Capacity Management - Engaging providers in a centralized scheduling model
Presented by:
Stacy Calvaruso, CHAM
Ochsner Health System
• Largest integrated multi-specialty academic healthcare system in the Gulf Coast
• 8 hospitals across Greater New Orleans and Baton Rouge
• 44 health centers throughout South Louisiana with 2M patient visits annually
• 850+ physicians in more than 95 medical specialties and subspecialties
• Largest private employer in the state of Louisiana with more than 13,000 employees
Quality at Ochsner
• Health Grades Distinguished Hospital for Clinical Excellence
• Thomson Reuters Top 100 Hospitals, Top 50 CV Hospitals
• Thomson Reuters Top 15 Large Teaching Hospitals
• SDI Top 100 Integrated Systems
• US News & World Report Best 50 Hospitals – 11 Specialties
Our
World Class Clinical practices in Healthcare
may get them to call us...
butif they cannot get thru on the phone and/or get them the appointment that they want…..
Focus on Efficiency – key driver to Patient Access to Care
•
All current Ochsner clinic and hospital locations
are now on one system platform
•
We have pledged to empower our patients to be
partners in their healthcare experience
• Patient Portal to include appointment scheduling is currently being built
• iPhone and iPad access to their health information is now available
• Reminders at each visit from front desk thru clinical team about the MyOchsner portal
In the beginning……
• Each department scheduled their own appointment
• Multiple workflows • No consistency • Very disjointed
• Multiple staff members in each clinic area
• Scheduling Phone Statistics were poor
• Less than 75% average service level
• Wait times of over 10 minutes during high volume • Excessive amount of patient complaints
• No way to track staff productivity
• No way to track volume by clinic/provider, etc.
Bridging the Gap • Deep dive into the various visit types
• Approximately 1,000 visit types
• Approximately 300 different appointment time variations based on those visit types
• Review Physician Schedules
• Approximately 7400 different schedules
• Layered scheduling process for internal and external services • Shadow schedules
• Personal schedules
Basically we operated in a ‘have it your way’ environment!!
Get a grip!!
• Appointment Type and Time Modifications
• How many are for the same length of time
• How many are exact duplicates but named differently • How many have actually been used in the last 120 days • How many are ‘special order’ requests
How many New Patient and Established
Patient visits do you really need???
Provider Meet - Greet
• Invite a provider to breakfast with their ‘support’ team and ask them to describe the types of services they specialize in.
• Invite them to listen in on some of the calls that the team members take.
• Have a list of top 3 things the scheduling team needs from the provider.
• Share their statistics with them. (Appts booked, messages, etc.)
• Share the departments statistics with them.
Clinical Operations Team Meet - Greet
• Schedule clinic ops to listen in and ‘QA’ calls for 2 hours every 4 months
• Have them complete the standard QA audit sheet.
• Require an in-service for all new departments by clinical team members
• Have bi-weekly huddles
• Share their statistics with them. (Appts booked, messages, etc.)
• Share the departments statistics with them.
SCHEDULING 2.0
THE JOURNEY!
The journey begins….
1st Quarter 2013
• Call volume of 46,500 per month
• Scheduling capacity did not support projected budget
• Individual department leaders unable to manage clinic operations and scheduling process
• Patients could not get through on the phone therefore they showed up at the front desk seeking assistance
• Un-answered in-basket messages • Prescription refills
Initial Steps
• Identify the issues utilizing a SWOT analysis
• Scheduling staff members were not answering the phone • Silo approach
• Lack of Standard Operating Procedures
• Limited understanding of call center / scheduling center operations
• Limited reports and access to metrics • Employee engagement issues
• Gather the troops
The Centralized Scheduling Focus
Extended time allotment for
pre-registering and scheduling of patients who need special care due to nature of services
3 Basic Scheduling Models
Often involves multiple same day and appointment
cancellations/movements as well as payor plan changes.
Specialists Scheduling
General Medicine Internal Medicine
Three distinct service areas to allow enhanced training
activities
KPI’s = Call center, denials, reduction of WQ items, Kiosk acceptance, FD wait times, etc.
Metric Driven Focus
Pediatric Scheduling
Highest volume of calls and highest area of visits with benefit errors.
Standa rdiz e for im pr ov em en t
Identify needed Resources
• Metrics
• Scheduling slots available
• 3, 5, 10 day out availability by provider / location • Phone statistics
• Budget considerations • Employee productivity • In-Basket messages
• Clinical liaison / support
• Open communication with providers
• IS assistance
• Administrative support
Take Action
• Gather the troops
• Relocate scheduling staff members to a centralized area
• Work with Telephony representatives to modify ACD lines and current call cascading process
• Resolve Employee Engagement Issues
• Training
• Salary review
• Competency Review
• Staffing level
• Leadership and career ladder development
• Create a focused approach
• Focus on quick wins and set long-term strategic plans that supports the organizations overall goals
Resources
Resources necessary to drive change
1. Identify the targets
2. Understand how you can set up your schedule to meet/exceed the target
3. Train the schedulers to be appointment analyst 4. Identify clinical partners
5. Have an escalation process for appointment add-on’s, triage calls, etc.
Other Reports / Resources
• Daily phone stats
• Daily Rep performance levels
• Messages taken by agent
• Same Day Appointment %
Employee Development Activities
• New Job Description Developed
• Updated career ladder / path
• Scheduling Competency test
• Extensive Training program (app. 6-8 weeks)
• Shout-out’s!!
• Stable work environment
Employee Accountability Activities
Scheduling Competency – Examples from test….
a. True b. False
10. If a patient calls with active chest pain, what should you do?
a. call the triage line c. Tell the patient to go to the emergency dept
b. send a message
d. First, call the triage line, & if no answer, direct pt to seek immediate help
a. new
b. established
12. If a patient calls to make a sleep appt, you should:
a. make an appt c. Tell the patient no one is answering, please call back b. send a message d. Call Kari, if no answer, send a message
a. not drive c. Book an audio appt and provider appt b. not to take meclizine, Dramamine, or antivert d. Both b and c
a. True b. False
13. If a patient calls to make an appt with ENT,(and the pt is dizzy), you should inform them that they should restrict what (???) 48 hours prior to their appt:
14. When a patient calls and explains side effects to a medication, you should relate to them and tell them to stop taking the medication
11. A patient that has not been seen in 3 years would be considered as: 9. We must input appt notes for every appt scheduled.
Dashboard Version 1
Dashboard Version 2
How have we changed our workflows?
Previous mode of operations --Ignorance is bliss……
• Scheduling team members are at the table
• Providers consider the front line impact
• Never had the reports to compare to the phone system performance reports
• Consistent metrics across the system
• Ability to share various KPI’s with all levels
• Leadership has ability to see all KPI’s in one dashboard
• Workflows allow for consistent performance
Peer Accountability
Baton Rouge 4/1/2014
Department Total Offered Answered Abandon ed Abandone d% Deflecte d Deflecte d % Service Level Answ er % 3530 3407 117 3.31 0 0 90 97
Employee Calls Taken Unanswere
d Calls Held Calls
Transferre d Calls Handle Time Message s Taken Total Booked Appts Onlin e time hours Online Percent (target 90%) Kronos Time Avg Appts booked to hours worked Avg Msg to hours worked Adams, Brittany 78 1 0 1 2.06 23 25 6.2 92% 6.77 4.03 3.71 Anderson, Margo 107 2 0 14 2.53 29 41 7.83 97% 8.05 5.24 3.70 Aucoin, Melissa 64 3 0 10 2.15 20 13 3.77 94% 4 3.45 5.31 Bell, Shantelle 29 0 0 0 1.5 9 12 1.47 17% 8.6 8.16 6.12 Bringier, Ernest 120 7 0 18 2.15 43 26 7.33 92% 7.98 3.55 5.87
Brisco, Tewanda #DIV/0! #DIV/0!
Brumfield, Onnie 120 3 0 8 2.32 29 25 7.1 88% 8.07 3.52 4.08
Cap, Tu #DIV/0! #DIV/0!
Cubbedge, Amy 128 0 0 12 2.33 37 36 7.55 94% 8.03 4.77 4.90
Dillon, Jessica 143 3 0 9 1.55 43 25 7.32 92% 7.98 3.42 5.87
Ellis, Nakita 113 0 0 16 3.04 26 33 7.82 96% 8.15 4.22 3.32
Results Delivered
Month Offered Answered Abandoned Abandon Rate % Service Level Calls Within Target Service Level Total Appts made Total Same Day Appt Apr-13 47,005 41,124 5,592 11.89% 55.7% 26,177 11,688 2,599 Jul-13 62,884 60,490 2,322 3.69% 80.7% 50,748 13,928 2,427 Oct-13 73,122 70,313 2,741 3.74% 79.6% 58,209 18,970 4,379 Mar-14 87,572 86,482 1,090 2.01% 94.2% 85,358 24,782 59,231 Notes:
Mar-13 Started full registration at point of scheduling
Sep-13 1) Began outbound calling campaign to assist with OPE activities
2) Began flagging of messages to identify patient specific messages/ability to accelerate clinical assistance when needed for add-on's, etc.
MOR Scheduling Operating Results
Key Metrics Jan 2014Actual
Prior Month Actual 2nd Prior Month Actual YTD Average National KPI OHS Target Volume Metric Inbound Calls 51,454 64,191 68,380 63,925 Appointments Booked 14,127 15,287 15,854 15,362
% booked as Same Day 19% 23% 22% 20.89% 20%
Messages Volume 24,026 24,303 24,759 24,537
Quality Metric
Service Level 91.31% 98.13% 90.59% 94.29% >85%
Abandonment Rate 2.24% 1.87% 2.15% 2.02% <5%
Productivity Metric
Average Calls per FTE 120 107 114 107 >100
Average Scheduled per FTE 33 27 23 26
Average Messages per FTE 57 43 63 119 Other Metric
Successes We’ve Seen So Far
• Scheduling team members are at the table
• Providers consider the front line impact
• Revenue Cycle improvements
• Quality and Safety
• Productivity successes
• 100% Meaningful Use compliance
• Uncovered poor processes and behaviors
• Near real time feedback – alerts, reminders,
• Continuing to drive standards
• Reduction/removal of silo’s
Sustaining our Results
• Balance of People and Process
• Drive for consistency
• Call management becomes responsibility of everyone
Workforce Management:
“Getting the right number of people on the
phones at each period of the day to meet defined service levels while minimizing cost”
Overall Improvement • Daily communication • Daily Dose • Provider changes • System updates • Morning Huddles • Reporting Availability • Access partnership
• Leadership rounds ½ day at each clinic per month at least
• Monthly provider meeting
• Review of metrics
• Messaging Classification
• Assisted clinical areas with monitoring operations • Reminds everyone they have ‘skin in the game’
