Call center redesigns around staff flexibility

Increased staff capability, cross-training are key

A full-scale redesign of the patient access department is under way at St. Vincent Hospitals and Health Services Indianapolis, and the focus is on bringing "like" functions together, says patient intake director John Woerly, RRA, MSA, CHAM.

"The key is building upon those likenesses, and also building staff capability and cross-training, Woerly emphasizes. "In the past, no one was cross-trained. You were hired as a registrar and that’s what you did. Now people will be working in other areas to support the needs of the department."

In the past year, he says, the patient access department has added 2.5 full-time equivalents (FTEs) for utilization review, one for secretarial duties, 5.5 for training and auditing, 15 for preregistration, three for emergency department (ED) registration, 3.5 for patient accommodations (bed control), four for core admissions, and one for systems administration.

Six FTEs have been added to the nursing staff of the hospital’s call center, which is being dramatically expanded as part of the patient access redesign. He’s currently responsible for about 152 FTEs overall, Woerly says, and that number will continue to increase as patient intake adds other job functions.

The new call center will be the most dramatic manifestation of the patient access redesign. After a year of planning, the project officially got under way Oct. 1, Woerly says, when he assumed management of the existing call center.

The idea, he explains, was to expand what was already a successful telephone patient referral program into a new integrated call center that will provide a more rapid response to customer inquiries. The overall mission, Woerly adds, is to enhance customer service, build customer loyalty, and increase operational efficiency.

The expanded call center, which will move into its new location in February or March, will consolidate some existing functions and add others, he notes. Services provided under the integrated call center will include:

• ambulatory scheduling;

• inpatient and outpatient observation scheduling;

• customer service, patient financial services;

• switchboard (telecommunications operators and information calls);

• nurse advice/disease management through telephone triage;

• preregistration/precertification;

• physicians’ answering service;

• physician referral/CARE line;

• access to a health information library, consisting of information tapes about various diseases and injuries;

• marketing fulfillment;

• patient accommodations;

• utilization management;

• medical order processing.

The call center project, expected to cost more than $3 million and is massive in scope, with plans for 140 work stations and the integration of 30-plus computer systems, Woerly points out. The goal is that those systems — for physician referral, patient registration, and precertification, — be Windows-based, and that staff be able to maneuver among various programs on their screens as needed.

"We’re to the point of selecting a final vendor partner, who will help with data integration and data design," he says. "The goal is that staff will be cross-trained, and that the automated call distribution (ACD) system will determine workload and hand out work."

The idea is that if, for instance, a large number of customer service calls — patients inquiring about their bills — come in, call center representatives who were making preregistration calls would be diverted from that task to fill the more immediate need, Woerly explains. Different representatives will have different skill sets, and the ACD system will know which calls can be handled by which employees, he adds.

Existing preregistration and precertification employees — about 25 FTEs — will be incorporated into the new call center, he says.

Because of a temporary space constraint — the space originally allocated for the call center is now needed for a clinical department — the number of work stations will remain between 70 and 80 for about 18 months, Woerly notes. For that reason, switchboard operators, operating room (OR) schedulers, and employees handling primary care customer service calls will not be moved to the call center right away.

They will be added to the mix when the call center moves into new corporate offices within the next two years, he says.

Initially, the call center will serve three of the six hospitals that make up Central Indiana Health System, which is St. Vincent’s corporate parent. As the health system expands, plans are that the center could cover seven hospitals within 18 months, and an additional five hospitals within the next 18 months, Woerly adds.

Other goals for the call center include the following:

• produce custom reports for each facility;

• maintain a minimum queue of less than 12 seconds;

• have the capability of relating customers to those in the Master Patient Index (MPI).

Perhaps the biggest obstacle to the redesign effort, Woerly says, is the politics involved in moving into a centralized mode of operation from a patient-focused care environment and institution-specific services.

"People are used to having things decentralized, and now we’re going to central management," he adds. "It’s difficult to roll out because it’s such a change from how we’ve done business for the past five years. "Reaction at one of the hospitals was like, These are our people — you can’t move this function to the corporate area.’ We had to go to various meetings and get their buy-in and understanding of what we’re doing."

The payoff in quality is expected to be well worth the effort, Woerly explains. "When [customers] call in to the organization, there will be consistency in how we answer, and the information we share," he says.

"There will be a database that tracks every encounter we have with the patient. For marketing purposes, we’ll be able to track the first time we talk with them, and then every time they visit one of our physicians or sites or come to the hospital."

There will be a comprehensive, easily accessible record, he points out, of all the services pa-tients receive, and of their financial history. "One of the things we’ve not been very good at in the past is calling a patient back to reschedule when they’ve missed an appointment. In the future, we’ll be doing that," Woerly adds.

One concept being explored is billing advocacy. When the hospital doesn’t receive a patient’s payment for services provided the previous month, he says, a representative will call and say, "May we answer your concerns?" Additionally, the redesign team has looked at incorporating human resources functions, such as recruitment, into the call center, Woerly notes.

"If there are ads in the paper, there will be a specialized group [of call center representatives] that a person can call and ask about benefits and employment opportunities."

Another consideration, he adds, is to have call center representatives contact patients about annual gifts to the hospital foundation. "The concept is that any hospital business that can or should be conducted via telephone or computer could come out of this," Woerly says.