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Scenario: Plan, design and create a call center for primary care appointment scheduling. Improving the patient telephone experience… ACKLEY / CALL CENTER START UP

Create a wonderful healthcare telephone experience!

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Call centers can create better healthcare access with enterprise scheduling. Here is a live example of the process that created a call center that the medical and patient community found valuable!

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Page 1: Create a wonderful healthcare telephone experience!

A C K L E Y / C A L L C E N T E R S TA RT U P

Scenario: Plan, design and create a call center for primary care appointment scheduling.

Improving the patient telephone experience…

Page 2: Create a wonderful healthcare telephone experience!

A C K L E Y / C A L L C E N T E R S TA RT U P

Call Center for Primary Care Patient Appointment Scheduling

Medical Records

Population Health

Prior Authoriza-tion

Referrals

Tier I & IICare

Coordination

Informatics

Patient Ex-perience

Transitions of Care

Call Center

This project was one slice of a three year plan to develop a patient contact center.

Page 3: Create a wonderful healthcare telephone experience!

A C K L E Y / C A L L C E N T E R S TA RT U P

Why a call center?

Business valueSingular brandingEconomies of scaleCustomer responseBusiness alignmentStandardized service Scheduling efficiencyCompetitive access advantageRemove white noise from the clinics

Page 4: Create a wonderful healthcare telephone experience!

A C K L E Y / C A L L C E N T E R S TA RT U P

Project scopingCreate a call center for enterprise primary care scheduling.

• 5 adult medicine primary care clinics and 1 urgent care center• 500 phone calls per day (estimated)• 28 providers

Do this in a manner that creates better access and a singular telephone experience for patients in the community.

Mark’s rules of engagement:

• Must be scalable.• Must be sustainable.• Remain FTE budget neutral.• Must use existing technology.• Incorporate Lean principles and techniques. • Must clearly demonstrate value to both patients and medical providers.

Page 5: Create a wonderful healthcare telephone experience!

A C K L E Y / C A L L C E N T E R S TA RT U P

Starting point – know your present state

Antiquated phone system75 PCP appointment typesLabor pool talent challengesLackluster hospital call center19 different phone routing trees23 different telephone numbers23 different scheduling processesTrepidation from the provider communityPatients struggle to navigate the systemNo consistency in the patient telephone experience Long wait times to schedule an appointment inhibiting patient access

Page 6: Create a wonderful healthcare telephone experience!

A C K L E Y / C A L L C E N T E R S TA RT U P

Time sensitiveService standardsTechnologyManagement controlClinics lose control over their immediate scheduleCommunity perceptionCommunication between clinics and central schedulingEmployee buy-inPhysician buy-inBlending into hospital operations

EasyModerateDIFFICULT

Recognize the challenges

Page 7: Create a wonderful healthcare telephone experience!

A C K L E Y / C A L L C E N T E R S TA RT U P

Know what success looks like…

Live answerWarm hand-offs Provider engagementEasy hospital transitionExpanded scheduling hoursReduction in phone activity in the clinicsStandardize customer telephone experienceQuality control – fill rate tracking, no shows, call backsUltimately, one number to call for medical services in

Santa Fe

Page 8: Create a wonderful healthcare telephone experience!

A C K L E Y / C A L L C E N T E R S TA RT U P

PLANNING, COMMUNICATIONS & GOVERNANCE

Steering Committee

Clinical leadership

Operations Committee

Technology Committee

Clinic Committee

Consulting Services

• Weekly meetings• Constant feedback loops• Quality metrics published• Communication to clinics• Go-no go status for every

phase• All meetings open to

anyone

Planning and communications were the key components. This project demanded a high degree of discipline in project management, communication and transparency for every stakeholder in the network.

Page 9: Create a wonderful healthcare telephone experience!

A C K L E Y / C A L L C E N T E R S TA RT U P

Basic requirements for call center start up

Quality metrics and and agent monitoring.Provider scheduling targets and preferences.Standard answering and hand-off techniques.Telephone savvy, bi-lingual, telephone agents.Telephone routing protocols for warm hand-offs. Quiet office space with minimal background noise. Workstation cubicles with minimum of 36 square feet.Technology – computer, phone, headset, 2 large monitors.Instant messaging for communication between clinic and call center.

Page 10: Create a wonderful healthcare telephone experience!

A C K L E Y / C A L L C E N T E R S TA RT U P

Staffing Requirements: < 500 calls

Targets and Assumptions: Average number of calls per day

326 calls

Average call duration 76 secondsAverage wrap up time 60 secondsCall answering target 80% in 20 secondsTrunk blocking target 0.010Maximum agents 4Lines required 5

(Based on Erlang B and Erlang C Traffic Models)

Page 11: Create a wonderful healthcare telephone experience!

A C K L E Y / C A L L C E N T E R S TA RT U P

Start up call center staffing

3 agents processing an average of 326 calls per day 326 calls per day = 4.4 working hours per agent per dayThe remaining 3.6 hours in an 8 hour work day

(1.0) hr for lunch and breaks 2.6 hrs used for:

appointment reminders, processing notes, entering and updating patient information, transferring calls to office staff, rescheduling appointments if the provider’s schedule has changed last minute.

Page 12: Create a wonderful healthcare telephone experience!

A C K L E Y / C A L L C E N T E R S TA RT U P

Call center “go-live” strategy Tactical Choice – I used a “soft launch” approach and pointed all

existing phone lines to the central location making it invisible to the patient. The patient was calling “their clinic” and did not know the difference except for the increase in service and access.

We even did our best to match the call that was routed from the clinic to the agent who came from that clinic – it turns out that the patient did not care, they were just happy with the access!

Page 13: Create a wonderful healthcare telephone experience!

A C K L E Y / C A L L C E N T E R S TA RT U P

Sequential go-live rollout

Clinic 1

Clinic 2

Clinic 3

Clinic 4

Clinic 5

1. Debrief with clinic staff and providers2. Share quality and performance metrics3. Identify and resolve pain points4. Invite staff next in the queue to debrief5. Document all issues, resolutions and

successes6. Disseminate all information, network

wideWe continued the rollout in this manner and did not bring up the next clinic until all issues were resolved.

Page 14: Create a wonderful healthcare telephone experience!

A C K L E Y / C A L L C E N T E R S TA RT U P

Measuring call volumes

11/6/

2013

11/7/

2013

11/8/

2013

11/9/

2013

11/10

/2013

11/11

/2013

11/12

/2013

11/13

/2013

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/2013

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/2013

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/2013

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/2013

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/2013

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/2013

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/2013

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/2013

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/2013

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/2013

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/2013

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/2013

11/26

/2013

11/27

/2013

11/28

/2013

11/29

/2013

11/30

/2013

12/1/

2013

12/2/

2013

0

100

200

300

400

500

600

Cal

l Vol

ume 1 clinic

5 clinics live

153

532

Page 15: Create a wonderful healthcare telephone experience!

A C K L E Y / C A L L C E N T E R S TA RT U P

Understanding peaks and valleys11

/6/2

013

11/8

/201

311

/12/

...11

/14/

...11

/18/

...11

/21/

...11

/25/

...12

/3/2

013

12/5

/201

312

/9/2

013

12/1

1/...

12/1

3/...

12/1

7/...

12/1

9/...

12/2

3/...

12/2

6/...

12/3

0/...

1/2/

2014

1/6/

2014

1/8/

2014

1/10

/201

41/

14/2

014

1/16

/201

41/

20/2

014

1/22

/201

41/

24/2

014

1/28

/201

41/

30/2

142/

3/20

14

0

100

200

300

400

500

600

Call

Volu

me

Monday

Average calls per day: 340

Start!

MondayMonday

Page 16: Create a wonderful healthcare telephone experience!

A C K L E Y / C A L L C E N T E R S TA RT U P

Measuring qualityQuantitative

Dropped call rate < 2% Schedule fill rates have increased from 74% to 92%Average talk time increased from 45 seconds to 90 seconds. Call center is now scheduling 90% of all PCP appointmentsAnswer time = 3 seconds, post router message per ACD reports

Qualitative

Positive feedback from providers “Hey, this works!”Clinic noise level reduced to create quiet, calm spaces.Front office staff report they can focus on the patient in front of them.Positive feedback from the Patient Advisory Council “Thank you for listening!”

“Finally, I can schedule an appointment to see a Physician faster, talk to a live person and only have to dial one phone number!”

Page 17: Create a wonderful healthcare telephone experience!

A C K L E Y / C A L L C E N T E R S TA RT U P

This is scalable

Average number of calls per day

522

Average call duration 76 secondsAverage wrap up time 60 secondsCall answering target 80% in 20 secondsTrunk blocking target 0.010Maximum agents 5Lines required 6

(Based on Erlang B and Erlang C Traffic Models)

Using national call center industry standards, you can use Lean “load leveling” techniques to balance your resources against your need.

Growing your business? No problem, here is what you need to manage your phone traffic.

Page 18: Create a wonderful healthcare telephone experience!

A C K L E Y / C A L L C E N T E R S TA RT U P

There are no limits with smart growth

Average number of calls per day

1,695

Average call duration 76 secondsAverage wrap up time 60 secondsCall answering target 80% in 20 secondsTrunk blocking target 0.010Maximum agents 11Lines required 12

(Based on Erlang B and Erlang C Traffic Models)

Staffing requirement for a call center to manage over 1,500 calls per day and maintain industry standards at the 90th percentile.

Page 19: Create a wonderful healthcare telephone experience!

A C K L E Y / C A L L C E N T E R S TA RT U P

Call center project – final result

Live answerWarm hand-offs Provider engagementEasy hospital transitionExpanded scheduling hoursReduction in phone activity in the clinicsStandardize customer telephone experienceQuality control – fill rate tracking, no shows, call

backs

✔✔✔✔✔✔✔✔

Page 20: Create a wonderful healthcare telephone experience!

A C K L E Y / C A L L C E N T E R S TA RT U P

Complete, successful and ready for the next slice!