DH Appointment Center - Improving Patient Access
Denver Health Lean Academy principles rapidly transformed the Appointment Center into a high-morale team of leaders and specialists better able to serve the needs and aims of new and returning patients as well as providers.
The Appointment Center at Denver Health is the key to connecting patients to the health services they need and enabling providers to provide optimal care. The center can be the first and pivotal contact a prospective patient has with the Denver Health system.
Denver Health was aware of various operational shortcomings at the Appointment Center that resulted in consideration of increasing staff size again or, alternatively, decentralizing the appointment function.
Denver Health providers and patients reported unacceptable mistakes in appointments. The center experienced a high rate of abandoned calls, frustrated employees who were spread thin among competing tasks, lack of communication within the center, and recurring requests to administrators for more full-time staff positions to handle call volumes.
How Denver Lean Academy Helped
Lean Academy-trained managers, collaborated with staff using the Lean framework and principles to evaluate and identify procedural issues and potential solutions that could be objectively measured and quickly put in place to deliver improvements. Desired outcomes included short wait times for callers, appropriate and accurate disposition of calls, low rate of callers abandoning the lines, better deployment of existing resources, and greater satisfaction among providers, and center staff.
A one-day Value Stream Analysis gathered supervisors with the center director to focus exclusively on how well procedures were aligned with and meeting the organization’s vision of patient care, the system’s efficiency and the presence or absence of meaningful metrics.
Supervisors were encouraged to express every concern and need to the director. The joint effort led to many discoveries of unexpected pitfalls in procedures. Among the hindrances, every staff member was responsible for becoming an expert at every task assigned to the center.
Past efforts to increase productivity through multi-tasking and avoiding “downtime,” however, had backfired. Because staff member were blind as to who was doing a specific task at any one time, this scattershot approach led to bottlenecks in calls, duplication of efforts, neglect of some tasks, and unnecessary stress. An effort for staff to be constantly engaged in some unspecified activity greatly contributed to the high abandonment rates of callers and the untested “feeling” that more staff was needed to handle calls.
To smooth out workflow, several projects and “Just Do Its” were identified.
In order for Denver Health patients to receive the best possible care they must first get to the right provider in a timely manner and receive follow-up attention. As a result of the application of Lean Academy analysis, the call center was quickly reconfigured in ways that resulted in immediate improvements and also brought the center under systematic monitoring and measuring of quality of service and outcomes.
Immediate impacts and results include:
- Internal structures or silos were created that divided teams into duty-specific groups, such as a team for inbound calls and a team for outbound calls.
- Increased Leadership support through a narrow span of control model moving from 2 Supervisors to 4 and 4 Team Leads to 8. Each Supervisor has oversight of 2 Section Leads who provide support to 8 staff members. The 4 supervisors report to an Operations Manager.
- A Quality Assurance Team was created.
- Fewer people are answering calls during slower periods, but for identified peak times, all hands are on deck so resources are available when needed.
- Specific metrics are set and measured, such as each staff member should average 85 calls a day (during an 8-hour shift), roughly 4 minutes a call, so quality of contact is emphasized over quantity and burnout is avoided.
- Center procedures, metrics and areas needing improvement are posted, highlighted and regularly reviewed.
- Staff turnover has dropped from an average per quarter in 2016 of 9.6 percent to 6.8 percent year-to-date in 2017. Turnover was high in the first quarter of 2016 at 19.5 percent. In the first quarter of 2017 it fell to 6.8 percent.
- The staff take an average 2,640 calls per day and schedule 1,263 appointments daily.
- On average, the center is taking 4,000 more calls a month compared with last year.
- The average speed to answer (ASA) has fallen from 2 minutes, 51 seconds in 2016 (and it had been as high as 5:45) to 1:27, YTD 2017.
- Quality Assurance activities had been reactive, simply investigating scheduling errors reported to us by our clinic partners. Now Quality Assurance activities are mostly proactive in nature with 65 percent of total identified errors found through proactive schedule auditing.
- The abandoned call rate of 14 percent in 2016 has fallen to 8 percent YTD, and has been as low as 6 percent.
- These dramatic improvements were achieved without an increase in staff size.
Long-range Goals and Metrics Identified
- The Appointment Center will continue to focus on engaging employees by recognizing their leadership potential while staying laser-focused on improving availability, timeliness, quality of service and attitude.
About Denver Health Lean Academy
Unlike many other hospitals in the nation that only implement select Lean tools, Denver Health has installed a unique strategy-based approach to Lean systems deployment.
In 2005, Denver Health began to embrace the Toyota Production System and its Lean principles. The goal was to identify waste and to improve efficiency. Denver’s safety-net hospital, with 525 licensed beds, was ready to undergo a cultural change that would allow it to remain financially stable and continue providing high-quality patient care in an environment of uncompensated care and declining reimbursements. Since then, Denver Health has experienced unparalleled success integrating the Lean philosophy into its culture.
- Denver Health is the first healthcare organization in the world to be awarded The Shingo Bronze Medallion for Operational Excellence and, in 2016, received the Peak Performance Award.
- Denver Health has involved more than 2,000 of its employees in Lean improvements.
Denver Health Lean Academy participants say it best:
“The Lean Academy principle of a Vision Management Board makes it easy for us to highlight and review commitments, key processes, metrics and challenges so we can continually improve resource availability, timeliness, quality of service and attitude.”