one destination, two journeys: call center centralization ... · henry ford medical group...
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Performance Improvement Series
AMGA Member Best Practices
One Destination, Two Journeys: Call Center Centralization at Henry Ford Medical Group and The Jackson ClinicThomas Nantais, Chief Operating Officer, and Cyndy Orrys, Contact Center Director, Henry Ford Medical Group; and Mark Allen, Chief Operating Officer, and Amy Smith, Contact Center Manager, The Jackson Clinic
Webinar, September 4, 2014
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“I like to refer to the call center like
a virtual front desk. We’re much
more than an appointment
center—we can handle literally
anything the patient calls for.” — Cyndy Orrys, Contact Center Director,
Henry Ford Medical Group
Detroit-based Henry Ford Medical Group handles 1.2 million clinical visits and $800 million in revenues
across 32 locations. The Jackson Clinic, located in rural Tennessee between Memphis and Nashville, is
an independent specialty group with 750 employees, including physicians. These two organizations
embarked on similar quests—centralizing their call center operations—sharing similarities and
encountering differences.
Henry Ford began its journey eight years ago,
partially to find cost efficiencies in the Detroit
market, where one can find roughly $250 million a
year in uncompensated care. Other drivers included
an inconsistent patient experience across Henry
Ford’s many locations and call abandonment rates
of up to 20 percent. “We look at every call that is
dropped as a missed opportunity,” Orrys said. “If you
can control service levels, the abandonment rate
really takes care of itself.”
For The Jackson Clinic, the quest to achieve a “one-
stop shop” began roughly a year and a half ago. The mission was to address patient complaints—such
as multiple transfers around the world and the feeling of getting stuck on eternal hold—as well as a
lack of measuring capacity. Under the old system, there was no way to track important metrics like the
number of calls coming in or hold times. The new call center’s vision is a central place for patients to ask
questions, request a refill, or schedule an appointment, with employees answering the phone able to
address patients’ issues. “We are not there yet but we are much closer than before,” Allen said.
Setting Up OperationsHenry Ford’s 300-plus person, 32,000-square foot call center handles 260,000 calls and 6,000 e-mails
a month with a 19-second speed to answer and an 88 percent effectiveness rate in answering a call
within 30 seconds or less, a metric based on what callers would typically tolerate before hanging up.
The call center also handles automated appointment reminders, calls into the 1-800 “catch-all” phone
line, and “cross-selling” opportunities (encouraging a patient to schedule an upcoming mammogram
or colonoscopy at the end of a visit, for instance). Within established protocols, RNs in the call center
handle prescription refills at both Henry Ford and Jackson Clinic.
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At Henry Ford, agents, who are referred to as
“advocates,” work in 17 “pods” that answer calls
for multiple care sites or a specific product line,
such as orthopedic health. This gives advocates
a depth of knowledge and skill to address calls
appropriately, Orrys said. RNs, which are staffed
at a 1-to-3 ratio with call center advocates,
handle triage, giving advice and scheduling
appointments when appropriate and refilling
prescriptions in their downtime. This process has
improved first-call resolution and reduced ER
visits. With a call volume 30 percent more than
planned, phone engineers were embedded in the
call center. Managing it all is Orrys, the call center
director and “traffic cop.”
Getting there required intensive coordination
among the CMO, the director of nursing, and
IT staff, as well as strong partnerships between
the front desk and various departments. A
senior leadership group and physician steering
committee met monthly to ensure efforts in
metrics, advocate education, and other areas were
proceeding to plan. For instance, the orthopedics
chair gave call center staff an anatomy lesson,
the CMO and director of nursing helped write
protocols to ensure standardization, and the IT
staff helped move Henry Ford from an antiquated
25-year-old phone system to video IP.
Henry Ford’s ultimate goal is to integrate
specialties and business operations even more
CALL METRICS AT HENRY FORD MEDICAL GROUP
Call Types
Current Metrics
Average Monthly Volume:■ Phone: 260,879■ Email: 6,165
Phone Metrics:■ Speed to Answer: 19 secs■ Average Service level: 88.1% in 30 secs■ Average Handle Time: 3 minutes 11 sec■ After Call Work: 3 minutes 19 sec
Performance Goals:■ Service Level: 80/30■ Abandonment Rate: <6%■ Agent Adherence to Schedule: 95%■ Agent Quality Score: 100%
Other 10%
Rx Re�lls 25%
Inquiries 25%
Appointments 40%
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into a one-stop resource for everything from
scheduling an appointment to paying a bill. Also
on deck are insurer partnerships to, in Orrys’
words, “get patients with bad debt to a good
place.”
Jackson Clinic’s contact center supports 25
full-time employees, each assigned to an
administrative/scheduling group or a nursing
group, and these employees work in staggered
shifts to support calls from 7 a.m.-11 p.m., seven
days a week. Phone nurses are also embedded in
primary and specialty care. Centralization of these
previously scattered employees required physical
relocation of many employees to the new space,
new job descriptions, and additional training.
In terms of IT, Jackson Clinic discovered a capacity
issue that was the opposite of Henry Ford’s: Due
to “spaghetti routing,” the clinic was double-
and triple-counting phone loads, taking in up
to 1,000 fewer calls per day than previously
believed. A new “less is more” call tree now routes
unanswered calls to employees. Patients put on
hold now listen to ads and waiting prompts with
an option to speak to a live person or go to voice
mail. The clinic aims to eventually route calls by
skill set, which will enable customized handling of
calls throughout the clinic during peak times.
Costs for both call center initiatives were charged
under “general and administrative” using
corporate allocation.
Finding and Training the Right People
Every job posting at Henry Ford’s call center
typically attracts around 200 applicants. How
are the right ones chosen? Orrys uses a robust
behavioral interview guide—peppered with
questions like “How did you handle…?” and
“Talk about a time when….” She also looks for
customer service experience—and not necessarily
experienced gained at a call center. In these cases,
“we’re sometimes undoing bad.” However, “you
can’t teach nice, and you have to be nice in order
to handle this job.”
JACKSON CLINIC CALL CENTER ORGANIZATIONAL STRUCTURE
ContactCenterAgents
ContactCenterPhone Nurses
Operators
Primary Care
Appointments
Specialties
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Even after offering pay increases and retention
bonuses to retain employees, the new call center
still needed more staff. The organization originally
used an agency and 90-day temporary terms for
some hires but soon went to a permanent-hire
model, which attracted better candidates and
helped lower turnover to 2-3% per month. Many
of these employees are nurses at the end of their
careers who don’t want to be on their feet all day.
Allen said that he sees many of these applicants as
well, who view the position as a foot in the door
to The Jackson Clinic. The candidate per posting
ratio, however, is lower in Jackson’s less-populated
coverage area—roughly eight to 10 applicants per
opening.
In both organizations, a new hire participates in
several weeks of intensive training between his
or her first day on the job and first day alone on
the phones. Initially, Henry Ford immediately
sent new hires to its 15-seat training center,
which is equipped with a full-time trainer and
adult learning curriculum, to reinforce the
professionalism of the position. But the sudden
classroom immersion proved overwhelming.
Now, new hires first spend a few weeks in the
pod listening in to get a feel for the job. Time
in the classroom is led by trainers educated
themselves through the train-the-trainer method
for standardization purposes. It’s followed by
a “nesting” period back in the pod to reinforce
lessons before taking calls solo.
Training at Jackson Clinic includes a 10- to 12-
week training program, which the clinic is aiming
to shorten when more things are standardized,
and biyearly reviews of protocols, which aid
accountability, Smith said. Due to the complexity
of the training and the position, the clinic looks
for longevity when it hires.
Measuring ResultsThrough standardizing its call center protocols,
Jackson Clinic has empowered its employees to
make decisions while reducing or eliminating
transfers. The ultimate aim, Smith said, is “one-
call resolution,” getting all of a patient’s needs
handled before the end of the call. Jackson also
wants to improve other metrics in areas that
impact the patient experience, such as hold
times and abandonment ratios. An abandoned
call report shows wrong numbers, patients who
waited too long for an answer, and the average
time to answer a call, which is currently around 49
seconds.
Analyzing overall call load also is very important
in defining peak times and forecasting loads for
staffing and other tasks handled during down
time. Jackson bases much of its staff scheduling
on when calls are coming into the clinic and the
defined service level it’s committed to uphold—
answering 80% within 40 seconds. Smith said they
couldn’t find enough industry stats for guidance,
so they use login time to measure who is available
for incoming calls and average talk time to see if
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agents are taking care of calls and not transferring
them elsewhere unnecessarily. Long on-hold or
consultation times can indicate employees in
need of training.
Henry Ford measures many metrics, including
quality, advocate adherence to procedures,
average talk time, and average after-call work
time. “A lot of places buy tools but don’t use them”
due to budget cuts, Orrys said. “We use tools to
the full extent.” These include Verint Systems’
Impact 360 Quality Monitoring. The organization
already measures loyalty and retention and
is looking at Press Ganey for ways to measure
courtesy.
An advocate’s number of calls handled is
compared with his or her peers, mostly to detect
trends, as Henry Ford’s overarching goal is quality,
and the QA score the organization aims for is
100%. Advocate adherence— specifically, how
well advocates mirror what Henry Ford wants
them to be doing—is key to achieving these
goals. Quality coaches and mentors listen in to
advocate calls every two weeks, and an advocate’s
QA score comprises promotions, opportunities,
team membership, and more.
Maintaining MoraleMorale is important in any customer-facing
position, and Jackson Clinic works to boost it
with activities like cubicle decorating, posting
baby pictures, and other activities planned by
employees. Agents also get opportunities for
more responsibility; for instance, one of the
agents was recently named team leader of the
nurse’s call center group.
Similar activities take place at Henry Ford,
including recognition via a regular newsletter
(“The Podville Times”), postings on a bulletin
board, and monthly events planned by the call
center’s WOW advisory committee. Advocates
have opportunities for multiple layers of
advancement—level one, level two, staffing
for the 1-800 line, a QA or workforce role, then
supervisory and managerial roles. Orrys said
that the center has had more than 80 internal
promotions so far. This includes the advancement
of her current call center manager, who started
out as a Level 1 advocate.
Another motivational incentive—and one that
dovetails with the call center’s growth—is the
opportunity to work at home as a Henry Ford call
center advocate. Eligibility criteria include one
year of employment, quality scores of 100 percent,
and excellent attendance. So far, 50 advocates
have met the requirements. The $5,000 “desk-in-
a-box” that enables this includes a laptop that’s
fully loaded with software and a robust firewall.
Because of HIPAA requirements, advocates who
work from home must work from a room with a
door and are not allowed to hook up a printer to
this laptop. The call center has experienced no
breaches, Nantais said.
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From the Audience
Q: Did physicians like the call center idea, or was there pushback to overcome?
A: Physicians at Jackson Clinic thought they were having something taken away from them at
first, Allen said, which was an obstacle. But then they saw that their patients were getting their
problems resolved more quickly, without being passed around, which improved buy-in. At Henry
Ford, pushback came from not bringing all physicians into the call center service at first. “Some clinics
thought they could do better,” Nantais said. “But we showed over time that service levels were better
and won them over.” Putting physicians on the call center steering committee helped as well.
Q: What impact did the one-stop call center have on your patient portal?
A: In the six months that Jackson Clinic’s call center has been live, call volume has increased and the
time spent on portal-related requests has increased, as Allen expected. Henry Ford’s call center also
handles tasks related to its MyChart EPIC EHR, such as general internet requests, activation codes, and
assistance with the technical functions of the portal.
Q: How are nurses triaging calls and passing them on to physicians?
A: Orrys said that nurses at Henry Ford chart every call and let physicians know the outcome,
meaning nurses rarely have to pass calls along. At Jackson Clinic, triage is protocol-driven, with
situations that fall outside of established protocols passed on to physicians.