Some patient access departments are moving toward centralized scheduling, where appointments are booked all in one place. There are many advantages to this; still, tracking productivity is a challenge.
“It is a very manual process. Many times, it does not paint the entire picture,” says Jessica Budri, RN-MSN, APRN, senior manager in the patient access department at Connecticut Children’s Medical Center. Centralized scheduling is fairly new at the health system; leaders implemented the system only within the past few years.
Important metrics include: How many calls are made? How many calls are received? How many patients are scheduled? How do incoming referrals compare to outward calls made to patients? These numbers are not readily available. “We do not have a reliable source of ‘one-truth’ data to gauge how the team is doing,” Budri says.
Inaccurate data on productivity are an ongoing source of frustration. Phone reports give limited information on how many calls are made and how long each call lasts. “But we aren’t consistently capturing those patients who cannot get through,” Budri laments. Similarly, there are no good data on how many times staff try to contact one particular patient or family. How quickly the first incoming call from a referred patient is handled also remains a mystery. The number of appointments made by employees (the goal is at least 15 per day) is known, but the number of calls they answered is unknown.
“It is hard because it is phone tree-based, with little detail on a specific user,” Budri notes.
The percentage of “dropped” calls (those that go to voicemail without anyone answering) are kept to an absolute minimum. “Our goal is to have zero dropped calls,” Budri reports. “That is what we strive for but do not always achieve.”
Many data points that would help the department assess its performance are not captured. “A key metric we would love to be able to [capture] is follow a referral through to completed appointment,” Budri says. Other wished-for-but-elusive metrics: How much back-and-forth happens before registrars actually make contact with a family? And how long does it take from that point until an appointment is actually scheduled?
The quality of customer service given is hard to pinpoint, too. The Connecticut Children’s Press Ganey surveys include two relevant questions about “the ease of scheduling” and “the helpfulness of the registration person.” Schedulers receive a target goal and a stretch goal based on the previous year’s results. “We are excited that we are currently above our stretch goal for both inpatient and outpatient registration services,” Budri reports.
The medical center’s social media specialist informs the department about when someone is posting about it. “This has helped us identify a few key opportunities very quickly,” Budri says. One parent posted that they had called three times and still could not get through and hashtagged the facility. “This helped us quickly review the account, connect with the family, and provide service recovery,” Budri says.
It turned out the parent had only called twice. Also, it had just happened the night before, allowing for a timely reply. “It still gave us great insight into a parent’s point of view on the importance of always being able to answer their calls as a free-standing children’s facility,” Budri explains.
Northwestern Medical Center in Saint Albans, VT, opened its Central Access Center in early 2019. Currently, the center is scheduling outpatient visits for eight of the hospital’s 15 practices. “Our goal is to slowly incorporate all the practices over the next two years,” says Patient Access Manager Frederick J. O’Neill. Staff also track referrals and obtain prior authorizations. “After opening the access center, it became evident that we needed to upgrade our phone system to one that provides more tools to measure productivity,” O’Neill recalls.
Creating goals for employees was not the problem. “We had a ‘magic number’ of how many calls a scheduler can answer within an hour. That seems to be on track,” O’Neill says. The department also measures the number of abandoned calls, which is at less than 1%. “But we currently have no way to monitor calls for quality assurance,” O’Neill laments.
There also is no way to track appointments scheduled per employee. The department is working on upgrading its phone system. Also, patient access is working with electronic medical record vendors to add additional reporting features.
The new Central Access Center was implemented as “totally budget-neutral.” O’Neill visited each practice to determine how many FTEs would be taken away. “We ended up using phone volumes to determine the amount of FTEs we would need,” he says.
One hundred calls per day, on average, was considered equal to one FTE. For example, if an office answered 100 calls per day on average and had two FTEs working there, one employee was taken from that office. “It got kind of tricky with some of the smaller practices,” O’Neill notes.
Next, each practice had to sign off on algorithms for how they wanted their patients scheduled.
“We had to standardize some of the scheduling processes across the practices,” O’Neill says. It soon became apparent these were overly complex, with more than 60 different appointment types in the mix. “We wanted to reduce the amount so someone in the Central Access Center would not have to learn what each appointment code meant,” O’Neill says.
Appointment types varied at all the practices and even sometimes differed for providers within the practices. Some were using a “consult” appointment type, while others used “new patient” or “office visit.”
“In essence, they all meant the same exact thing,” says O’Neill. “We worked with each practice to see if they could eliminate appointment types. We have been successful in a few areas.” Many offices were fine with just using the “consult” type to simplify things. Patient access continues the work on reducing appointment types within the practices. “Some algorithms were updated five times in just the first few months of operations,” O’Neill notes.
Inconsistent processes for patients who needed to follow up also were problematic. At some clinics, electronic triage messages were sent to nursing staff. Other practices transferred calls directly to a nurse triage line. “We were able to adjust staffing in clinics,” O’Neill reports. “They now all have dedicated nurse triage lines.” This important change makes things easier for schedulers, and patients appreciate it, too. “We have seen an increase in patient satisfaction,” O’Neill adds.