Healthcare and PowerHouse have a very long and rich history. We have had the privilege of working with some of the best systems in the country as they address the new and emerging demands of the 21st century patient experience. Access Centers have been a special focus of our consulting work; they are, after all, contact centers first and foremost. The history of Access Centers provides context as to where they are today. They demonstrate incredible value in responding to and handling the disruption of COVID-19. It is through the Access Center that healthcare organizations are able to address a future they didn’t see coming.
Access Center Origins
Access Centers came into existence in the past 20 years due to many factors; the most compelling is the consolidation of healthcare systems. Most of us have firsthand experience with this phenomenon as our own physicians are now “owned” by a hospital, university or a group of investors. Hospitals and practices have been acquired at a very rapid pace, putting new organizational and operational demands on healthcare institutions.
This consolidation was driven as much by consumer demand as by economic gain. Consumers of the private practice model were subjected to conditions found unacceptable to the 21st century consumer. Growth within the private practice model outpaced internal practice operations; practices were often too understaffed to handle demand, on all levels.
Practices were often too short-staffed to answer the phone, used voicemail for coverage within the day, and frequently neglected to return calls in a timely manner. Individual practices booked appointments weeks, if not months, out. Many appointments resulted in “no shows,” which caused loss of provider productivity and revenue. In addition, practices often closed for lunch, or for an afternoon, or to conduct meetings. These conditions blocked access and delayed response to patients, frustrating or losing patients altogether.
Access Centers began to get traction when systems started hearing complaints from patients about “access” and the patient’s inability to reach a practice by phone or book an appointment within a reasonable period of time. We’ve been informed on more than one occasion by practices that patients would drive to the practice to book an appointment because they couldn’t get through on the phone. The single most startling fact about this story is that it was told almost with a sense of pride—“Look how much our patients love us; they tolerate this unacceptable behavior!” Once a healthcare system owned the practice, the complaints reached a new executive audience that was not only concerned with the patient experience but with the impact on its own revenue.
Hence, Access Centers emerged as the solution to these problems. The system solution was to centralize appointment scheduling. Access Centers facilitated the relocation of call answering and appointment scheduling to a centralized contact center operation. The Access Center strategy was to allow practice personnel to focus more on the clinical experience… managing patient needs in real time as well as the day-to-day practice operations.
Today, many Access Centers have gone well beyond centralizing scheduling to provide “virtual front office” service by routing all practice calls to the Access Center where protocols are followed for handling various interactions. Access Centers remain open continuously to service patients and prospects; some even offer extended hours. Access Centers are better positioned to handle multiple channels, programs, locations and providers within the same operation.
Today’s Common Challenges
The challenges Access Centers face today span everything from managing growth and gaining efficiencies to having an ongoing identity crisis, not unlike contact centers in other industries. Access Centers must repeatedly “prove” that centralization is successful to those who are unhappy with the model. The removal of appointment scheduling from the office to a centralized model for some has been traumatic. Many physicians feel as if they are losing “control” and the office staff feels they are losing “status” as the gatekeeper to the physician’s schedule.
Among the biggest challenges is the documentation and implementation of physician “protocols”… whom the physician will see, what age, what conditions, in which locations, and for what duration. Some protocols are severe, for example, “l only see 35-year-old, left-handed men on Tuesdays when it’s raining.” (Ha ha!) This sounds silly, but truly, some protocols are written to make centralization more challenging; they create conditions that require the call to be “transferred to the practice” for scheduling. So the Access Center does all the upfront work, and the patient is subject to a handoff instead of enjoying a “one-and-done” experience. This is especially egregious when a patient can book an appointment on the organization’s website with barely more than insurance verification.
Sadly, executive governance over physician protocols is widely varied. The best-of-breed Access Centers have guidelines. For example, there must be a clinically driven reason for transferring back to the office. The system might also establish a limited number of appointment types or require additional new patient slots to be available. This potentially reduces the number of patients pushed out the furthest, as these most likely result in lost opportunities.
"In the middle of difficulty lies opportunity."—Albert Einstein
The Access Center’s organizational and operational approach (as in any contact center) determines the effectiveness of this business unit and the type of culture that will emerge. The thing about Access Centers is that they are in a highly complex environment. If you have ever seen the interface of an Electronic Medical Record (EMR) system, it makes the airlines’ look simple. Even landing a carrier-based aircraft could be less complicated!
Given the nature of healthcare, the Access Center workforce must bring strong critical thinking and relationship-/communication-building skills. Callers are generally dealing with an undesirable situation, making empathy and compassion requisite. The organization must treat frontline resources like the professionals we want them to be or to become.
The old-fashioned, militaristic, factory-like, and production-based call center management approach of the 20th century won’t hold the kind of talent needed for success in today’s complex business environment. In fact, the old model typically yields a culture of compliance and mediocrity rather than one of discovery, development and excellence. Operational sophistication is necessary. Nearly everything we do must be frontline-focused.
Needs of the Future
Everything I say here is true for all contact centers, not just healthcare operations. Regardless of industry, the future of customer care will be in handling more complex issues and problems than can be handled by “self-service” options. The contact center’s “cognitive load” will increase; skilled frontline agents will demand to work in environments that nurture and grow their talent and skills.
You must create a learner-based culture of strong and smart business people that are treated and provisioned in a way that optimizes, not minimizes, their talent. The organizational model must support and not distract from the mission. If the Access Center is poorly staffed, funded or managed, a talent exodus is very likely to follow.
There are four features of a solid organizational model that many Access Centers actually follow.
1. Training and job support—A massive and ongoing investment is made in training, job aids, tools and an online knowledge base that supports frontline agents. A learner-based training program focuses on what agents need to know, do and feel. Transactional systems are taught within the context of the job. The goal is to help learners become independent, empowered and efficient.
2. Quality management—I define a quality program as a quality “coaching” program rather than a compliance audit. Like training, a quality program must be learner-focused, conversation-based and self-development oriented. The supervisor serves as coach, with a ratio of no more than 1 supervisor to 15 agents (12 is even better) and an expectation of 25% to 30% of supervisor time allotted for coaching. Each supervisor has a team lead to ensure that coaching time is not forfeited for other tasks.
3. The organizational model includes a quality manager to oversee the quality program itself, define its goals and behavioral elements, and coach the coaches. As well, a quality analyst tracks trends and collaborates with these support teams: WFM for training/coaching time, Operations for process issues, and Training to reverse negative trends. The goal is to document issues, identify solutions, and ultimately, celebrate successes!
4. Workforce management (WFM)—WFM is a strategic partner and recommendations for staffing are funded and followed. Access Centers of the future (and some today) will identify as revenue engines and act accordingly when addressing investment in people, process or technology.
Access Center as Value Center
Due to COVID-19, much has changed in healthcare. Access Centers have certainly demonstrated their value during this pandemic. Take Penn Medicine’s Access Center in Philadelphia, as an example. In addition to successfully moving 300 or more agents to a work-from-home model, Penn Medicine’s Access Center also was able to respond to massive change.
In pre-COVID days, anyone who wanted a lab (blood, etc.) test needed no appointment. It was a “walk-in world.” Well, no more! When the labs at Penn opened up in order to meet social distancing and safety requirements, labs now needed to book appointments and were struggling mightily. Enter the Access Center. According to Danielle Werner, Penn Medicine COO, “We had an opportunity to leverage our Access Center centralization model to assist our lab’s conversion from a walk-in operation to an appointment-based operation, increasing appointments scheduled by nearly 500%.” Prior to Access Center cross-training, the labs scheduled around 1,100 appointments a week. When the Access Center took over, it scheduled nearly 5,000.
The Penn Medicine story has been echoed across the industry footprint. Access Centers have a bright future to work toward though it won’t always be an easy or clear path. However, the journey is rich with learning and opportunity!