In the first medical practice that I joined after residency, two women named Holly and Amanda (names changed to protect the innocent) managed our front desk, which was my actual “front door to care.” At my second practice, that job was handled by Mason, a jovial multi-tasker who loved to schmooze with my patients. All three of these individuals had the same responsibilities: answer the phone, check patients in, keep pharmaceutical representatives out, and occasionally call 911 for a medical emergency or handle the rare irate, irrational patient.
My patients loved these people, and not just because the only way to get to me was through them. They were genuinely nice, capable, interested and empathetic people. On the occasions when I would answer the practice phone myself, it was common to hear a bit of disappointment in the caller’s voice when they realized that they weren’t going to be able to chat with Amanda, Holly, or Mason. Because of the relationship that these employees developed with my patients, a lot of inconvenience was forgiven. As long as Mason picked up the phone, even if he had to put the caller on hold for 5-10 minutes, the caller was accepting of a less than speedy interaction.
It wasn’t until I joined my third practice, a large, academic multi-specialty group, that I began to experience first-hand the concept of a call-center in ambulatory medical practice and the subsequent “industrialization” of the simple act of answering a phone call. With the co-location of individual practice receptionists into a large centrally located call center, a whole new language developed around patient phone calls. Calls were now called touches. Receptionists were called agents or representatives. And phone calls became a commodity that could be measured; in number, in length, in sentiment, in quality. Calls and callers were “handled”, not greeted, treated, or assisted. And an entirely new cadre of managers were needed to make sure that these agents met their KPI’s. Mason, Holly, and Amanda didn’t have a directive from me to handle calls in a certain amount of time. I trusted them to spend as much time as was necessary to get the job done. But in the modern healthcare call center, an agent is constantly being measured against a 30-second clock. Only say, an NBA player has a shorter window to perform their function. So patient calls become balls that are caught and passed as quickly as possible, without regard for the customer experience.
KPIs focused on output measures such as call duration can drive even the most empathetic and capable human beings to try to game the system. For example, one call center would answer a tranche of calls in rapid succession, putting each on hold and then coming back to the beginning of the hold queue to manage calls. Another system celebrated its call handle time which was “in the green” over 90 percent of the time, without considering the impact on call resolution, which was below 50 percent. Essentially, they were rewarding their players for shooting three-pointers, instead of paying them for the number of successful three-point shots.
So what’s the solution? Solving the problem requires truly understanding the issue. This involves getting down to ground truth and looking at the data. The first thing to realize is that healthcare has for way too long been burdened by an analog problem. Eight out of nine patients or consumers use the phone as the primary channel with which to contact their healthcare provider, which translates into 12-16 million phone calls per year for a $10 billion health system. It is this fact that has led to the development of the health system call center. With the call volume that health systems handle, it is reasonable to take an all hands on deck mentality and combine individual phone agents into a larger co-located model to reduce waste in the system and provide a more uniform experience for the average caller. This creates a wide-mouthed funnel that is able to capture the majority of callers.
Unfortunately, this model also impedes the ability to create the meaningful human-to-human relationships that Amanda, Holly, and Mason were able to form with my patients in private practice. Those relationships take time, and time is a precious and costly resource for agents that are expected to field 18 or more calls every hour or 3000 plus calls per month. Too much chit-chat results in longer hold times and increased abandonment rates, which in turn results in disgruntled callers. If money was not an issue, ensuring ‘concierge’ service for every caller would be feasible. But that is not reality. Quality and appropriate human-to-human connections are not possible at every phone encounter. And actually, are not necessary.
My experience collaborating with colleagues has shown that 40-50 percent of calls to a frontline call center involve complex requests or patients/consumers that truly require high touch. The remaining 50-60 percent of calls involve a handful of relatively simple requests. These include connecting to an individual, room or department, scheduling an appointment, requesting a refill, leaving a message or obtaining information like visiting hours. These transactional requests are ripe for automation and self-service.
Artificial intelligence has developed to a point where a computer can be trained to understand spoken word and, more importantly, be trained on how patients talk about healthcare needs. An AI can supercharge the call center and remove redundancy to make it personal again. It does this by ingesting, normalizing and arranging large data sets from multiple point solutions into a coherent knowledge graph, thereby expediting a patient’s request. It can also scale and answer all incoming phone calls without regard to volume, reducing hold times and abandonment rates to zero. There are solutions in the market that can automate over 40 percent of calls for a general call center and up to 90 percent of calls for specialty use cases.
The end result? Call centers become much more efficient from the patient’s perspective and agents shed the mind numbing work of catching incoming calls and manually transferring them. Instead, they are now freed up to pay attention to the more complex patient issues where a strong human connection is so important.
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