(Originally published in H
ealthcare Call Center Times in September 2020.)
ROCHESTER, NY—There once was a time in the not too distant past when Rochester Regional Health maintained 27 distinct call centers, each comprised of three or more dedicated staff members handling phone traffic into the organization. Today, the story is much different. Between 2014 and 2016, these were consolidated into one contact center operation, which now has 250 staff members taking care of a wide range of functions from centralized scheduling, physician referral, post discharge calling, transfer center and nurse triage.
Most of the folks in the Communication Center work on the centralized scheduling piece. One of the interesting areas occupying the management of this part of the contact center is in changing how access availability is calculated. Traditionally, a common way to understand how easy it is to access a health system can be looking for the third next available appointment. However, says Jason Zawodzinski, Senior Project Manager, Technical Operations, there is another way to look at access, one that is very much congruent with a lot of patients’ preferences these days.
He says that the contact center is now looking at the five next available appointments in its access analysis and moving toward looking at the 10 next available appointments. The statistics can be diced by individual provider, specialty or region, providing a number of ways to view the access issue. With this data in hand, one of the big changes in access analysis is looking at the values of the younger generations.
That is, the five next available appointment slots with provider A may not be convenient for the patient or be at a time too far into the future from when the patient wants to be seen. But, more and more, younger patients value being seen quickly over which provider sees them. That means, from the point of view of the patient population, that the contact center might well be served by providing them the option of quicker appointments with nearby providers who have them available.
Another shift in the centralized contact center workflow is for those calls that historically have been escalated to a nurse. The call center has been working on reducing the percent of those calls that go to a nurse. The reason is that some of these calls do not need the expertise of a triage nurse, yet have been going there because the caller expressed a symptom. The way this can be reduced, “is to ask one or more questions,” says AJ Melaragno, Principal with the Chicago-based Singola Consulting, who is working with Rochester Regional. “For one of our other clients, they reduced the calls passed through to their nurses from 60 percent down to 23 percent.”
Asking additional questions can make the situation more specific. In some cases, the response needs to be, if certain health metrics are met, that the patient may need to be scheduled for an immediate care or same day appointment, but does not have to have the intervention of the triage nurse.
Within the contact center’s escalation processes, there are certain key words that if the caller uses, then the call must be listened to by a team lead within the hour. Some of these key words are: chest pain, fever, dizziness and numbness. The non-clinical staff member listening to these phone calls is looking to make sure that everything about the call center’s processes has been done correctly. If there is a concern the call moves right to a nurse, who then is responsible for getting hold of the patient.
The contact center uses LPNs and RNs to handle its post-discharge calling program of all inpatients discharged to home. Three attempts are made to reach the patient within 72 hours of discharge. If the first is unsuccessful then another attempt is made later that day. Altogether, Zawodzinski says, fully 90 percent of discharged patients are contacted. Right now, the RNs who do post-discharge calls also handle inbound nurse triage. But, LPNs, of course, do not.
The newest service from the contact center is facilitating video visits with Rochester Regional’s own doctors, rather than using a third party vendor. Adult video visits began this past February and pediatrics coming onboard shortly. Schedulers have been trained on how to present the video visit option to patients who quality for it. Zawodzinski also has a technical team in place to help patients with the technology end of making a video visit work.