Capacity Management - Engaging providers in a centralized scheduling model

Presented by:

Stacy Calvaruso, CHAM

Assistant Vice President, Patient Access

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

• And Growing!

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

• Top 11 Transplant program in the U.S.

Our World Class Clinical practices in Healthcare

may get them to call us...

but

if they cannot get thru on the phone and/or get them the

appointment that they want…..

they will move-on to the next available provider……

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

THE GOOD OLE’ DAYS!!

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.

• No way to determine same day conversion rate, 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???

We believe in Profiling !!

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.

• Brag……

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.

• Brag……

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

• Medical Advice

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

• Create a focused approach

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.

Sta

nd

ard

ize

for

im

pro

vem

ent

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

• Determine what success means………….

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.

6. Easily obtainable metrics/results

Other Reports / Resources

• Daily phone stats

• Daily Rep performance levels

• Messages taken by agent

• Same Day Appointment %

• Agent Report card

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

• Salary adjustments

The Daily Dose

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

Easy Tracking Analysis

Dashboard Version 2

Analytics Drive Actions

Same Day Access

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

Current mentality -- LEAD WITH METRICS….

Peer Accountability

Baton Rouge 4/1/2014

Department Total Offered Answered Abandon

ed Abandone

d% Deflecte

d Deflecte

d % Service Level

Answer %

3530 3407 117 3.31 0 0 90 97

Employee Calls Taken Unanswere

d Calls Held Calls

Transferred Calls

Handle Time

Messages Taken

Total Booked Appts

Online 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

Foster, Vanessa 95 0 0 17 3.4 26 22 7.4 91% 8.12 2.97 3.51

Results Delivered

Month Offered Answered AbandonedAbandon

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 Actual

Jan 2014

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

Turnover Rates 0% 10% 3% 8.7% <12%

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

Highly Engaged Team!!!

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’

QUESTIONS