Five actions to take to end the call center as we know it

On Tuesday, December 7th, 2021, Notable held its inaugural Digital Transformation Council meeting, a convening group of healthcare executives who are committed to advancing a shared vision of industry transformation through intelligent automation. The discussion was focused on the call center — more specifically, and perhaps controversially — on what it would look like to eliminate the need for it.

This may seem infeasible, or even impossible given the pace of change in healthcare compared to other industries. However, this digital transformation has already taken place across travel, retail, and the highly-regulated banking industry.

“The current landscape is not going to be sustainable,” Notable Co-Founder and CEO, Pranay Kapadia pointed out. “You cannot expect past generation technology to support the consumer-first mindset that every other industry has embraced. Think of the travel agent. What were the tactics used to digitize travel, to make it touchless; to make it automated?”

Healthcare has long been due for a change. As other industries have shifted to digital, so have consumer expectations. It’s problematic — and unacceptable — to leave patients on hold for so long they eventually abandon the call. Health systems must be able to scale their patient engagement strategies as needs evolve. 

“Our fundamental belief as a company is that the time for change is  here and now. Over the next five years, healthcare will be digitized at a faster rate than ever before,” said Kapadia.

But where to begin? While there is buzz around the concept of the “digital front door,” the first time patients actually contact the health system is frequently overlooked. One of the most common entry points is the call center. 

However, do patients really need to call the health system if there is appropriate technology in place? If those technologies are working, why are patients still calling? What are they calling about?

Throughout the conversation, the Council uncovered five key actions to eliminate the need for the call center, most of which can be accelerated through the application of intelligent automation:

1. Define the front door expansively
2. Quantify productivity, experience, and waste
3. Design for complexity and resiliency
4. Optimize for quality alongside efficiency
5. Establish team buy-in to make the impossible, possible

To start, leaders must define access points to the health system. After identifying these entry points, they can begin to gather data on areas of productivity, experience, and waste, to evaluate where patients are entering the system and how effectively their needs are being met. This data can be used to prioritize where to begin digital tooling efforts. When designing those digital tools, it’s important to design for complexity and resiliency first. The end-to-end quality and efficiency for all participants must be considered. Finally, there may be areas that feel too complex to tackle, but these can be accomplished by  collaborating and establishing team buy-in. 

These actions will collectively enable health systems leaders to obviate the need for the call center. Let’s deep dive into each one:

1. Define the “front door” — expansively.

If you ask five different people to define the “digital front door,” you’ll likely end up with six different answers. Access doesn’t start in the clinic waiting room, nor does it start with the call center. Before the patient calls to schedule an appointment, they might use online tools such as symptom checkers to determine their need for care, and then the “find a doctor” functionality. By defining the “digital front door” too narrowly (i.e.: only the patient portal), these additional steps can be overlooked and a portion of the patient population may not receive the timely care they need.

Dr. Lisa Yerian, Chief Improvement Officer at Cleveland Clinic, offered an expansive definition of the “digital front door”: “We consider the digital front door starting from the first notion that there’s a need for care, a desire for care.” Tracing the patient's journey across all channels means evaluating how well each of the components, from a Google search to a phone call to collections, are functioning in providing a clear path to the patient. 

“So how do we more effectively get people to our site?,” Yerian continued. “We have seen an increase in site visits by over 65% year over year. As a result, we are radically changing what the content is, and how that content guides people to the doctor, the chat bot, the online scheduling mechanism, so that they can connect with the care that they want.” 

How easy is it for a patient to navigate and search the website? Can they easily determine which provider they want to (or should)  see online? And when they go to schedule an appointment, can they self-schedule through the website, or are they directed to make a call? These are the questions digital leaders must ask when defining the key access points.

By defining the front door expansively, it’s possible to consider all the different access points and how easy or difficult they are to navigate — and to what extent they can be consolidated or overhauled entirely. Starting with too narrow of a focus can lead to additional work or backend inefficiencies in other parts of the healthcare system. 

Friction in these early stages of the process can act as a barrier to care. Yerian noted, “The barrier to being on the phone creates a barrier to care, which changes outcomes. Any time you can deliberately shift manual volume to digital, that’s a win for many reasons. Our patients like it better, it reduces cost, it frees up precious time for clinicians on the phone with folks that need higher touch care.” 

Dr. Manish Naik, Chief Medical Officer and Chief Medical Information Officer for ARC, added that creating a digital scheduling solution is essential to remaining competitive. “There is a growing segment of our population that if they have to pick up the phone to make an appointment, they will go somewhere else. Period.” Intelligent automation enables organizations to meet patients wherever they are in their care-seeking journey, and captures that percentage of the patient population that otherwise would go elsewhere. 

2. Quantify productivity, experience — and waste.

After identifying all of the relevant access points, gathering call center metrics can help determine what changes to prioritize, and what gaps might still exist in the digital experience prior to the patient making a phone call. Ryan Smith, Vice President and Chief Information Officer of Intermountain Healthcare, discussed call center data on abandonment rates and wait times. “You look at this abandonment rate of 16% — well, that’s 16% of your patients calling in that are having a bad experience.” 

Presumably, patients are dropping from the call when the hold time is too long. Examining data on abandonment rates and calls answered within 30 seconds calls into question why the volume of inbound calls is so high, and if the call center is really capable of keeping up. To be able to drive call volume down, the next question is, why are patients calling?

By first quantifying the kinds of calls coming in, it’s easier to determine where to focus initial digital tooling efforts. If 59% of calls are related to appointment scheduling, a logical next step is to enhance digital scheduling capabilities.

3. Design for complexity and resiliency.

Call centers are not designed to move fast, and need a lot of guidance to handle complexity. Staffing has to be predicted months in advance, making it very difficult to accommodate unpredictable spikes. 

Ryan Smith of Intermountain Healthcare said of trying to scale call center staffing to handle pandemic-level spikes in calls, “In fact, it’s almost impossible… We’ve got to press forward with digital capabilities that offload that.” 

David McSwain, Chief Medical Information Officer of MUSC Health, noted one of his learnings during the pandemic was that telehealth systems were not designed for patients with disabilities or who don’t speak English. “You have to design the equitable solution first,” McSwain advised. “Design the hardest case first. Because if you design it for the English-speaking non-disabled person with minor illnesses, and that’s your initial foray, then everything else is catching up.” Everything else then stems from that use case. Designing for accessibility first means capturing the greatest possible percentage of the patient population from the beginning, and becomes the standard. With intelligent automation, designing for complexity and resiliency is built into our core principles. Interfaces are user-friendly and accessible for patients, and easily scalable. 

4. Optimize for quality alongside efficiency.

When designing a system that eliminates the need for the call center, it’s crucial to focus on both front-end and back-end impact. Intelligent automation enables the entire system to work efficiently as a whole, never making improvements to the front-end at the expense of the back-end. With rates of clinician burnout and staffing shortages higher than ever, it’s essential to prioritize cutting down the overall amount of work. Tom Bowen Wright, Vice President of Digital Health at Baylor Scott & White (BS&W), provided a cautionary tale about the outcomes of failing to consider back-end impact:

In some of their digital efforts, BS&W made it easier for patients to directly message their providers. “Beware what you wish for,” Bowen Wright said. “That has had some really unintended consequences, where our primary care providers spend an hour a day on their InBasket after hours.” 

While it’s important to use data as a jumping off point, it’s also important to place that data in context — to consider the whole system, rather than just its discrete parts. Design for quality and efficiency for everyone within the system — patients, providers, and staff — considering the end-to-end life cycle of each design element. Explicit goals for cutting down on the overall amount of work and reducing burnout for everyone involved should be top of mind. 

5. Establish team buy-in to make the impossible, possible.

Making such large-scale changes is quite challenging, and the sheer scale, complexity, and sense of inertia can make these tasks feel impossible. One workflow many find to be especially intimidating is specialty scheduling. This requires a variety of triage questions to make sure the patient is sent to the right provider at the right point in the process, for example, after they have completed certain tests or imaging. 

This can be a very inefficient process, particularly if any of those components are scheduled incorrectly, and the patient gets bounced around the healthcare system. Toby Cosgrove, former CEO of Cleveland Clinic and a strategic advisor for Notable, remarked on specialty scheduling issues within Cleveland Clinic’s call center 15 years ago. All the specialties complained they were not being scheduled appropriately. “So we got the individual groups involved in putting an algorithm together so that they got the proper chest x-ray before they saw the pulmonologist, their pulmonary function test, et cetera…  You can’t do it without actually getting the specialists involved.” 

Particularly with complex workflows like  specialty scheduling, designing an alternative to the call center may seem difficult. It is possible, however, with team involvement, utilizing the expertise from different parts of the system.

The end of the call center?

While the call center has long served an important role, it has become a roadblock to care, and it is now possible to design digital solutions to minimize the need for it altogether. Doing so has many advantages, including modernizing to meet patient expectations, scaling to handle public health challenges, capturing a greater portion of the patient population, and streamlining and reducing overall staff workloads. 

But, as Dr. Naik noted, “If every organization is going to try to individually solve this, that’s a lot of redundant work.” Thankfully, each individual organization doesn’t have to. 

Notable is an industry leader in intelligent automation, empowering our health system partners to compete on experiences, drive down operational costs, and support superior outcomes.

Using a combination of artificial intelligence, robotic process automation and natural language processing, Notable creates an intuitive digital experience for patients that feels familiar and approachable. For example, patients don’t need to download an app or create yet another username and password to register for an appointment, and information from past visits pre-populate in their indicated primary language. Based on their reported symptoms or reason for their visit, relevant specialists will populate and patients can book directly from the Notable experience. 

The patient can also toggle between different languages automatically, choosing their native language to answer the triage questions. The patient can be checked for any emergent conditions, and can be asked if they have completed prior tests or imaging. They can upload any relevant files from those tests and imaging. Then their insurance eligibility can be checked. From there, they can be brought to a list of appropriate providers and can schedule an appointment directly from within the portal. 

The status quo has been adding manual work for staff when simplifying the front-end work for the patient. Notable’s approach is eliminating the underlying work. 

Bowen Wright said, “Just know that whether it’s a front desk person, it’s an InBasket message, or it’s a call center person, that there’s an enormous amount of waste wherever you go, which means there are rich opportunities for automation.” The call center is ripe for this kind of holistic transformation - but there’s certainly far more ahead.

Dive deeper into how intelligent automation from Notable can modernize health system call center operations. Download our latest whitepaper.