1. Call Center Improvement Project
CQI Team Members:
Executive Leadership:
Change Leaders:
William Caplan MD – UWMF CQI Associate Medical Director
Linda Drummond – UWMF CQI Lead Consultant
Michael McGrew – UWMF CQI Lead Consultant
Cheryl Andree - UWMF CQI Director
Lori Hauschild, Richard Welnick MD
Henny Regnier NP and Shelly Key RN

2. Project Description
One of the larger primary care clinics in UW Health
2 family medicine clinics merged to become Odana Clinic
in Spring 2007
23 providers
Approx. 15,000 calls monthly
Calls routed via two queues (based on patient selected call type)
Non-Clinical (Receptionists)
Appointment scheduling
General clinic information
Clinical (MA’s, LPN’s, and RN’s)
Symptomatic calls
Prescription renewals
Lab related calls

3. Problem Definition
Phone abandonment rates at the clinic were higher than goal (3 - 5%)
Average abandonment rates June 2007 to Dec 2007:
10% - Odana Clinic
4% - Overall UWMF
Low patient and provider satisfaction with Communications Center performance
Site
Clinic Expansion
All Clinics
Although call volumes seen in December 07 are very close to those experiences in April and May, the corresponding abandonment rates were more than 5% higher.
Site
Clinic Expansion
(added 4 providers)

4. Project Goal
Reduce overall clinic telephone abandonment rate to 3% or below while maintaining call handling quality by August 2008
Defined Project Metrics
Quantitative – Abandonment rate (AR), call volumes
Qualitative – Patient and provider satisfaction related to access to reaching clinic by phone

5. Define “Current State”
Initial assessment revealed a complex and confusing process with multiple hand-off’s

6. Solution Development Current Situation Analysis Conclusions
Literature review
Medical Group Management Association
Family Practice Management
International Customer Management Institute
Best practice review
Internal: After Hours Call Center
External: Kaiser-Permanente
Root cause analysis
Brainstorming
Nominal voting
Work system analysis
Process flows
Data analysis
Call types and volume
Abandonment rate, queue times
Conclusions
Call routing model
Less than ideal
Current staffing
Low FTE/call ratio
Misaligned staffing model mix
Open positions not filled
Call routing
Non-clinical calls going to Clinical Queue
Non-value added steps
Potential for simplification
High volume of refill/lab results calls
Staff unavailable
Additional tasks preventing answering calls

7. Phase I Supply Management: Allocation of staff from existing FTE
Receptionist moved to communications center
RN Care Managers assigned to communications center
Optimized staffing to match demand
Moved “Lunch and Learn”
Balanced staffing to meet call demand
Demand Management:
Clinic welcome message revised
911 and Rx information moved to beginning of message
After hours message revised
To better route patients to HealthLine
Improved efficiency for calls related to narcotic renewals
Reinforced use of protocols
Site
Add text box RE: Same volumes as Sep 07, but with lower AR’s in May 08
UWMF Clinics

8. Phase II: Simulation Model 1 Analysis:
Eliminate communication center - all calls routed directly to clinical teams
Predicted costs:
Information Services system changes
Salaries/benefits for additional 6-8 Reception/MA/RN FTE
Construction costs for space re-allocation
Total of ~$315k increased cost
Model 1: $280K - $378K per year salaries/benefits (2 Reception, 3 MA, 1 RN, 32.7% benefits, avg salaries for each or 2 Reception, 5 MA, 1 RN, 32.7% benefits, avg salaries for each)

9. Phase 2: Simulation
Model 2: $110K - $148K per year salaries/benefits (1 Reception, 1 RN, 32.7% benefits, avg salaries for each or 2 Reception, 1 RN, 32.7% benefits, avg salaries for each)
Model 2 Analysis: Redesign existing telecommunications center
All calls answered by dedicated receptionist pool, appropriate calls routed to clinical staff in call center
Predicted costs: IS system changes + Salaries/benefits for additional 2-3 Reception/MA/RN FTE => Total of ~$125k increased cost

10. Call Handling Revision
-Old way: First Call Resolve
All calls routed to agent based on patient preference in automated selection menu
-New way: Best Call Resolve
All calls routed to receptionist, then routed as applicable based on patient needs
Previous confusing flow => new clean, straight forward flow

11. Abandonment Rate Results
Jan to Aug 08 abandonment rate decreased from 13% to 1.3%
To date, still a top performer!
Phase I (Staff Balancing)
Site
Phase II (Routing Revision)
UWMF Clinics
Difference in AR for a consistent call volume (Jun 07 – Jun 08 => 8% vs. 4% respectively)
CC = Call Center
Sched = budgeted FTE
Actual = FTE actually hired and working in the clinic at that time
MA/LPN CC Staffing 4 5 3
Recep CC Staffing 6
RN CC Staffing 1
MA/LPN Sched (actual) FTE 10
17.2 20
20.5
22.4 (17.33)
23.4
Unk
Recep Sched (actual) FTE
6.6 7
6.8
9.8 (5.92)
9.2
RN Sched (actual) FTE
1.9
2.7
3.5
4.4 (2.57)
6.9

12. Patient Satisfaction Results
Phase I
Phase II
The lowest score corresponds to the highest AR in Dec.
Press Ganey Score (Access to Care Section)
Rating: Ease of getting clinic on phone
From opening to Feb 2008 => significant decreasing trend
From Feb 2008 to present => significant increasing trend

13. New Perspectives Impact on the clinic Systems perspective
“If we change this, how does it affect that?”
Data driven decision making
Measure effects of changes
Monitor to ensure sustained improvements
Team engagement in problem solving
Improved physician and staff satisfaction
“I used to be embarrassed by [our abandonment rate], and now I am proud of it.” – OA Physician

14. Team Evaluation Feedback on Internal Consulting Team (ICT)
Surveyed Staff Members of Telecom Team: 4.3 Average
9 out of 5 recipients responded, 5 = Strongly Agree, 1 = Strongly Disagree
ICT Feedback
Please rate the Internal Consulting Team (ICT) as a whole for the following questions:
Answer Options
Average
They understood our problems and needs.
4.2
They listened to our issues and concerns.
4.3
They developed processes and/or solutions that helped us meet our objectives.
They helped build and maintain a motivated and focused team.
3.9
They helped the Telecom Group address performance gaps.
4.1
They were professional, trustworthy, and empathetic.
They shared their knowledge and insights to promote learning.
4.6
They added value to our project.
4.4
I am satisfied with the ICT's work on this project. 14

15. Moving Forward Lessons Learned Next Steps
Importance of communication to those directly and indirectly impacted by changes
Development of proactive formal and informal communication plan
Coordinated feedback process
Importance of using data
For informed decisions
To evaluate success or failure of changes
Next Steps
Dissemination of key points to other locations
Project review for process streamlining
Monitoring for sustainability

16. QUESTIONS? “Promoting a culture of continuous
learning and improvement”
QUESTIONS?
Michael McGrew