Do More with Less: 15 Opportunities, Two Mistakes, and One Performance Ceiling

By Richard D. Stier, MBA

“Now more than ever, healthcare providers must begin to test innovative healthcare delivery and payment models such as accountable care organizations, bundled payments, clinical integration, and the patient-centered medical home,” states John Redding, MD, MBA. “Ultimately, providers will need to learn how to do more with less.”

At the 24th Annual Conference of Healthcare Call Centers held June 20 to 22 in Philadelphia, this writer facilitated a roundtable of senior healthcare contact center leaders from across the United States. The key question was, “What is your number one challenge moving forward?”

Responses included “How can I achieve my goals with inadequate space?” and “I’m losing touch with my team because we’ve eliminated management positions.” As these leaders shared their ideas, a consensus emerged, “Our number one challenge is doing more with less.”

This chorus has had frequent replays over the past three decades of healthcare’s evolution. How can call center leaders lift the performance ceiling? The discussion uncovered fifteen opportunities:

1) Offload non-clinical functions to free-up clinical staff. Time every activity performed by clinical team members. Which tasks can be reassigned to non-clinical team members? For example, could non-clinical staff front-end the calls? Should they make non-urgent physician appointments following clinical triage?

2) Replace one agent with two less expensive operations specialists who are cross-trained for multiple non-clinical roles, both of whom develop intentional areas of specialization, such as data analysis and reporting or outbound calling.

3) Replace one full-time role with two part-time or split shift positions to allow greater scheduling flexibility and improved coverage.

4) Require appropriate FTE support when asked to be responsible for additional call center functions from other areas of the organization.

5) Charge participating physicians on a per call basis for after hours first call support. Depending on the organization, this may be a fee calculated to cover direct expenses rather than to generate a margin on services provided to partnered physicians.

6) Increase productivity to reduce cost per transaction. Where possible, automate letters, faxes, and e-mail; replace direct mail with email; and use text messaging for appointment reminders. Reduce or eliminate staff time required for printing, collating, and mailing. Cut expenses for supplies and postage.

7) Use volunteers in non-clinical and non-technical support roles where possible, such as for items requiring printing, collating, and mailing.

8) Hire students. Students want to learn and can add inexpensive value for part-time or split shifts in non-clinical roles.

9) Consider modifying agent compensation. Instead of paying agents by the hour, pay a flat fee per call to agents who maintain or exceed a predefined quality standard. Some participants suggested that this may be more feasible for non-clinical roles.

10) Leverage technology such as voice recognition systems and call monitoring systems. Integrate the provider database with a single source of truth for physician information.

11) Cross-train nurses, with each nurse having specialized expertise in specific clinical areas that align in support of the organization’s clinical centers of excellence.

12) Refer unattached ER patients to in-network primary care physicians. Place a call center representative in the emergency department. This approach can reduce the use of ER for primary care and align patients who might have gone elsewhere with in-network PCPs.

13) Co-locate first point-of-contact services. This might include scheduling, transfers, physician referral, class registration, physician-to-physician referral, nurse triage, and switchboard, which can reduce or eliminate duplicative expenses and provide a central first point of contact.

14) Integrate the call center with the Website to increase transaction volume without a corresponding increase in FTEs. Activate live chat to add value to Web users and potentially moderate call volume. Report both call and Web transactions using the same database.

15) Redefine call center metrics. Make a list of legacy metricsto be phased out. Select new metrics, such as documenting the value of reimbursement recovery from reduced avoidable readmissions.

These call center leaders also identified two mistakes to avoid:

1) Do not assign team members to roles that require skill sets they don’t currently possess. For example, it should not be assumed that because a nurse has excellent clinical triage skills that she or he has an equal ability to communicate over the phone in a way that nurtures trust.

2) Don’t press well-intended team members to perform beyond their capacity. Encourage and reward excellence while being sensitive to the boundaries of each individual’s capabilities.

Lastly, there is a performance ceiling. Two filters determine a contact center’s performance ceiling. They are either a limiter, which constrains what is possible, or an accelerator, which empowers it. These filters are capacity and attitude.

Capacityaddresses fundamental intellectual horsepower and skill-based ability. Capacity begins with training and is seasoned by experience. Learning strategist Jay Cross indicates that 80 percent of training dollars are typically spent on structured, formal learning in the classroom or, perhaps, with e-learning. However, 80 percent of what people actually learn is informal or social through on-the-job discovery or through collaboration with co-workers who serve as mentors.

Attitudeis a choice. Whether a team member’s attitude is one of positive anticipation or negative expectation, behavior will follow attitude. The single largest limiter or enabler of contact center performance is attitude.

Raising a contact center’s performance ceiling to meaningfully do more with less requires two intentional actions: continuously expanding capacity and hiring for attitude. In the words of Dr. John C. Maxwell, “Motivation determines what you do. Ability determines what you’re capable of doing. Attitude determines how well you do it.”

Opportunities to do more with less require contact center managers to lift the lid on what is possible. Mistakes and missteps tighten that lid.

Richard D. Stier, M.B.A., is vice-president of marketing at HealthLine Systems, Inc.

[From the October/November 2012 issue of AnswerStat magazine]