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Call Center Improvement Project
CQI Team Members:
Executive Leadership:
Change Leaders:
William Caplan MD – UWMF CQI Associate Medical Director
Linda Drummond – UWMF CQI Lead Consultant
Michael McGrew – UWMF CQI Lead Consultant
Cheryl Andree - UWMF CQI Director
Lori Hauschild, Richard Welnick MD
Henny Regnier NP and Shelly Key RN
• One of the larger primary care clinics in UW Health– 2 family medicine clinics merged to become Odana Clinic
in Spring 2007– 23 providers– Approx. 15,000 calls monthly
• Calls routed via two queues (based on patient selected call type)– Non-Clinical (Receptionists)
• Appointment scheduling• General clinic information
– Clinical (MA’s, LPN’s, and RN’s)• Symptomatic calls• Prescription renewals• Lab related calls
Project Description
2
• Phone abandonment rates at the clinic were higher than goal (3 - 5%)
– Average abandonment rates June 2007 to Dec 2007:
10% - Odana Clinic
4% - Overall UWMF
• Low patient and provider satisfaction with Communications Center performance
OA Monthly Abandonment Rate Comparison to all UWMF Automatic Call Distribution (ACD) Sites
(Monthly Averages: Mar - Dec '07)
0.0%
2.0%
4.0%
6.0%
8.0%
10.0%
12.0%
14.0%
Mar '07 Apr '07 May '07 Jun '07 Jul '07 Aug '07 Sep '07 Oct '07 Nov '07 Dec '07
Month
Ab
an
do
nm
en
t R
ate Site
All Clinics
OA Monthly Call VolumesMar - Dec '07
12000
13000
14000
15000
16000
17000
18000
19000
Mar-07 Apr-07 May-07 Jun-07 Jul-07 Aug-07 Sep-07 Oct-07 Nov-07 Dec-07
Call Volume
Mo
nth
Site
Clinic Expansion
Clinic Expansion (added 4 providers)
Problem Definition
3
• Reduce overall clinic telephone abandonment rate to 3% or below while maintaining call handling quality by August 2008
• Defined Project Metrics– Quantitative – Abandonment rate (AR), call
volumes
– Qualitative – Patient and provider satisfaction related to access to reaching clinic by phone
Project Goal
4
Anyone calls Clinic
Telephone Call Routing Process Map
Is call Clinical (CL) or Non-Clinical (NCL)?
Caller enters CL Queue
Caller enters NCL Queue
Receptionist answers call
Can Receptionist resolve call?
Call is resolved
Is call Clinical?
Is call for specific
provider?
NCLCL
No
No
Yes
CL Staff (MA) answers call
Call is transferred to CL Queue
Yes
Can CL Staff resolve call?
Is provider in?Call routed and
resolved by provider
Yes
Yes
Message left for Provider Call Back
No
Call routed/xferred as needed
No
Call is resolved
Call is transferred to Care Manager
(RN)
No
Yes
Can Care Manager (RN) resolve call?
Call is resolved Yes
No
Call routed to DOD or provider as
needed
Call routed to Dr’s Hotline
Is call from patient or Health Care
Representative?
Health Care Representative
Patient
Define “Current State”
5
• Current Situation Analysis– Literature review
• Medical Group Management Association
• Family Practice Management• International Customer
Management Institute– Best practice review
• Internal: After Hours Call Center• External: Kaiser-Permanente
– Root cause analysis • Brainstorming• Nominal voting
– Work system analysis• Process flows
– Data analysis• Call types and volume• Abandonment rate, queue times
• Conclusions– Call routing model
• Less than ideal– Current staffing
• Low FTE/call ratio • Misaligned staffing model mix• Open positions not filled
– Call routing• Non-clinical calls going to
Clinical Queue– Non-value added steps
• Potential for simplification– High volume of refill/lab results
calls– Staff unavailable
• Additional tasks preventing answering calls
Solution Development
6
Supply Management:Allocation of staff from existing FTE
• Receptionist moved to communications center
• RN Care Managers assigned to communications center
Optimized staffing to match demand• Moved “Lunch and Learn”• Balanced staffing to meet call
demand
Demand Management:Clinic welcome message revised
• 911 and Rx information moved to beginning of message
After hours message revised• To better route patients to
HealthLine
Improved efficiency for calls related to narcotic renewals
• Reinforced use of protocols
OA Monthly Abandonment Rate Comparison to all UWMF ACD Sites
(Monthly Averages: Jan - May '08)
0.0%
2.0%
4.0%
6.0%
8.0%
10.0%
12.0%
14.0%
Jan '08 Feb '08 Mar '08 April '08 May '08
Month
Ab
and
on
men
t Rat
e
Site
UWMF Clinics
Phase I
7
Phase II: Simulation
Model 1 Analysis:Eliminate communication center - all calls routed directly to clinical teams
Predicted costs:Information Services
system changesSalaries/benefits for
additional 6-8 Reception/MA/RN FTE
Construction costs for space re-allocation
Total of ~$315k increased cost
8
Phase 2: Simulation
Model 2 Analysis: Redesign existing telecommunications centerAll calls answered by dedicated receptionist pool, appropriate calls routed to clinical staff in
call center
Predicted costs: IS system changes + Salaries/benefits for additional 2-3 Reception/MA/RN FTE => Total of ~$125k increased cost9
Anyone calls Odana Atrium
Previous Telephone Call Routing Process Map
Is call Clinical (CL) or Non-Clinical (NCL)?
Caller enters CL Queue
Caller enters NCL Queue
Receptionist answers call
Can Receptionist resolve call?
Call is resolved
Is call Clinical?
Is call for specific
provider?
NCLCL
No
No
Yes
CL Staff (MA) answers call
Call is transferred to CL Queue
Yes
Can CL Staff resolve call?
Is provider in?Call routed and
resolved by provider
Yes
Yes
Message left for Provider Call Back
No
Call routed/xferred as needed
No
Call is resolved
Call is transferred to Care Manager
(RN)
No
Yes
Can Care Manager (RN) resolve call?
Call is resolved Yes
No
Call routed to DOD or provider as
needed
Call routed to Dr’s Hotline
Is call from patient or Health Care
Representative?
Health Care Representative
Patient
ANYONE calls Odana Atrium
Call is queued to Receptionists
Does call meet criteria to be resolved?
Call Resolved YES
TRANSFER to Neighborhood ‘Must Answer’ Line
Revised Call Routing Process Map
Call is answered by receptionist
MESSAGEYESDoes call meet criteria to be messaged?
Does call meet criteria to be transferred to Neighborhood?
NO
NO
YES
NO
Last Update: 6/4/08
Epic Neighborhood
Pool
Place Call in appropriate Communication Center
Clinical ACD Queue
Is call from patient or Health Care Representative?
Call routed to Dr’s Hotline
Health Care Representative
Patient
Call Handling Revision
-Old way: First Call Resolve
All calls routed to agent based on patient preference in automated selection menu
-New way: Best Call Resolve
All calls routed to receptionist, then routed as applicable based on patient needs
10
Jan to Aug 08 abandonment rate decreased from 13% to 1.3%
To date, still a top performer!
OA Monthly Abandonment Rate Comparison to all UWMF ACD Sites (Monthly Averages: Mar '07 - Aug '08)
0.0%
2.0%
4.0%
6.0%
8.0%
10.0%
12.0%
14.0%
Mar'07
Apr'07
May'07
Jun'07
Jul'07
Aug'07
Sep'07
Oct'07
Nov'07
Dec'07
Jan'08
Feb'08
Mar'08
April'08
May'08
June'08
Jul'08
Aug'08
Month
Ab
an
do
nm
en
t R
ate
Site
UWMF Clinics
Phase I (Staff Balancing)
Phase II (Routing Revision)
OA Monthly Call VolumesMar '07 - Aug '08
10000
11000
12000
13000
14000
15000
16000
17000
18000
19000
Mar-07
Apr-07 May-07
Jun-07
Jul-07 Aug-07
Sep-07
Oct-07 Nov-07
Dec-07
Jan-08
Feb-08
Mar-08
Apr-08 May-08
Jun-08
Jul-08 Aug-08
Call Volume
Mo
nth
MA/LPN CC Staffing 4 4 4 4 5 4 3
Recep CC Staffing 3 3 3 3 3 3 6
RN CC Staffing 0 0 1 1 1 1 3
MA/LPN Sched (actual) FTE 10 17.2 20 20.5 22.4 (17.33) 23.4 Unk
Recep Sched (actual) FTE 6.6 7 7 6.8 9.8 (5.92) 9.2 Unk
RN Sched (actual) FTE 1.9 2.7 2.7 3.5 4.4 (2.57) 6.9 Unk
Abandonment Rate Results
11
45
55
65
75
85
95
Aug-07 Sep-07 Oct-07 Nov-07 Dec-07 Jan-08 Feb-08 Mar-08 Apr-08 May-08 Jun-08
Ea
se
of
Ge
ttin
g C
lin
ic o
n P
ho
ne
Site Press Ganey Scores (Based on Date of Service)
• Press Ganey Score (Access to Care Section)• Rating: Ease of getting clinic on phone
• From opening to Feb 2008 => significant decreasing trend• From Feb 2008 to present => significant increasing trend
Phase I
Phase II
Patient Satisfaction Results
12
Impact on the clinic• Systems perspective
• “If we change this, how does it affect that?”
• Data driven decision making•Measure effects of changes•Monitor to ensure sustained improvements
• Team engagement in problem solving
• Improved physician and staff satisfaction
“I used to be embarrassed by [our abandonment rate], and now I am proud of it.”
– OA Physician
New Perspectives
13
14
• Feedback on Internal Consulting Team (ICT)• Surveyed Staff Members of Telecom Team: 4.3 Average
•9 out of 5 recipients responded, 5 = Strongly Agree, 1 = Strongly Disagree
ICT Feedback
Please rate the Internal Consulting Team (ICT) as a whole for the following questions:
Answer Options Average
They understood our problems and needs. 4.2
They listened to our issues and concerns. 4.3
They developed processes and/or solutions that helped us meet our objectives. 4.2
They helped build and maintain a motivated and focused team. 3.9
They helped the Telecom Group address performance gaps. 4.1
They were professional, trustworthy, and empathetic. 4.3
They shared their knowledge and insights to promote learning. 4.6
They added value to our project. 4.4
I am satisfied with the ICT's work on this project. 4.4
Team Evaluation
14
Lessons Learned– Importance of communication to those directly and indirectly
impacted by changes• Development of proactive formal and informal communication
plan• Coordinated feedback process
– Importance of using data • For informed decisions• To evaluate success or failure of changes
Next Steps– Dissemination of key points to other locations– Project review for process streamlining– Monitoring for sustainability
Moving Forward
15
QUESTIONS?
Michael McGrew [email protected]
“Promoting a culture of continuous learning and improvement”
16