1. 1 Medina Healthcare System: Centralized Scheduling Center

2. 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 No Yes No Transfer call to hospital department 2 Physician to Physician Pharmacy to Physician Patient calling MA to return call Get up and find physician Get up and find MA Inbound Calls

3. Process Flow Chart: Scheduling Center Inbound Calls (Continued) 3 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 No Problem w/insurance Call insurance company/v erify Patient on hold Yes No Inbound Calls Cont.

4. Data Analysis June 1, 2012 – May 30, 2013 4

5. 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 5

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10. Data Analysis June 2013 10

11. 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 11

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16. Data Analysis July 1 – July 23rd 16

17. July - Record of changes made 06/29/2013: 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 17

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20. 20 Mean shifted from 5:00 in June to 4:30 in July

21. 21 Mean shifted from 5:00 in June to 4:30 in July

22. Hypothesis Ho: June and July cycle times were essentially the same Ha: June and July cycle times were significantly different 22

23. Hypothesis Testing Two-sample T test for Cycle Time vs Cycle Time1 N Mean StDev SE Mean Cycle Time 36 0.003477 0.000304 0.000051 Cycle Time1 36 0.003127 0.000355 0.000059 Difference = mu (Cycle Time) - mu (Cycle Time1) Estimate for difference: 0.000349 95% CI for difference: (0.000194, 0.000505) T-Test of difference = 0 (vs not =): T-Value = 4.49 P-Value = 0.000 DF = 68 23

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25. Comparison of Cycle Times 25

26. Other important numbers… Average Delay to Abandon 2012-2013: 1:45 June 2013: 2:03 July 1-23 rd 2013: 2:01 Calls abandoned 2012-2013: 21.47% June 2013: 23.73% July 1-23 rd 2013: 17.59% 26

27. 2 nd Hypothesis: Ho: Regardless of the call type, data is essentially the same Ha: Call cycle time is significantly different between call types 27

28. 28 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

29. Call Type/Location/Time Interval Data – July 29

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34. Take Aways It 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 processed 18% of calls in July were from patients who were calling to leave a message for their physician 34

35. 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 staff 1.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 35