Lost-call rates down by half; service levels up 40%
When it came to streamlining the way patients, referring physicians, and other interested parties contact Geisinger Health System in Danville, PA, for various access-related services, it seems that one good idea led to another.
Key among a number of initiatives, explains Carol Swank, director of the access center, was improving the way customers accessed specialty services - which traditionally had controlled their own scheduling - by centralizing scheduling and moving the specialty schedulers into the system’s access center.
"Service levels were not being measured, so they had no idea if they were losing calls," she notes. "The access center [staff] were getting overflow calls [from the specialty practices], but were not able to schedule."
Another issue, Swank adds, was that scheduling for the practices had taken place only between 8 a.m. and 5 p.m., while the access center is in operation 7 a.m. to 9 p.m.
Furthermore, she says, physicians weren’t referring patients to Geisinger as often as they should have been, a problem that the system’s new chief of operations targeted by forming a team to strengthen physician relations.
With the oversight of Karen McKinley, RN, CHAM, vice president, access and care management, the centralization effort got under way, with groups of schedulers brought over in phases to the access center, Swank says.
As the process continued, she notes, problems in how the individual clinics did their scheduling began to surface. "As we brought over the [clinic personnel], we found there was work that was never done, referrals - some that went back several months - that weren’t scheduled." With only one person [in each of the specialty services] to manage access as well as perform other duties, Swank notes, open slots in the schedule often were not filled.
"With the telephones they were using in the clinics, there was no way to look at how many calls they were losing or at their service levels," she adds. "The only way to find out was if people complained."
During visits to the referring physicians, she says, Geisinger’s chief administrative officer found "the offices had 20 or 30 telephone numbers, 20 or 30 different fax numbers" that were being used to speak with or make referrals to staff or physicians in Geisinger’s specialty practices.
Appointments were not made on the initial call, Swank notes. The response, she adds, was always, "Fax the referral, and we’ll make the appointment and get back to you.’ Often, that never happened; and the [referring offices] would have to make a second call or fax to one of the 20 or 30 different numbers."
With the tendency of fax numbers to change frequently, Swank adds, the sheets containing those contact numbers often were outdated. A process called Medlink, whereby referring physicians use one toll-free number to call Geisinger, now is in place in the access center, she says, and "has made a huge difference in pleasing our referring physicians."
During the Medlink pilot, Swank notes, the chief administrative officer visited the referring physicians and promised them that they would be able to make an appointment on the first call, and Medlink was advertised and promoted as part of the access center services.
When the schedulers for the specialty services were brought into the access center, she explains, they were arranged in pods, with two pods for the medicine services, such as dermatology, gastroenterology and cardiology; two pods for surgery services, such as ophthalmology, general surgery, and oral surgery; and one pod for pediatrics.
CareLink employees answering calls from the toll-free patient number - who already were working in the call center - were dispersed throughout the pods, so they could back up the specialty schedulers as needed, she adds.
"A lot of patients we serve are out of area and like to use the toll-free number, so before the [specialty schedulers] came here, [toll-free staff] ended up taking the scheduling calls and had to transfer them to the clinics," Swank explains. "We never knew what was happening to the calls."
Now, she says, the two groups of employees can work together, providing service to a patient in one call and making sure appointments are coordinated if, for example, a husband and wife would like to come in at the same time and see different specialists.
The first group of specialty schedulers moved to the access center in March 2002, Swank says, and the process was fully implemented by August 2002. While the schedulers’ service levels and lost call rates still are not fantastic, they improved dramatically after the groups began working in the access center, she says. Within a couple of months of arrival, Swank adds, each group’s lost call rates had decreased by half, and service levels had increased by 40%.
"Combined with efforts to improve patient access in the clinic sites," McKinley says, "the movement to specialty scheduling pods enhanced our ability to meet the needs of our patients."
IVR on the way
A person using the 800 number may reach the surgery pod, for example, when the need is for the medicine group, Swank notes. "That requires [the employee receiving that call] to get up and go over and talk to the medicine pod." The toll-free number gets a lot of different calls, she points out, ranging from people trying to reach inpatient rooms to those who want to speak to their physicians about a prescription. Of some 38,000 calls per month that come in through that number, she adds, about half have had to be transferred, causing unacceptable service levels and lost calls.
That situation was expected to improve dramatically, Swank says, with the advent of a sophisticated interactive voice response system (IVR) implemented in late January 2004.
A large pharmacy chain that uses the same system for patients to get their prescriptions refilled reports a 99.5% accuracy rate, she continues. With the IVR, patients will be greeted by a recorded voice, told that the new system allows them to speak their request, and asked to say the name of the physician or department with which they wish to speak.
If the person says "orthopedics," Swank adds, the system will respond, "I believe you said orthopedics." After making that selection, Swank continues, the patient will be asked, "Is this about an appointment?" If the answer is yes, that call will be transferred to the pod that is scheduling for that department. If not, the call will be sent to the specialty clinic, where the person can speak with a physician. If the caller speaks a physician’s name - Dr. Newman, for example - the system will say, "I believe you said, . . ." and will give its interpretation of what was said. If the caller’s response is negative, she adds, the system will offer the option of spelling the name.
A pilot of the IVR, involving some 25 internal medicine patients, indicated that about 75% found it easy to use, she points out, even though they weren’t reaching the right destination because the system’s vocabulary was not fully built. "What we had to do to build the system," Swank explains, "is to look at what patients actually call these physicians, many of whom have names that are complicated or difficult to pronounce. There were synonyms we had to build in that could identify a mispronunciation."
Similarly, the system had to be tweaked so that it could take callers to the correct department whether they spoke the word "otolaryngology" or said "ENT" or even "ears, nose, and throat," she adds. Another consideration, Swank says, is that the system is extremely sensitive and will not work correctly if the caller is carrying on a conversation, or if the television is playing at loud volume in the background, while waiting for a response.
The IVR is expected to enhance the success experienced with the Medlink process, notes Lynn Schankweiler, CHAM, Geisinger’s manager for system access education, by reassuring referring physicians that they are being connected. In the near future, she says, these physicians will be able to just say, "transfer center," to reach personnel who will arrange for an admission. Also down the road, Schankweiler says, the IVR will interface with Geisinger’s Epic scheduling system to make the process even more seamless. If the call is about an appointment, she adds, the caller will be asked to state a medical record number or a Social Security number, and the person’s account information will pop up on the scheduler’s screen.
It is anticipated that the new system will increase service levels, allowing for more effective staffing, she notes.
With 40 or 50 calls coming in within 15 minutes, half of which are nonscheduling-related calls that need to be transferred to other areas, it’s been impossible to staff for peak hours. While those calls now have to be transferred manually - by staff trained to do a "warm" transfer, making sure the patient is connected properly - with IVR they seamlessly will be routed, Schankweiler points out.
"Overall, it’s going to not only increase patient satisfaction, but make staff more efficient and increase productivity by getting patients where they need to be the first time around. I believe it will increase staff satisfaction as well, because, from their perspective, it’s frustrating when you answer 50 calls and, with 25 of them, you can’t help the patient and have to do a transfer," she adds."