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. 1 st 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
Standardize for improvement The Centralized Scheduling Focus 3 Basic Scheduling Models Specialists Scheduling Pediatric Scheduling General Medicine Internal Medicine 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. Metric Driven Focus KPI s = Call center, denials, reduction of WQ items, Kiosk acceptance, FD wait times, etc.
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. 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 b. send a message seek immediate help 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? 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 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 Foster, Vanessa 95 0 0 17 3.4 26 22 7.4 91% 8.12 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 2 nd 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