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

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QUESTIONS?

Michael McGrew Michael.mcgrew@uwmf.wisc.edu

“Promoting a culture of continuous learning and improvement”

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