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Medina Healthcare System: Centralized Scheduling Center

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Patient calls 30 sec.

Automated message

Process Flow Chart: Scheduling Center Inbound Calls

Scheduler greets patient

Schedule apt.?

Take message?

Scheduler available?

Placed at the back of queue

Rolled to registration

Call picked

up?No Yes

Wait ≤7min?

No

Yes

No

Yes

Yes

No

Yes

No

Transfer call to hospital

department

Physician to Physician

Pharmacy to Physician

Patient calling MA to return call

Get up and find physician

Get up and find MA

Inbound Calls

3Process Flow Chart: Scheduling Center Inbound Calls (Continued)

New patient?

Verify Insurance

Schedule patient

Input message

Immediate doc.

contact? Call doc

Forward doc message/

printer

Re-schedule/ Schedule follow-

up

Input info

Call patient back

Yes

Yes

No

No

Problem w/insurance

Call insurance

company/verify

Patient on hold

Yes

No

Inbound Calls Cont.

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Data Analysis

June 1, 2012 – May 30, 2013

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• Average queue time per 15 minute time interval

• Average service time per 15 minute time interval• Reduces variation; data in the tails

• Does not include the time the patient spends on “make busy”

• Calls interflowed that return to the queue are then tracked as if they are new calls

Data Limitations

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Data Analysis

June 2013

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June - Record of changes made

04/2013: Added phone tree. Issues: Incorrect routing, Took too long to get through the

phone tree. Interflow noted as a problem

06/01/2013: Took out phone tree, routing to physician line removed Issues: Interflow a continued problem

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Data Analysis

July 1 – July 23rd

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July - Record of changes made06/29/2013: Added physician phone number to beginning of automated

message.

7/01/2013: Removed interflow completely. Began using referral center staff during peak times (Mornings)

7/02/2013:Radiology dept. staff began giving patients in need of follow-up appointments the radiology scheduling line while reminding them not to call the clinic scheduling line for these appointments

Clinic scheduling center staff began sending emails to employers requesting information needed to process workman’s comp claims

Started using Recondo. Avoiding the rework of pasting information into templates previously entered – Faster insurance verification

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0.00400.00360.00320.00280.0024

USL

LSL *Target *USL 0.004Sample Mean 0.00312725Sample N 36StDev(Overall) 0.000354939

Process DataZ.Bench 2.46Z.LSL *Z.USL 2.46Ppk 0.82Cpm *

Overall Capability

% < LSL *% > USL 0.00% Total 0.00

Observed Performance% < LSL *% > USL 0.70% Total 0.70

Exp. Overall Performance

Process Capability of Converted

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Mean shifted from 5:00 in June to 4:30 in July

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Mean shifted from 5:00 in June to 4:30 in July

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Hypothesis

• Ho: June and July cycle times were essentially the same

• Ha: June and July cycle times were significantly different

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Hypothesis Testing

Two-sample T test for Cycle Time vs Cycle Time1

N Mean StDev SE MeanCycle Time 36 0.003477 0.000304 0.000051Cycle Time1 36 0.003127 0.000355 0.000059

Difference = mu (Cycle Time) - mu (Cycle Time1)Estimate for difference: 0.00034995% CI for difference: (0.000194, 0.000505)T-Test of difference = 0 (vs not =): T-Value = 4.49 P-Value = 0.000

DF = 68

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Comparison of Cycle Times

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Other important numbers…

Average Delay to Abandon

2012-2013: 1:45June 2013: 2:03July 1-23rd 2013: 2:01

Calls abandoned

2012-2013: 21.47%June 2013: 23.73%July 1-23rd 2013: 17.59%

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2nd Hypothesis:

Ho: Regardless of the call type, data is essentially the same

Ha: Call cycle time is significantly different between call types

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• Manually tracked

• Not all calls fit cleanly into a category

• Time includes service time but not time spent waiting

• Time does however include time spent on “make busy”

• Data sampled from 3 different time periods on 6 different days

• No interflow point

Data Limitations

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Call Type/Location/Time Interval Data – July

Count 254 25 15 14 8 7 6 5Percent 1.539.7 18.4 11.0 10.3 5.9 5.1 4.4 3.7Cum % 100.039.7 58.1 69.1 79.4 85.3 90.4 94.9 98.5

Call Type

140120100806040200

100

80

60

40

20

0

Count

Perc

ent

Pareto Chart of Call Type

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Take AwaysIt is vital that systems are in place to accurately report on performance of the call

center. Times need to include “make busy” and at least include a range or standard deviation for the wait time and service time per time interval

Seemingly minor changes in the processing of calls makes a significant impact– Interflow point removal– Recondo – eliminate rework– Workman’s comp calls

Adjusting staffing for peak times will reduce time spent waiting– Referral coordinators used during peak times

Potential improvements: Designate a staff member to focus only on insurance verification during peak times

Redesign how messages for physicians are processed18% of calls in July were from patients who were calling to leave a

message for their physician

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The Path Forward

1. Develop reports that track call center data. Enabling us to analyze performance and continually make improvements

2. Create weekly and monthly goals for scheduling center staff1. Improving patients satisfaction through decreased wait times and a

more consistent scheduling process

3. Ensure changes and improvements are sustained through monitoring the process using statistical process control charts and re-evaluating every quarter