The Power of One: The Challenge of Centralized Scheduling. Tamela Dodds, Danielle Stern

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1 The Power of One: The Challenge of Centralized Scheduling Tamela Dodds, Danielle Stern

2 Your Speakers Tamela Dodds Operations Manager Cincinnati Children s Hospital Medical Center Danielle Stern, MHA Service Integration Director Sutter Physician Services 2

3 Cincinnati Children s Hospital Scheduling Center Overview Tamela Dodds

4 CCHMC s Vision and Mission Vision To be the leader in improving child health Mission Cincinnati Children s will improve child health and transform delivery of care through fully integrated, globally recognized research, education, and innovation. For patients from our community, the nation, and the world, the care we provide will achieve the best: Medical and quality of life outcomes Patient and family experiences Value

5 Scheduling Center Mission Ensuring a superior scheduling experience for families and healthcare partners

6 Centralized Scheduling Overview Assisting patients, physician s offices, and internal staff with Scheduling appointments Pre-registration Pre-authorization Orders and referral processing Scheduling Agents handle the following averages per day 2,500 inbound calls 1,300 outbound calls calls per Scheduling Agent 1,000 referrals and orders Concierge Scheduling Coordinate scheduling for patients outside the 8 county region

7 Scheduling Center Organization Chart Administrative Assistant 3 Operations Specialists 8 Leads 4 Managers, Operations Chris Korneffel Director, Scheduling Center Operations 72 Scheduling Agents Concierge Intake Facilitator, RN Manager, Insurance Verification 3 IVR Coordinators 10 Insurance Verification Reps 4 Business Analyst II 3 Business Analyst I Pam Masters Director, Clients Services Project Coordinator Data Coordinator 4 Trainers Manager, Training & Auditing 4 Auditors 3 Aides

8 Systems Epic - Medical records, contact information, appointment scheduling, physician templates, billing, insurance tracking, orders and referrals Avaya - Call management, staffing and reports, and customer satisfaction surveys Uptivity- Voice/screen recording, quality auditing Nextrio - Off site secure storage of referrals and orders Televox Outbound Reminder Call Vendor

9 Sutter Physician Service Overview Danielle Stern

10 Sutter Health Integrated Health System 100+ communities in Northern California Not-for-Profit 24 Hospitals 7,000 Aligned MD s 40,000 Employees 10

11 SPS Story Wholly owned by Sutter Health Focused on the physician enterprise Entrepreneurial venture pull, no push Standardized workflows and consistent quality Economy of scale and skill High performance Efficient, lower cost delivery solutions Nationally recognized, Culture of Excellence 11

12 SPS Mission Our mission at Sutter Physician Services is to provide physician groups, hospitals, and integrated delivery systems with health care services that enhance their ability to: Improve the patient experience of care (including quality and satisfaction) Improve the health of populations Reduce the per capita cost of health care 12

13 SPS Services Revenue Cycle Management Patient Access Solutions Accountable Care Solutions Patient-centered billing MNCR forensics Care center access Clinical access Support Capabilities Managed care admin. Care coordination Analytics & BI Independent Practice Services Technology Analytics & Business Intelligence Integrating independent practices through EHR practice management, and other solutions. Epic and GE/IDX-certified support for implementation, optimization, and ongoing applications support of the physician enterprise. Routine and ad hoc reporting and analysis for finance, operations, utilization management, clinical performance, regulatory compliance, and quality performance. 13

14 The Patient Service Center Today Over 850 Employees (Including 120 RNs) 5 + Million Annual Calls Robust Quality and WFM Advanced Telecom Systems Registered Nurses Patient Service Representative Home Agents 14

15 Care Center Services Provider Service Clinic Access Health Concierge Call Campaign Care Center Access Member Service Answering Service Revenue Cycle Patient Portal 15

16 Clinical Services After Hours Nurse Advice Primary Care Nurse Advice Specialty Nurse Advice Patient Outreach Rx Renewal Clinical Access Readmissi on Mgt. ED Discharge Anti- Coagulation Wellness Coaching Disease Mgt. Coaching 16

17 Internal Centralization Tamela Dodds

18 Driving Factors In 1999 Cincinnati Children s had tripled in size and scheduling became more difficult for patients Scheduling was done in silos; each division scheduled their own services Patients had to call multiple phone numbers to schedule any appointment or service needed Communication between divisions was increasingly disconnected Used multiple antiquated scheduling systems

19 Driving Factors New Scheduling System Identified Need Dos-based system lacked reporting capabilities More sophisticated system was needed to keep up with volume growth Selected Resource Selected EPIC to increase efficiency and EMR Implemented Resource Implemented the scheduling system one department at a time Leadership paved the way

20 Relationship Building & Communication Standardized processes and policies across divisions Analysts built partnerships between physicians and division schedulers Scheduled meetings with physician leadership to explain centralized scheduling and its benefits Invested time with division staff and providers to support the creation of concise scheduling rules and templates Established quarterly meetings with division leadership to address all questions and keep open lines of communication Reviewed and observed workflows to learn special circumstances, processes, and policies in each division Trust & Buy-In Established annual satisfaction surveys to measure and improve divisional customer satisfaction

21 Creating an Optimal Infrastructure Original goal: Train all agents to schedule all divisions Ultimate solution: Created six teams of schedulers with three to seven divisions assigned to each team Common illnesses and/or diseases were used to determine team based scheduling

22 Integrating Staff and Processes Many schedulers from the divisions were absorbed and relocated to the Scheduling Center Where applicable, other schedulers remained in the division to serve as internal resources for the Scheduling Center Division schedulers were cross-trained in a number of divisions Agents were informed of new performance standards and that their calls were being recorded New system also monitored the availability of each scheduler Monthly coaching on performance standards Created operations specialist position Analytical responsibilities: Call volume, ASA, queue management, reporting and staff monitoring

23 Developing the Scheduling Process Scheduling Center analysts developed questionnaires and scripts to guide scheduling agents to the correct visit type Example: if a parent calls the Cardiology line and says their child has fainted, the scheduling agent starts with cardiology new visit and selects fainting on the questionnaire the agent is then directed to the syncope visit type and questionnaire to go over with the caller

24 Centralization Challenges Two divisions took back scheduling responsibilities: Division of Developmental & Behavioral Pediatrics Seven to nine month wait for new visits Needed to redesign how patients were prioritized and scheduled Cancer and Blood Disease Institute (Hematology/Oncology) Unable to schedule appointments within needed timeframe Agents consistently called the department directly to make appointments

25 Training: Developing Team Responsibilities and New Hire training program- six months Mentorship program Structure Bi-Annual customer service refresher training Auditing: 6-10 calls audited per agent per month Two of these call are live monitored and scored Uptivity software: voice and screen recording Call calibration sessions hosted for management Scheduling Agents Agents scored monthly on: Average handle time (AHT) Quality Accuracy Customer service Personal aux

26 Culture & Recognition Programs Culture: Potlucks Activities committee Scheduling Center newsletter Birthday club Volunteer opportunities Incentives and recognition: Quarterly star performer Monthly top performer Monthly team award for best ASA

27 Benefits & Results of Centralization Cost savings: 72 scheduling agents- 56 FTEs Fewer people handling more calls Increased patient satisfaction: Significant reduction in wait time Improved call scores One call number, multiple divisions Increased number of pre-registered patients

28 Lessons Learned Bring about change slowly and in phases Include stakeholders from each role in the process Set achievable, yet challenging, goals for staff Benchmark productivity by team first, then overall by department Select leadership with various backgrounds for implementation

29 Steps Taken to Centralize Scheduling 1. Determined department location 2. Implemented new scheduling system 3. Developed scheduling department hierarchy and staff job descriptions 4. Determined FTE allocation and reassigned division schedulers accordingly 5. Conducted visits to the divisions and observed staff 6. Selected a phone system and quality auditing software 7. Developed an action plan for each division and workflow changes 8. Obtained clinician buy-in by conducting office visits and meetings 9. Identified departments who were unable to participate 10. Developed training and auditing teams for scheduling operations 11. Organized and assigned staff to teams- began cross training 12. Determined and implemented Scheduling Center, team and scheduling agent performance standards

30 External Business Danielle Stern

31 Driving Factors Standardizing processes and tools Creating efficiencies Establishing best practices Desire to support the IHI Triple Aim Initiative Improving the patient experience of care Improving the health of populations Reducing the per capita cost of health care 31

32 Implementation Framework Recognize importance of implementation process Apply lessons learned Establish standards Build a robust structure Complex many stakeholders The Denali concept

33 Implementation Framework The Denali implementation process: Moves organizations from conceptual strategy through successful go-live Utilizes a timely and efficient methodology Address business and regulatory requirements.

34 Oversight Structure The project governance structure includes the following oversight and work group teams: Executive Leadership Committee Implementation Steering Committee Patient Service Standard Workgroup Clinical Care Workgroup Communications Workgroup Reporting & Quality Workgroup Technology Workgroup Human Development Workgroup 34

35 Communication Communications workgroup meetings General organization-wide announcement Talking points for leadership Employee feedback inbox FAQ/Project site Weekly updates Go-Live announcement Final re-cap/announcement

36 Support Buy-in/Relationship Building Strategic community awareness process Reports Weekly check-ins with Operations Team Monthly check-ins with Executive Team Letter correspondence between agents and clients MemorialCare promise 36

37 Culture/Morale New hire welcome baskets Team accountability Subject matter experts Employee Recognition Team luncheons Friendly competition Celebrating the wins 37

38 Questions? *For additional questions visit SPS booth #24 in the back right corner of the conference room

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