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Without proper technology in place, call center leadership 'managing blind'
'You can't manage in the absence of information'
Health care organizations that are operating a call center or centralized scheduling department without the appropriate technology as a foundation might as well put blindfolds on their managers, suggests Judith Brown, president of Brown Healthcare Consulting in Chicago.
"If you don't know how many calls are coming in, how many people are holding, and how long you're making those customers wait, you're managing blind," says Brown. In such situations, she adds, there's no way to know how many potential customers are hanging up and going somewhere else for care.
When, as a call center director, Brown inherited that responsibility at another facility after a merger, she was told by her predecessor that "nobody hangs up, there are no complaints, and all the calls get answered really fast."
"I said, 'How do you know?' and the answer was, 'We just know.'"
Once call center software was installed, she found that people were holding for 15 minutes and there was a 20% abandonment rate. "If it's your first experience with an organization and you hold for 15 minutes, you might find somewhere else to go — especially if you're not feeling good, and our customers don't always feel good," Brown adds.
"I'm not a big 'technology is the answer' person," she says, "but you can't manage in the absence of information." That information also helps call center management establish service standards, Brown adds. "What percentage of calls do you want to answer in what period of time? Do you want to answer 80% of calls in 20 seconds or less?"
Armed with those data, she says, "there are formulas to plug in that determine what you need in terms of staffing."
At Swedish Covenant Hospital in Chicago, the goal is for the call center to become "a full-service marketing contact center," says Rose Jeanfreau, call center director. "We want to be the central nervous system for the whole hospital."
The concept is not something that would be entirely new, Jeanfreau adds. "We are not only scheduling appointments for 11 ancillary departments, we are making reservations for patients calling in to attend a class, event or screening. There is a cost for some of these classes, and we have the ability to collect payments on-line."
The Swedish Covenant call center already is unique in her experience, Brown says, because of the way it has melded the central scheduling and marketing functions. Representatives "go from scheduling a mammogram to signing up a caller for a senior class to providing information to someone who is looking for an obstetrician."
All of those callers might be people who are new to the hospital, she adds. "They have the opportunity to cross-market, to lead the callers into other services."
For example, if it's December and the caller who is signing up for the senior class is 65, the call center representative might ask if he has scheduled a flu shot, Brown notes. "Age is critical because so much of health care is driven off of age. If the caller is a woman who is 40, you talk about a mammogram. If it's a call about prenatal classes, you ask if the person has a pediatrician."
At the same time, she cautions, "You have to be careful how you word it. You don't want to appear Big Brother-ish. If you do it well, people are happy to know about it."
Expanding the scope of the call center is something that "has always been in the back of directors' minds," Jeanfreau says, particularly the idea of bringing in the telecommunications department. The former senior director of access services, Gillian Cappiello, laid the groundwork for such a move, she says, by increasing and refining the functions performed by hospital operators.
Cappiello — now a consultation services specialist with Planetree, a nonprofit membership organization that promotes patient-centered care — was instrumental in adding a physician answering service to the operators' duties, for example, and in implementing scripting to ensure that employees at the first point of contact "were on the same page," Jeanfreau adds. "The thought was always that it would be nice if we could somehow combine the two departments and have the call center be the one department that houses everything."
Upgrading the phone system
With that in mind, Swedish Covenant is upgrading the telephone system to enable "skill-based routing," she says. "It's a fantastic option so we can direct certain calls to certain operators. Say I had 15 employees and five of those specialize in insurance verification. I can set up those five as an agent group and identify them under skill-based routing."
Transfer to those representatives, Jeanfreau says, would be triggered from an automated phone: "For insurance verification, press this number. To schedule an appointment, press this number."
An agent group could be created temporarily to handle a special campaign, such as a vascular screening promotion that was recently conducted by the hospital, she adds. At the point a mass mailing on the screening started reaching the communities served by Swedish Covenant, Jeanfreau notes, "we were getting calls like nuts."
The ACD upgrade to the call center's phone system also will streamline a number of reporting functions and efficiently provide feedback on call center operations, she says.
At present, Jeanfreau says, she uses two databases for reporting: Meditech generates individual staff daily activity, such as how many patients were preregistered for an appointment in a day, and the overall volume of appointments scheduled for all 11 of the ancillary departments.
A customized database created by Swedish Covenant's web provider, she adds, gives Jeanfreau the capability to generate the number of physicians referred and the number of registrations for a class, event or screening in a day.
With the upgrade, Jeanfreau says, she will be able to generate the number of calls received per staff member, the number of abandoned calls, the average length of time per call, as well as incoming and outgoing telephone numbers.
"All three reports should provide me more accurate volumes overall," she adds, noting that the statistics will be presented on a spreadsheet. "I'll still need to work a manual process through Meditech with the appointment scheduling reports."
Also with the phone upgrade, management will be able to see, for example, how many calls are coming in after the call center closes, she notes.
At present, the call center is open 7 a.m. to 7 p.m. Monday through Friday and 8 a.m. to 4:30 p.m. Saturday, Jeanfreau says. "It would be nice to know how many calls we're getting after 7 p.m., whether it's worth staffing for another hour."
The call center telephone number already is used a lot more than the hospital number, she notes, "because we're so involved in the whole marketing piece. When we had an emergency department expansion, or if a number is given in case people need directions, marketing publishes our number."
The ultimate goal, however, is to take the connection even further, Jeanfreau says. "We want it to be one-stop shopping. [The call center] would be the front door. We would like to be the main number, 24 hours a day, seven days a week to route any calls — general inquiries, any patient information, the physician answering service."
The marketing department, meanwhile, wants to have the call center even more heavily involved in the fulfillment piece of the process, she adds. "We've got a database that can literally track when the patient was referred to a physician, whether the patient made an appointment, when the patient comes in — the whole return on investment piece."
Gradations of technology available
In many cases, centralized scheduling is "something that sort of happened to people," Brown points out. "You're taking calls for radiology, then they add nuclear medicine, because it makes sense for those things to be together, and then, 'How about mammography and ultrasound?'"
In that scenario, she continues, the provider may have started with a basic telephone system, which probably worked fine when schedulers were taking calls for one department and getting maybe 100 or 200 calls a month.
"But what about when you're getting 2,000, 3,000, or 30,000 calls a month?" Brown says. "If you think of every call as a person, can you imagine trying to manage 30,000 people coming into your facility and putting blindfolds on your staff?"
Gradations of call center technology are available, she notes, starting with a basic system that will take a call and push it to the available person who's been waiting the longest to get a call.
That kind of system "doesn't give a lot of data back," she says. On the other end of the spectrum, Brown adds, are systems that are able to route calls based on skill sets, with certain calls going to certain individuals.
"The problem hospitals run into [with the latter] is that it gets expensive," she acknowledges. "So you start looking at, 'How can we take this expensive technology and deploy it as widely as we can?'"
That might mean — as with an organization where she worked as vice president of consumer, corporate and government relations — using the technology not only in centralized scheduling and the marketing call center, but also for the help desk in the information technology (IT) department, Brown notes.
"When I was there I bought monitoring technology because I wanted to use the calls for training purposes," she says. "The IT department had similar kinds of issues, so they used the same monitoring tool. The technology was purchased once, and it gets much less expensive when a lot of people are using it."
One of the advantages to call center monitoring systems, Brown points out, is that "they take the subjectivity out of, 'I need more people.'"
Knowing how many people hang up after being put on hold, for example, a call center manager can conclude, "This is how many calls I'm losing in this line of business," she adds. "If you just do a basic percentage — I'm losing 10% of the calls and 30% of those are [for services that cost] $3,000 — you can look at that and say, 'I can pay for another representative.'
"[Call centers] are one of the few departments I've ever managed where I could just go and say, 'Our abandonment rate is this. This is our call volume; we are up from this to this, and we've taken on these departments — I need another FTE,'" Brown says. "This is a mathematical equation."
'Particular type' of employee needed
It's important to hire call center representatives who are comfortable with the marketing aspects of the job, Brown says. In one of her previous positions, she notes, she supervised a "wonderful, compassionate woman" who was good at her job until she "had to extend herself and say, 'Here's something I can do for you.'
"She could not get past [her difficulty with] asking people who called for a referral if they would like assistance in scheduling an appointment," Brown adds. "Not everyone can do the selling piece. It's one of the things to look at when you're going from a transaction-based environment."
One of the practices Brown incorporated into her management experience with marketing call centers, she notes, is to have job candidates actually sit in the call center for a few hours in order to understand what the position entails.
"If they feel uncomfortable, this is a better time to talk about it than after they've been on the job for awhile," Brown says.
That was something she did in a marketing environment, rather than in a setting where HIPAA privacy regulations would be a consideration, she points out. While that type of firsthand exposure might not be possible in a scheduling department, Brown adds, managers can certainly talk to potential employees about whether they're comfortable with this referral or "selling" aspect of the job.
It's also important, she points out, that potential employees fully realize the constraints associated with a call center position.
"You want to be in a spirit of full disclosure," Brown continues. "This requires a particular type of individual. It's not like other jobs, where you can move from one department to another. You pretty much work at a desk and your customers come to you, but they are coming to you via telephone, so you don't have much change in environment. You're looking at a computer terminal, a telephone, and your coworkers."
Once the hiring's done, she says, there should be a strong emphasis on training, which she breaks into several categories.