Put a stop to complaints on call center wait times

Patient access leaders at St. Joseph's Hospital Health Center in Syracuse, NY, knew there was a perception by some people that scheduling medical imaging procedures was difficult. What they didn't know was why.

"Until we surveyed our physician offices and reviewed a year's worth of call data, we could not identify the root causes for this perception," says Carol Triggs, MS, director of patient access.

Last year, senior leadership identified five clinical and nonclinical processes that provided opportunities for improvement. Each of these was important in support of the hospital's mission, vision, values, and strategic plan, and provided a potential return on the investment.

One of the projects looked at all outpatient procedures scheduled for computerized tomography scans. After a data analysis, several root causes were identified, which could potentially cause barriers to efficient scheduling.

These were lack of available time for the procedure, the need for additional calls to obtain clarification about procedures, lengthy wait times before calls were answered by centralized scheduling, inadequate staffing, and increased call volumes at certain times.

"We determined which steps in our current processes were value-added for the customer, versus those steps that were non-value-added. We worked to eliminate the non-value-added steps," says Triggs.

An example of a value-added process for the customer is the time spent "reading back" the procedure, time, and location to the caller as a confirmation. An example of a non-value-added process was the time the customer was placed on hold during the call while scheduling contacted medical imaging to clarify a procedure request.

The improvement team assembled for each project followed a Lean Six Sigma systematic approach to problem solving. This involves five steps: define, measure, analyze, improve, and control. Here are the steps that were taken during each phase:

Define: The problem at hand is characterized and depicted as a "process map," which is a high-level flow chart of the process steps. "The value of the tool is to define the boundaries of your process and help you make sure the goal of your project is not too broad or too narrow," says Triggs. "You do not want to bite off more than you can chew with just one project."

In this phase, the cost of poor quality, which becomes the basis for the return on investment, is calculated. This was done by assessing the time spent by both the scheduler and the CT during the additional calls that were made from scheduling to medical imaging.

"We also looked at the percentage of calls that were abandoned before the scheduler was able to answer the call, and translated that to potential lost revenue," says Triggs.

Measure: Baseline data are collected on the process in question. The goal is to help understand the extent to which energy, time, or resources are wasted. Key metrics used to analyze opportunities for improvement included the average wait time for calls to be answered, the percentage of calls answered within 50 seconds, and the percentage of calls that were abandoned before they were answered.

"Through the data collection process, including surveys with physician offices and an analysis of call center phone data, the team was able to determine where the process could be improved and developed an implementation plan," says Triggs.

Analyze: The actionable root causes of the poor process performance are identified. The most critical of these root causes are selected as a target for improvement.

"Our most critical root causes were the call wait times and the additional calls that were made from scheduling to medical imaging during the scheduling process, which incurred an increase in 'hold time' for the caller," says Triggs.

Improve: The improvement strategy is selected. A plan is established for piloting on a small scale. The process improvement plan included three components:

1. The schedulers' work flows were restructured to better serve patients during peak volumes.

"We altered break times and lunch times to meet these needs," says Triggs.

2. The volume of calls that had to be made by scheduling to imaging during the scheduling process was reduced.

These calls were made to either clarify procedures or to "add on" patients for the same day. "Our medical imaging department developed cheat sheets, so the physician office staff could more easily identify correct procedures," says Triggs. "We also created interactive view ability in our software system for the scheduler to identify open slots for add-on patients."

By doing this, extra calls made to imaging to schedule add-on patients were eliminated.

"We piloted these changes over two months," says Triggs. "Although we saw substantial improvement in our call wait times, we are not yet at our goal."

3. A secretarial position was added.

This freed up a scheduler from secretarial duties. The secretary collates all documentation faxed into scheduling for surgical and invasive procedures.

"The documentation received from the physician offices is checked against our software system, to ensure that the written orders match the orders in the system. This includes pre-admission testing orders," says Triggs.

Control: Methods are established to track the process and sustain its improvements. Weekly tracking of metrics is performed by the manager to ensure goals continue to be met.

"We are tracking the department's weekly average call hold time and the percentage of calls answered within 50 seconds," says Triggs. "These data are shared with the schedulers on a weekly basis. A monetary monthly incentive plan for our schedulers was implemented in 2010, based on attaining the designated goals in each category."

Scheduling streamlined

The team's overall goal was to streamline the scheduling process for medical imaging, by decreasing inefficiencies within the process. "Our results within the first six months have exceeded our initial expectations," reports Triggs. Since August 2009, the average wait time for a call to be answered by centralized scheduling has been reduced from 38 seconds to a current average of 12 seconds. The percentage of calls answered within 50 seconds has risen from 73% to 94%.

"Our abandoned call rate has decreased from an average of 9% down to an average of 2%," says Triggs. "The improvements in response time are measured for all calls to centralized scheduling, not only medical imaging." Thus, these improvements translate to all services, both diagnostic and surgical.

"We learned so much through this Lean Six Sigma project. Most importantly, we learned that the front-line folks make all the difference," says Triggs. "It was critical that all of our schedulers were engaged in the process and project. They are the ones who do the work day to day and can ensure sustainability."

For instance, schedulers were the ones who identified the bottlenecks in additional calls being made to medical imaging during the scheduling call. "We would not have known this without their input," says Triggs. The schedulers also worked closely with medical imaging in creating the cheat sheets, so the physician office staff could more easily identify correct procedures.

"Their input was critical to us finding the root causes for the additional calls and eliminating those causes," says Triggs. "Their continued engagement with the process improvements has been critical to our ability to sustain these results."

[For more information, contact:

Carol Triggs, MS, Director of Patient Access, St. Joseph's Hospital Health Center, 301 Prospect Avenue, Syracuse, NY 13203. Phone: (315) 448-5379. E-mail: Carol.Triggs@sjhsyr.org.]