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The voice coming through Shirley Paradis’ headset on a recent weekday afternoon was insistent with a hint of frustration.

The caller wanted a second opinion following a recent surgery and there weren’t many options in her rural Colorado community. She wanted an appointment with a UCHealth specialist, one recommended by her general practice physician in her hometown roughly four hours from Denver.

And, she wanted it fast.

The call came to Paradis’ cubicle in an office building on a suburban street a few miles from the specialty clinics at UCHealth University of Colorado Hospital on the bustling Anschutz Medical Center campus in Aurora. There, as part of UCHealth’s Patient Line, agents take calls for 59 UCHealth primary care clinics and 20 specialty clinics ranging from Estes Park to Sterling, Fort Collins to Colorado Springs.

While routine for Paradis, she knows such calls are anything but run-of-the-mill for patients. She heard the caller’s description of her symptoms, her frustration with local options, and fear of the future. In seconds, as she flicked between multiple computer screens, Paradis, a two-year veteran of UCHealth’s centralized contact center, checked the availability of the requested physician, confirmed the caller’s insurance coverage, transcribed an overview of the call, and scheduled an appointment.

Paradis and the more than 200 agents like her are often the first contact with UCHealth as they take calls to schedule appointments, process referrals to specialists, support prescription refills, direct to nursing triage and serve as hospital operators. They take calls on headsets inside lines of cubicles or, more recently, from home offices across the Front Range. The department is testing work-from-home options as a way of recruiting staff juggling work and family or those who are interested in part-time work without a lengthy commute.

Using sophisticated software, three staff members in an interior office work like air traffic controllers. They can see which agents are available and adjust their schedules to get the best possible customer service.

Last year, Patient Line handled more than two million primary care calls, one third of which resulted in appointments. Other services include registered nurses who speak with patients about symptoms and help find the most appropriate place for care and a referral and authorization center to streamline requests for specialist consultations, testing and surgery. Patient Line also provides oversight for hospital operator teams and after-hours calls to hospitals and clinics.

Needed: A different approach

Dr. Brian Bacak knows the pressures placed on clinics for office support and the frustration felt by provider and patient alike. As a family physician and a medical director for Patient Line, he knows patients want personalized, efficient service. Their requests, large or small, should be a priority and each should be handled politely, quickly and with a minimum of fuss. Providers want the same thing.

Before Patient Line, doctors and nurses often did an excellent job with the calls that got to them.

But many calls never did. They fell victim to busy signals, delayed responses to messages or calls that went unanswered, arriving as a staff member was tied up on another line or stepped away from the phone for even a moment.

Something had to change.

Adding clinic administrative staff was a common suggestion from clinic managers, one that Bacak compares to building another lane on one of the state’s overcrowded highways. At best, adding a new staff member was a temporary fix, he reasoned. A request for one staff member often turned into two to ensure phones were answered at the busiest times, over lunch hours and during vacation or sick leave. Two staff became four, four became eight as success in one area brought pressures on another.

“UCHealth needed the equivalent of light rail,” Bacak said. “A different approach to the problem of the volume of administrative tasks that providers were being expected to complete.”

While different, that approach needed to support UCHealth’s pillars of innovation, experience, performance and accessibility and values of patients first, integrity and excellence. New ideas were focused on putting doctors and nurses where they needed — and wanted — to be, with patients.

A star is born

Creating a call center, one that would handle appointments and other back office tasks, was no small feat. For example, early work with 330 UCHealth primary care physicians uncovered more than 350 different appointment types. If the system was going to work, there had to be common workflows and processes. Even more daunting was the realization physicians would also have to relinquish control of their schedules.

While call centers are used in industries ranging from computer tech support to airline reservations, Bacak and Vice President Gary Henry, a 30-year veteran of call centers and other industries, knew health care was different.

“You don’t call your doctor with the same attitude as you do Marriott Hotel,” Bacak quipped. “You’re usually calling for something serious and often very personal. This isn’t booking your next vacation or changing your stay from three days to four because you’re having such a good time.”

Discussions about a call center began in 2014 with initial efforts launched in 2016. Patient Line leadership involved physicians in designing the new system, one that was efficient and patient centric.  An original contact center software application, was scrapped.  Another platform was subsequently implemented to improve functionality, reliability and capacity.

In the long rows of cubicles, teams are divided into neighborhoods or specific pods of clinics they support.  Neighborhoods are often separated by pictures of the providers served by agents. By seeing faces, agents are reminded they are all part of the same virtual team.  As part of their training, agents take field trips to clinics. Knowing your neighborhood means pronouncing the provider’s names correctly, knowing the clinic’s location and what specialized services are available such as a sports medicine consult or osteopathic manipulation.

A neighborhood might have five to 10 clinics assigned to it. When call volumes are high, calls can roll over to another neighborhood of primary care clinics. Dedicated pods are used for specialty clinics such as oncology or surgery.

Big data, big results

Henry and his Patient Line management team measure dozens of metrics in their quest for efficiency and patient satisfaction. A few key measures are length of calls, speed to answer and abandonment rate, also known as hang-ups.

For example, managers know call volumes are highest on Monday mornings, particularly after holidays. They staff appropriately. Now, more than 80% of calls to clinics served by Patient Line are answered in 30 seconds or less.

The efforts are paying off. Providers are expressing appreciation for having more time to spend with patients, and less on either the telephone or computer.

“Having Patient Line has helped with the confusion at our front desk trying to accommodate six or seven different provider scheduling preferences,” Dr. William Oligmueller said. “The impact to patients and staff, including cancelling and rescheduling patients, has greatly decreased. We are able to focus on the clinic function and direct our energy to the patients being seen that day.”

There’s always room for improvement. While Henry encourages call efficiency, he knows there are times when a sympathetic ear is needed. He’s optimistic about the future, including UCHealth’s new online scheduling options and a physician-led governance structure to help ensure patients and providers spend more time together and less time on hold.