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
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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
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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
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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
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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
Standardize for improvement
3 Basic Scheduling
Models
Specialists
Scheduling
Pediatric Scheduling
General Medicine
Internal Medicine
Metric Driven
Focus
Three distinct service areas to
allow enhanced training
activities
Extended time allotment for preregistering and scheduling of patients
who need special care due to nature
of services
Often involves multiple same day
and appointment
cancellations/movements as well as
payor plan changes.
Highest volume of calls and highest
area of visits with benefit errors.
KPI’s = Call center, denials,
reduction of WQ items, Kiosk
acceptance, FD wait times, etc.
Identify needed Resources
• Metrics
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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
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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
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Daily phone stats
Daily Rep performance levels
Messages taken by agent
Same Day Appointment %
Agent Report card
Employee Development Activities
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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….
9. We must input appt notes for every appt scheduled.
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
d. First, call the triage line, & if no answer, direct pt to
seek immediate help
b. send a message
11. A patient that has not been seen in 3 years would be considered as:
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
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:
a. not drive
c. Book an audio appt and provider appt
b. not to take meclizine, Dramamine, or antivert
d. Both b and c
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
a. True
b. False
Dashboard
Version 1
Easy Tracking Analysis
Dashboard
Version 2
Analytics Drive Actions
Same Day Access
How have we changed our workflows?
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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
Department Total
4/1/2014
Offered
3530
Employee
Adams, Brittany
Anderson, Margo
Aucoin, Melissa
Bell, Shantelle
Bringier, Ernest
Brisco, Tewanda
Brumfield, Onnie
Cap, Tu
Cubbedge, Amy
Dillon, Jessica
Ellis, Nakita
Foster, Vanessa
Answered
3407
Abandon Abandone Deflecte Deflecte Service Answ
ed
d%
d
d%
Level er %
117
3.31
0
0
90
97
Avg
Online
Total
Appts Avg Msg
Unanswere
Transferre Handle
Onlin Percent Kronos
Calls Taken
Held Calls
Message Booked
booked to hours
d Calls
d Calls
Time
e time (target Time
s Taken Appts
to hours worked
hours 90%)
worked
78
107
64
29
120
1
2
3
0
7
0
0
0
0
0
1
14
10
0
18
2.06
2.53
2.15
1.5
2.15
23
29
20
9
43
25
41
13
12
26
6.2
7.83
3.77
1.47
7.33
92%
97%
94%
17%
92%
6.77
8.05
4
8.6
7.98
120
3
0
8
2.32
29
25
7.1
88%
8.07
128
143
113
95
0
3
0
0
0
0
0
0
12
9
16
17
2.33
1.55
3.04
3.4
37
43
26
26
36
25
33
22
7.55
7.32
7.82
7.4
94%
92%
96%
91%
8.03
7.98
8.15
8.12
4.03
3.71
5.24
3.70
3.45
5.31
8.16
6.12
3.55
5.87
#DIV/0! #DIV/0!
3.52
4.08
#DIV/0! #DIV/0!
4.77
4.90
3.42
5.87
4.22
3.32
2.97
3.51
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
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%
24,026
24,303
24,759
24,537
Messages Volume
20%
Quality Metric
Service Level
91.31%
98.13%
90.59%
94.29%
>85%
Abandonment Rate
2.24%
1.87%
2.15%
2.02%
<5%
>100
Productivity Metric
Average Calls per FTE
120
107
114
107
Average Scheduled per FTE
33
27
23
26
Average Messages per FTE
57
43
63
119
3%
8.7%
Other Metric
Turnover Rates
0%
10%
<12%
Successes We’ve Seen So Far
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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