Seven essential tracks for building a successful centralized operation.
This article is part of Kathleen Peterson’s continuing series on the requirements that business leaders must address to get the strategy “right” in healthcare.
In previous articles, we focused on the importance of defining your organization’s strategic purpose, gaining executive support and implementing the key tactical initiatives that make strategic goals a reality. Let’s move to the essentials of building a centralized scheduling contact center, an enormous strategic endeavor undertaken by many healthcare organizations in support of physician primary care and specialty practices.
For point of discussion, I have organized this article in the same way that we drive our client centralization projects. There are seven key focus areas or “tracks” that capture what it takes to yield a successful centralized operation and to mitigate the pitfalls. These are: Executive Decision-making, Transition Planning, Contact Center Organizational Model and Practices, Technology, Facilities, Human Resources, and Learning and Performance.
I can’t stress enough the importance of executive support when initiating a project to centralize a formerly decentralized scheduling function. While the healthcare industry is changing in many ways, establishing a centralized scheduling contact center to support physician practices is more than just a tactical exercise. It must be driven by a set of strategic objectives for both short- and long-term benefits. The typical strategic drivers for centralization are growth, efficiency, access and the patient experience. As healthcare systems grow, the demand for appointments reflects that growth. As a result, many systems have found themselves with a “constellation” of small individual scheduling centers that are inefficient and not scalable to support ongoing growth. Hence, the decision to centralize becomes a viable option.
These centralization projects are of the scale to require executive “governance,” a steering committee of sorts that provides oversight in multiple areas and a destination to escalate disputes which may occur during the project. This governing committee assures that strategic objectives are properly represented, issues are identified and resolved, and budgets and timelines are met.
In addition to governance, the development and distribution of a communication plan is necessary. This represents the change management piece of the initiative and is a requisite for success. Beyond a clear set of objectives set forth by the executive sponsor, we have found that “inclusion” is the best form of change management as it drives a smooth transition. When the project team includes those folks most impacted by the change, concern and confusion are minimized. Potential issues are addressed via discussions around why the change is happening, what it will mean to them, how it will all play out, and their role in the project.
There are other specific activities necessary in this track. Of critical importance is the standardized and consistent collection of what we call physician “protocols” (also known as “rules” or “guidelines”) used to schedule appointments. Many organizations and consultants involved in centralized scheduling projects simply send a form requesting the physician information. We have found that onsite visits to the practice and collecting the information in person is much more effective. Meeting with the practice managers, existing schedulers and the physicians themselves yields a richer interaction and more effective results. The targeted practices feel important enough to merit in-person meetings and are able to have their questions answered in a timely fashion. The project team collects the requisite information while simultaneously noting concerns.
Changes to how scheduling is done is a massive upset for some physicians, particularly those who have spent the majority of their career in a private practice model. The project team often bumps up against what we call “PREVIOUSLY PROTECTED RITUALS.” This may include how physicians build their preferences for scheduling—be it protocols, time off or clinic cancellations. Trust me, you will know the rituals when you see them and it takes a very tender touch to manage impending changes.
Contact Center Organizational Model and Practices
Contact centers have many possible organizational models. It is best to design yours rather than let it simply emerge by default. It is important to design the operation based on strategic goals such as access and the patient experience. But bear in mind that many healthcare systems have adopted a “patient-centric” philosophy to be reflected in the plan. We advise our clients to amend the philosophy to be “patient-centric and provider-sensitive.” This reassures physicians that their needs are taken seriously as part of an overall philosophical approach.
Those who begin a centralized scheduling contact center without a solid plan may wind up with an inefficient and costly model, one that is broken up into small groups dedicated to individual practices. This model is more likely to exist when scheduling for specialty practices rather than for primary care. We call this siloed model the “clientele approach” because it is built on differences between practices rather than on similarities. I recently witnessed a scheduling center with eight independent teams; the queue status display showed one queue with five calls waiting with the longest wait of 10 minutes. Yet there were three teams with zero calls in queue and six agents available! It was widely agreed that those available resources would certainly have been able to provide assistance. What a waste and what a shame!
We often move clients that have specialty practices from the “clientele” model to a “custom” model. In a custom model, the similarities between all practices are highlighted to train agents in handling a “cluster” of practices rather than a single practice. Calls are routed via a skills-based model with assignment of primary, secondary, and tertiary skills to allow call volume to flow with less delay and fewer abandons.
A “standard” model may be applied when protocols are less complicated. Primary care practices often fall into this category, where the likelihood of standardizing scheduling protocols is greater.
The centralized scheduling contact center requires a few other important items:
- Master Plan—outlines contact center mission, function, hours of operation, systems supported, services offered, etc.
- Responsibilities Document—delineates and differentiates the roles and responsibilities of the contact center and the practices.
- “Must-Answer” Line—must be provisioned in the practices to assure that calls coming from the contact center are received and answered in a timely fashion.
Contact center leaders must also determine service level objectives, develop a quality program, identify key performance indicators (KPIs), determine what reports the center will utilize, and identify what information is important to share crossfunctionally.
As a final point, many successful centralized environments provide a nurse triage unit to handle medical questions and urgent appointment requests; this significantly minimizes the number of calls that must transfer or consult with the practices.
There are many technologies involved in centralizing scheduling. The two most dominant are the telephone automatic call distribution (ACD) system and the scheduling system, often part of the electronic medical record (EMR) system. There may also be other software applications to assure that patient needs are fulfilled (e.g., fax routing systems, quality monitoring systems).
Newly implemented contact centers must identify hardware and equipment requirements, including new PCs, monitors, wall displays and printers. Dual monitors should be considered if schedulers need to access multiple systems.
The ACD must be properly configured and the contact center MUST HAVE administrative control over such tasks as reassigning skills and adding/deleting agents. If the model has the contact center opening a ticket with IT for changes needed to be made in real-time, the system investment will never be optimized. IT help desk tickets are not handled in real-time.
Contact centers are well served by applications that track contacts across multiple channels. While many healthcare contact centers share an enterprise CRM, the system does not always provide the ability to track contacts by channel and allow schedulers and leadership to better understand this important part of the patient journey.
Healthcare is an industry constantly struggling with space/facilities issues; this has led to some very “creative” contact center environments. The center must be sized based on the forecasts for demand and the organizational model which includes agents, supervisors and managers. Other things to consider are a dedicated and secure training room, a comfortable break room, food and beverages, a conference room, access to public transportation, and safe and near-by parking.
Work-at-home (WAH) is becoming a solution to facilities issues. The key is to have a formalized program that defines equipment requirements as well as a formal WAH agreement with contact center staff. An effective agreement outlines what the healthcare organization provides and expects. (Work-at-home is NOT a solution to a child care problem; most agreements require no children in the home under the age of 13 during working hours.) This includes network connection methodology, dedicated Internet connections (e.g., no Wi-Fi, no use by household allowed), PC payment responsibilities, use and locations of printers and fax machines (if applicable), and site inspections to determine whether the home has a proper WAH space. Work-at-home agents must use the same phone system, KPIs and quality tools as those in the contact center.
Human resources (HR) must be a collaborative partner within any centralized scheduling contact center initiative. It is the responsibility of HR staff to determine compensation and benefit packages, identity effective recruiting methods, and take a proactive role in screening and bringing in the right talent. Contact center leadership must craft job descriptions that properly represent the skills and competencies required so that the result isn’t a salary range impossible to recruit or a new-hire who lacks the appropriate skills sets and human qualities.
Learning and Performance
If there is a single critical success factor related to implementing a centralized scheduling contact center it is the creative design and focused delivery of relevant training and on-the-job reference tools. Learning will occur when the delivery of training matches the way that the scheduling function is actually performed. Realistic job scenarios must be set up to give equal attention to the transaction (actual job tasks) and the interaction (how the transaction is handled form a human perspective). As well, it is critical to create, organize, and populate an easily accessible online repository for quick access to all information the scheduler must reference during an interaction. This includes physician protocols, contact center/practice responsibilities, use of must-answer line, quick links, glossary, FAQs and contact information.
Be Prepared (Don’t Panic)
There are many, many facets to launching a nimble and efficient centralized scheduling contact center operation, and each is as important as the next. Woven together, these create an environment based on solid business decisions, careful executive planning, and a cleverly crafted tactical plan that reflects the best in today’s healthcare contact Centers.
My advice… be prepared and don’t panic when confronted by challenges. Initiatives such as this are an iterative process. Many things will be learned along the journey; subtle and sometimes significant changes will occur during the project. Enjoy the process; the results can be triumphant!