to 50%
Threshold, 55% Target and 65% Stretch by
September 2012.
Business Case: By improving the average speed of
answer of the registered nurses for our member’s
seeking advice calls, our member’s satisfaction will
increase due to faster RN response time. This
addresses our KP Value Compass in the area of best
service and affordability by staying cost neutral..
Team Members: Ashley Drahn, Office Supervisor
Janice Brashier RN
Ruth Higgins RN
Kris Leddin RN
Norma Mathews RN
Jeanne Norman RN
Patti Smith RN
Lori Wilson RN
Co-Leads: Debroah Beasely RN, BSN
Improvement Advisor: Becky Sheely, RN BSN
Lead IA: NA
Mentor: Paul Hans
Sponsor: Katy Hoxworth and Jose DelToro
PI Oversight Group: Colorado PI Department
RNs Average Speed to Answer Calls Colorado/Highlands Ranch Medical Offices
UCL 24.44
CL 12.41
LCL 0.37 0.00
5.00
10.00
15.00
20.00
25.00
30.00
Pe
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RN Average Speed of Answer Baseline Data
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Driver Diagram: Registered Nurse Average Speed of Answer for Member’s Phone Calls
Goal Primary Drivers Secondary Drivers Process Owners Initiatives & Metrics Method
Improve the
member’s phone
experience with
Registered
Nurses by
increasing their
average speed to
answer calls in
60 seconds from
17% to 50%
Threshold
55% Target
65% Stretch by
September 2012
Optimize
queuing
process of
calls
Increase RN
Awareness of
relevance and
importance of
phone
management
Decrease RN
Talk Time
Create Accountabilities
Increase Awareness
Increase RN
Available Time
Create Accountabilities
Increase Awareness
Decrease RN
Time in ACW
Create Accountabilities
Increase Awareness
Effective Queues
Increase Education
Increase
Awareness
Individual
RNs
Individual RNs
Individual
RNs
RN Team
Becky
Sheely
Becky
Sheely
Baseline Avaya data shared and
informed RNs with expectations
created
Baseline Avaya data shared and
informed RNs with expectations
created
Use Avaya CMS data displayed on
DTM screen to view call
information and ready states of
RNS. Inform/Create expectations.
Use CHAT function in sametime
for reminders and RN
communication
Recognition
Queues restructured to streamline
calls. Direct Connect Metrics used
to reinforce workflows
Communications/ through
daily huddle and Friday
weekly reviews. Education
of RNs. Inform with baseline
Avaya data and
expectations created
Recognition
JDI
JDI
JDI
RIM
JDI
Legend:
JDI – Just Do It
RIM – Rapid
Improvement Model
Project Selection:
How Does the Project Fit in Our Organizational Goal?
Impacts to all points of the Value Compass:
1) Quality- Improved quality by the "right people" answering the "right questions"
at the "right time.“
2) Service- Direct impact on patient satisfaction with ability to talk with their
physician's registered nurse and overall experience on the telephone.
3) Best place to work- Improved team work (through social agreement)
and decreased work load by answering the question on the first
call (not having to answer a message or a call back) which improves
morale too.
4) Affordability- Improved member experience on the phone translates to
improved member satisfaction which leads to greater retention. One
call resolution will decrease rework, making each call more affordable.
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What Are We Trying to Accomplish?
• Project Background The Registered Nurse Average Speed to Answer project was kicked off in
response to our member’s frustration of not getting their calls answered in a
timely manner when they wanted to talk to their nurse.
Initiate the development of a process to meet the customer expectations within
the current call volume.
Initiate a plan to eliminate wait times, transfers, call back to the clinic, and ensure
one call resolution.
• SMART Goal Improve the member’s phone experience with Registered Nurses by increasing
their average speed to answer calls in 60 seconds from 13% to 50% Threshold,
55% Target and 65% Stretch by September 1,2012[.
To ensure the best possible member experience on the phone, the registered
nurses are focusing on one part of the KP Compass: Better Service and will
positively impact member retention. This goal was set using the data from the
telephone metrics from the Avaya CMS. This goal is specific to RN average
speed of answer and is one goal that is sequential leading to any ultimate
outcome of improving RN Productivity.
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Project Milestones
Project Deliverables Due Date Status
Baseline data collected, goal set 05/11/12 Completed
Sponsor/champion engaged, team kickoff 05/011/12 Completed
Project charter finalized 05/18/12 Completed
Process/value stream mapped 05/18/12 Completed
Set of changes identified through PDSAs 7/15/12 Completed
Annotated run/control charts showing
results
9/1/12 Completed
Sustainability plan developed 10/1/12 Completed
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How Will We Know a Change Is an Improvement?
Family of Measures
Key Measures for the Project
Measure Operational
Definition
Type Data Collection Plan
Increase percent from
baseline that the registered
nurse average speed of
answer is less than 60
seconds
Use telephone metrics Outcome Weekly, Avaya Report
Increase percent of time RN
is in available state
Run report from CMS Avaya Process Weekly, Avaya Report
Maintain or decrease the
number of messages sent to
RN in-basket from DTM an
no increase in abandoned
calls.
Run report from HC Balancing Bi Weekly, HC report
Staff satisfaction with new
process
Huddles, discussion,
informal feedback
Balancing Daily, conversations
Member comments
regarding RN answer time
Qualitative recorded by staff
during member call
Outcome Daily, as comments are noted
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Current State Workflow for Member Calls at the
Highlands Ranch MOB, in Primary Care.
Future State Workflow
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What Changes Lead to Improvement?
Change Concept PDSAs Adopt, Adapt, Abandon?
Staff Education and
awareness
Educated staff on how to use different work states
on the phones, reducing variation and use “chat”
function in lotus notes sametime . while logged in
on phones, enhancing communication.
Adopt
Data availability
and monitoring
Data posted for quick reference on boards, verbally
reviewed at huddle, and RN “quick meeting” (30
minutes) every Friday to review data and problem
solve
Increase awareness of desired auto in state by
sharing weekly data
Adopt
Education
regarding proper
work states
Visible reminder of work state attached to phones
to increase awareness and affect behavior
regarding logging in. Custom made and affix a
bright pink log in state reminder to phones.
Adopt
Process change in
queuing structure
1.Combined MA/LPN to monitor and assist with
DTM queue and to back up RN queue for their team.
2. Streamline RN queues to ensure at least 1 RN is
available.
3. Monitor queues and change as needed to ensure
coverage for members to reach RNs.
Adopt
Reinforcement Create a “6 week” stretch goal reward plan to
reinforce behavior
Adapt, after initial off site recognition, will
need to adapt to more cost effective
program
How will we know a change is an
improvement? Monitoring the measures
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UCL 24.44
CL 12.41
LCL 0.37 0.00
5.00
10.00
15.00
20.00
25.00
30.00
3/19/2012 3/26/2012 4/2/2012 4/9/2012 4/16/2012 4/23/2012 4/30/2012 5/7/2012
Seco
nd
s
Date
Baseline Percent RNs Able to Answer Phone < 60 Seconds
Baseline mean is 12.4% of the time RN answers a call in < 60 seconds
per this graph. Goal is to increase by 50% Threshold, 55% Target and
65% Stretch by September 2012.
RN Phone Averages to Answer
calls in < 60 seconds
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PDSA #1
PDSA #2
Goal: Increase RN average speed to answer calls in 60 seconds from 13% to
50% Threshold, 55% Target and 65% Stretch by September 2012.
Stretch goal
Telephone Scorecard PDSA
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Data posted for
quick reference
on boards,
verbally reviewed
at huddle.
Positive
reinforcement of
RN that took most
calls and RN that
was most
available to take
calls shared daily.
PDSA Telephone Score Card Results
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Data posted for
quick reference
on boards,
verbally reviewed
at huddle.
Balancing Measure:
Percent of Abandoned Calls Decrease
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PDSA Implementation
Goal: Maintain or decrease the amount of abandoned calls.
Balancing Measure to ensure calls are answered by RNs
and not being sent as a message to RN Pool.
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Goal: To maintain or decrease the number of message sent to RN in-basket from
DTM
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LOG IN – click on “Log In” and enter your 5-digit
log-in number, then click on “Auto In.”
AUTO IN – when you are available to take a call
ACW – when you are completing work from a call
and are temporary unavailable
AUX – away from desk temporarily
LOG OUT – at lunch and end of day
PDSA - Bright Pink Reminders on RN Phones to assist with behavior change
Custom made and affix a bright pink log in state reminder to phones.
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Nurse 1... (1:17 PM) Dr. Wright's OBs pt guessing for
another hour
Nurse 2... (1:34 PM) Nurse 2 back
Nurse 3... (1:35 PM) OK, Nurse 3 leaving.
Nurse 1... (1:40 PM) OBs pt reported off to Nurse 4
going to lunch
DTM clerk…(1:42 PM) Nurse #2- You have been in aux
for 10 minutes, please return to auto in
Nurse 4 – (1:46 PM) Nurse stat being called, I am going
Example of PDSA Chat function in sametime for RNS
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Financial Impact
Soft Financial Benefit
Increase the likelihood of
member and staff retention
Member’s having their calls
to RNs answered 80% of
the time in < 60 seconds
will increase their
satisfaction.
Enabling staff to provide
this high level of service
increases staff retention.
Key Assumptions
Hard Financial Benefit
Improve performance
without increasing RN FTE
or overtime
If increase RN
FTE instead of
improving
performance, to
get to 80% of calls
answered in < 60
seconds would
need to add
0.6FTE
$93,000 Cost of RN with wages
and benefits
12-month
Financial Impact Key Assumptions
Sustainability Plan Sustainable
Activity
Accountability/Action Plan Frequency
Actions Continue all PDSA cycles that are to
be adopted or adapted. Manager will
communicate to RN team:
Ownership of this process and
outcomes-identify a champion
Weekly
Data Data shared daily at huddles Daily
Meetings RN Team meet to review outcomes
and problem solve any deviations
from their goal. Meetings are
scheduled routinely, results
standardized.
Monthly
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Recognition done at 6 weeks of sustaining stretch
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Moving Forward
• Key to Success Registered Nurses owned the need to improve
Daily and weekly data to share trends in their work to improve
• Barriers Existing governance board over changing queues unable to support our requests
RN staffing levels with summer vacations difficult to support all queues.
• Lessons learned Registered Nurses are excellent problem solvers due to learned critical thinking
skills so use their strengths to design pdsa cycles. The processes developed drives the performance and success of project.
• Next steps Share data on talk time and develop strategy to decrease talk time so that more
calls can be taken by the RN (average talk time – 5 minutes, 14 seconds)
Share storyboard with Janelle Banat to include in spread for telephone excellence
Next initiative is to look at RN work and capacity for role expansion
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Average time RN is on the phone with each call
Goal: To decrease talk time with each member so that the RN has more capacity for other
member's calls. Did not see a change in this metric but will use as baseline for next IA
Project around RN Productivity.
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RN Average time in Aux/Avail time needing to increase avaialbe and decrease Aux
Goal: To increase available time and decrease aux time so that RNs are
more available to take a member’s call. Did not see a change in this
metric but will use as baseline for next IA Project around RN
Productivity.
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"Evidence"/Expert Opinion/Basis: The average speed for RNs to answer member’s calls within 60 seconds were significantly increased from 13% of the time to 80% of the time in the Highlands Ranch medical center.
Opportunity: Performance Improvement
Source Throughput model, RIM,
Key
Assumptions
• Data, Culture, Technology, process efficiency, phone emphasis into integral daily process
Key
Enablers
• Ability to monitor and measure average speed to answer calls, PI Sponsor, PI support, PI Mentor
Sustainability
Plan
• Manager will communicate to RN team: Ownership of this process and outcomes-identify a champion. Data shared daily at huddles. RN Team meet to review outcomes and problem solve any deviations from their goal.
Contact Becky Sheely, RN BSN Highlands Ranch MOB Paul Hans, PI Mentor Colorado region Ashley Drahn – Office Supervisor Highlands Ranch MOB Deborah Beasley- RN Co lead
Lever: Utilize the KP Improvement* Methods to improve efficiency for Registered Nurses to answer member’s calls
Key Changes Applied:
RNs use chat function in sametime on computer to monitor calls with
DTM and communicate among themselves to ensure 1 RN is always
logged in.
Educated RNs as to different work states on phones and desired work
state (Available) to work in throughout the day
Conducted weekly RN quick meetings to discuss team and individual
results with expectation.
Conducted unit huddles during each morning to discuss yesterday’s
data, give recognition and discuss any potential needs for phone
coverage for that day.
Service level agreements for RN calls in < 60 seconds
Streamline RN queues to decrease variation
#00381
Improvement Metrics: Results RN Calls taken in < 60 seconds 13% to 80% increase
DTM to RN In-basket messages 80msgs to 30 decrease
Abandoned calls 13 calls to 2 calls decrease
PDSA #1
PDSA #2
