Contact centers are among the fastest-growing segment in the healthcare industry. Since the 1990s, hospitals have been consolidating and forming “systems.” These systems have also been absorbing physician private practices and centralizing functions.
It is relatively painless to centralize finance, billing and IT from an “emotional” perspective. The bigger challenge comes when front office tasks such as scheduling appointments and handling front desk calls are routed to a contact center. This type of center is widely known as an “access center.”
The Historical Perspective
Initially, healthcare access centers were dedicated to centralizing physician appointment scheduling for two reasons. First, patient calls were not being answered or voicemail messages were not returned by the practice. Secondly, this lack of response led to physicians being underutilized in the practice or specialty. This negatively impacted the bottom line of the system and in many cases the physicians themselves. (This is especially true when compensation is linked to utilization.)
I can tell you from our personal experience at PowerHouse that we have heard many tales of patients literally driving to a practice to book an appointment, request a prescription refill or request medical records. This is not an acceptable option for a growing enterprise in the 21st century!
Previously, there was little scheduling flexibility at the practice level. If one physician was fully booked, the practice would simply book the patient for two, three or even more than four months out. This often resulted in no-shows, health deterioration, or potential loss of work and quality of life until the appointment date. All this occurred in spite of the fact that the system may have had other offices or new providers able to see the patient sooner.
It was clear that centralizing appointment scheduling would positively impact the patient and physician experience as well as the enterprise bottom line. It is to this end that the centralization to an access center was intended.
The current state of healthcare contact centers is transitional. Balancing growth and maintaining performance bump up against the demands of patients, the practices they serve and the executives to whom they report. As well, there is a lack of contact center understanding and expertise at many levels. Healthcare is an industry that still believes call center operational leaders (as is often represented in position postings) must have “experience” in healthcare. This belief has cost this industry years of advancement as leadership struggles to apply management techniques that worked in the private practice model to the contact center. Far too often, the yield is a vulnerable infrastructure upon which to grow.
This vulnerability is further complicated by the adoption of factory-like production measurements that push much of the responsibility of achieving goals to the backs of frontline agents. Management focuses on and measures performance against factors such as agent calls per hour or call duration. These metrics are considered the sole means for improving access and (even worse) are used for staffing purposes.
Leaders in healthcare contact centers often link overall performance of the center to abandonment rates. Please keep in mind that abandonment is a response to a condition and NOT a condition in and of itself! Abandonment will be impacted by measuring performance against your plan and forecast, the scheduling and availability of agents, the randomly arriving workload, and the allocation of agents to various skills or channels. This is a more complex set of activities than linear math can accommodate.
Building Foundational Strength
I would like to focus on two factors that are critical to foundational strength for healthcare contact centers: training and funding.
The management performance gap illustrated above highlights the first of two requisite elements missing mightily… training. When we discuss training in the contact center (healthcare or otherwise), it is far too rare to find a solid learning program for management and supervisors dedicated to learning the art and science of contact center management. Instead, smart and ambitious individuals are thrown into this complex operational environment without the benefit of truly understanding the operation. Subsequently, they adopt poor practices.
The lack of training extends well beyond management. In many organizations, training is given very short shrift at every level including the front line. Side-by-side agent training is often the go-to method; it is a throwback to how staff has been traditionally trained in the practices. While this method may work in a practice, the approach in the contact center is frequently undocumented and delivered by agents who may or may not like to train or even be good at it. These “mentors” are often held to the same “production” metrics as their peers who are not “training.” There may be successes in this model, but there are far more failures.
I recently read a Harvard Business Review (HBR) article titled, “Retailers Are Squandering Their Most Potent Weapons.” The article highlights issues related to optimizing the front line in retail environments to produce more sales, improve the customer experience, and promote brand loyalty. It identifies challenges around the proper funding/investment in training and staffing and the ease with which management looks at these “costs” first when required to “cut costs.” The parallels to healthcare contact centers are stunning as the cost of labor is an obvious expense; training those expensive resources costs even more money. So when faced with making cuts, leaders go to the obvious where “the cost of payroll and training is clear cut.”
The authors of the HBR article call this a “losing age-old strategy… cutting expenditures on workers” because it ultimately damages the brand, the customer experience and company revenue. They go on to say, “Behind this losing labor strategy is business school thinking gone wrong. We teach our students to manage by the numbers. Not a bad idea, except that it leads business people to give too much weight to what’s easy to measure and too little to what isn’t… that imbalance opens the door to delusion.” This drives the belief that training exists when it really does not and justifies simply not investing properly in this critical function.
Contact Center Funding
The second driving force behind contact center success, and unique to healthcare, is how the contact center is funded. In my experience, no other industry has so many unique and (some might say) bizarre models.
I recently queried many of my healthcare contact center colleagues regarding how their access centers are funded. I thank again all those who were able to respond! There are so many varied models and most of them are throwbacks to how the practices have factored costs of labor and training for decades.
We have discussed how staff training has emerged as side-by-side from a private practice model. While this method is unscalable and generally ineffective for more than 10 or 20 agents, the funding method for staffing and other functions is often a more serious distraction to management. Poor staffing models simply lead to chronic understaffing. When you link understaffing to little or ineffective frontline and management training, success is unlikely to come about.
In my experience and research, healthcare contact center funding models lead to a varied set of outcomes. The most intelligent model is when the cost is handled by the enterprise, as it is in most other industries. This model is most likely to lead to success.
Another model has the practice paying for the contact center FTEs. In the worst version of this model, the practice not only pays for the FTEs it has the right to refuse the staffing forecast created by the center. If the center says we need 40 agents to handle Orthopedics and Orthopedics says, “We will only pay for 30,” so be it. And, the practices insist on the same quality previously promised! This model often has the aforementioned poorly trained contact center managers struggling to make the case for proper staffing.
“Split funding” is a model embraced by many operations. As described by a Boston colleague, split funding “is a 51/49 percent split… 51% paid by the enterprise and 49% paid by the practice. If I buy a ream of copy paper, it is a 51/49 split.” Imagine the impact on the managers having to calculate within this type of model. In another example, 80% of the staffing budget is paid for by the practices. Others bill back based on call duration or calls handled while still others bill back the practices based on appointments booked. Taking this to the extreme, there are those practices that pay only when the patient actually shows up for an appointment—as if that is in the control of the center!
Proper staffing in the contact center is a requisite for success. Understaffing creates burnout, cultivates turnover and generally results in a poor patient experience. Even if the budget numbers “look good,” the damage to the center is chronic and traction to success is stymied.
These varied funding models lead me to question the most senior leaders in the enterprise. Why is it so difficult to provide proper governance that will break the chain that links funding for staff and training to 20th century private practice models?
Many of today’s healthcare contact centers are struggling. They need to adopt a more contemporary and effective funding model that provides what is necessary to reach an optimum staffing level. They must have proficient contact center professionals to address proper planning, skilled management to provide new-hire and ongoing training, and executive governance to provide proper funding.
Only then will healthcare access centers be able to focus energy on efficiency gains, digital readiness, and a consistent and effective patient/customer experience.