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Sep 10

Patient Access- Staffing

  • September 10, 2019
  • Dr. Nancy Gagliano, MBA
  • Patient Access, Uncategorized

For a successful patient access center, you must have the right staff and the right number of staff.   The right staff involves hiring, training, management, leadership, and retention, supported by solid processes and technology.  Determining the right number of staff, must account for numerous factors such as handle time, service level, variation based on day and time, and turnover.  This article provides a guide on these two critical elements, determining the right number of staff and maintaining and excellent workforce through training and retention.

Staffing: The Right Number of People- The Erlang C Formula.

While it may be intuitive that the number of agents is based on the volume of calls and the average handle time, it becomes complicated because one call does not magically appear as soon as the last call ends.  The Erlang C formula allow you to calculate the staff required based on an average service level desired.  Because all calls do not have the same handle time, nor do calls come in precisely after one call has ended, there will always be variability in service level. Accounting for the variability is important in achieving an acceptable level of service and therefore important in budgeting.    The formula was developed by the Danish Mathematician, AK Erlang, in 1917, more than 100 years ago and is still used today.

 

The metric is the probability someone will have to wait based on number of agents available and call traffic.  The availability of call agents is typically more complicated than expected as vacation, sick time, lunch, breaks and turnover all need to be accounted for. The formula allows you to determine what level of service you are willing to accept and balance that with the staffing expense.   While you might desire 90% calls answered within 20 seconds, perhaps you can only afford 80% calls within 30 seconds and you will need to work reducing handle time to improve your service.

To complicate matters in the health care setting, agents are typically specialized, and access centers have “pods” based by clinical specialty, referrals, authorizations, etc.  Therefore, staffing needs to be calculated for different services offered within the call center.  While the formula may appear complex, there are various services, both on-line and in-person that can help you calculate your staffing needs.

Staffing: The right people

Unfortunately, call centers have notoriously high turnover rates. While impossible to avoid turnover, developing excellent training, on-going support, a career ladder, and other staff-engagement activities are critical to providing high quality customer service with low employee turnover.

 

We have seen both, training programs that are too long or too short leading to either poor service or costly onboarding.  As people have different styles of learning it is important to have a multimodal program with variety to keep attendees engaged.  Remember that attention spans are always shorter than expected and repeating important concepts is needed for best retention. While role playing certainly has its place, the sooner trainees can participate in actual calls the better. First have them listen in and soon after, take actual calls with a partner

Another valuable approach is creating a buddy system.   Connect new employees with a high-performing buddy.  This provides an early connection to their colleagues, additional support, as well as another mentor.   Employees are often reluctant to go to their supervisor with concerns and questions, while, a peer mentor is typically viewed as more approachable and less likely to be judgmental.   You will certainly prefer to have your high performing agents provide mentoring rather than a random call agent who happens to be available to answer questions.

Training does not end after orientation and should be formally incorporated into operations.   It is standard to have supervisors or quality assurance personal listen in to calls.  Some do this live and others do it through a recording.  Use this as an opportunity to provider positive as well as constructive feedback. Both accuracy and service should be formally reviewed. Feedback should be specific rather than general and tied to individual reference calls.  Therefore, it is best to use call examples that are timely, so that the agent can remember the call.

In addition, refresher classroom training is important.   As adult learners we only retain approximately 20% of what we are taught, and the rule of thumb is that things should be repeated three times to improve retention.  Therefore, having refresher sessions for all staff to reinforce and retrain is important.   Once again, making them interactive and having your proficient agents be “stars” of the classroom will help keep all engaged.

Engagement is critical to reduce turnover and therefore it is important to have a formal multimodal program.  Reward and recognition should consist of daily shout outs for spontaneous recognition and supervisors should walk the floor for visibility, encouragement and support.  Another way to have recognition would be monthly awards for quality, as well as service. Formal recognition should acknowledge excellent quality, such as monthly awards for hitting key performance metrics -empathy, customer service, accuracy, handle time.   Consider having a “recognition” team set up of agents to select metrics for rewards and approach for recognition including peer recognition.  Finally, provide appropriate vehicles for feedback.  While it is not feasible or practical to implement all ideas or complaints, staff needs to understand that their feedback is valued.

As mentioned above, ongoing education and training is important. Consider supporting a learning environment by having lunch and learn sessions run by agents.   Topics can include call center topics as well as topics completely unrelated, such as cooking or photography, which acknowledges lives outside of work and supports the development of community.

A career ladder is also a vital to reduce call center turnover.  There are numerous was to incorporate advancement without significant costs.   Volunteerism can be highlighted as important to advancement so mentoring, running lunch and learn sessions, and being on committees should be highlighted as components taken into consideration for advancement.   Consider levels of agents prior to pod leader, prior to supervisor, then to manager.   Making transparent, the career ladder and steps required is as important as having the advancement opportunities.

In summary, while extremely complicated to lead a successful call center this article has provided some suggestions to support your success.  Using the Erlang C formula provides you with a budgeting tool that that your CFO can appreciate.  Engaging your staff through training, recognition, feedback, and transparency will help reduce turnover and support your goal of delivering exceptional customer service.

Dr. Nancy Gagliano- MBA

 

 

 

 

 

 

 

 

 

 

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About The Author

Dr. Nancy Gagliano – Chief Medical Officer Dr. Gagliano brings more than 25 years of clinical and leadership experience to Culbert. Before joining Culbert, Dr. Gagliano served as senior vice president of CVS Health and as Chief Medical Officer of MinuteClinic, CVS Caremark. In these roles, she led operations, physician management, footprint expansion, health system affiliations, as well as innovation of new services including telehealth. Under her leadership, CVS/MinuteClinic grew from 400 to over 1,100 clinics in 6 years, seeing over 5 million patients annually. Prior to this, she served as senior vice president of Practice Improvement at Massachusetts General Hospital (MGH)/Massachusetts General Physicians Organization (MGPO), where she was responsible for improving patient access, clinical quality and operational efficiency for MGH’s 400 medical practices. In addition, as a physician leader she led efforts to enhance physician productivity, maximize use of the EHR, and to develop leadership talent. Dr. Gagliano completed her M.D. from Harvard Medical School, M.B.A. from Northeastern University and B.S. from Union College. She is a renowned speaker, most recently presenting at the following conferences, among others: IEEE PULSE EHR Visionary Series, Providence Women in Leadership Symposium, and The Wharton Business School Healthcare Conference. Additionally, she was recently recognized by Providence Business News as an industry leader in healthcare services.

Related Posts

  • Clinical Operations Insight into Revenue Cycle RevitalizationsJuly 6, 2016
  • Improving Patient Access: What’s Your 3rd Next Available Appointment?July 5, 2016
  • Patient Wait Times Should Be Your PriorityMay 25, 2016
  • Modernizing Physician Compensation Plans: Webinar May 29th 12:30-1:30 ESTMay 7, 2015

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