Going for the Gold: 
Excellence in Medical Call Centers

By Peter Dehnel, MD Medical Director

Summer, 2004

In the spirit of the upcoming 2004 Summer Olympics in Athens, think about your vision for excellence in a medical call center.  What would rate a "gold medal" level of quality and service to the center's customers?  How would those standards differ for quality and service delivered to parents and patients, subscribing clinics and medical facilities, or corporate sponsors?

Consider this picture of a "gold medal winning" medical call center that provides after-hours triage for a large group of pediatric providers practicing in a number of independent clinics.  Parents with concerns or questions can call in at any hour of the day or night without having to navigate a confusing automated attendant, getting a busy signal, or being put on hold.  They are connected in a timely manner with an experienced, well-trained nurse who is working in an environment designed to foster superior performance.

The nurse electronically accesses the appropriate guideline and care advice that is well founded, reviewed annually, and updated more frequently as needed.  The information systems used by the nursing staff would be up-to-date, user-friendly, and work without interruptions.  The information and care advice would be consistent among subscribing clinics and would appear seamless to the caller.

There would be a number of appointment times available to the call center nurse to schedule for the following day as needed.  Finally, a record of each call encounter is automatically sent to the caller's clinic by the following morning, where it is reviewed and follow-up actions are planned as appropriate.  An electronic copy of this care encounter is maintained at the call center for quality review as well as future reference.

An important prerequisite to this "gold medal" level of service and quality is the call center's leadership through a commitment to excellence.  The call center manager structures ongoing training and feedback through a very "hands on" approach.  The medical director of the center is engaged and knowledgeable.  There are robust quality assurance and performance improvement programs supporting the work of the center.  The governance of the center is composed of call center staff, subscribing clinics, a parent or community representative and a representative or two of the corporate sponsor.  The corporate sponsor would recognize the value of the call center's activity and would provide the necessary financial and administrative support to ensure excellent results.

While the above example illustrates one type of service, there are a wide variety of organizations that fit in the category of "medical call center."  They can range from a small center providing after hours triage for a handful of medical clinics, to one that is handling nurse advice calls on a national basis for a large health insurance company.  In any case, there is still a gold medal level of service and quality possible for each organization.  While the specifics may vary, the principles underlying that service and quality are going to be basically the same, whether the center handles 2,000 calls per year or 200,000 calls.

What about your call center?  How does it compare with your vision for what "could be" in terms of quality and service? While the example of the pediatric call center above is slightly idealized, it is possible to attain this level of performance.  The key is a commitment to excellence that must be shared at all levels of the organization and then promoting an environment where nurses can perform exceedingly well.

Beyond Telephones: While it takes determination and hard work to get to a high level of performance, it is even more of a challenge to maintain that "gold medal" level of service and quality over time.  It is especially challenging to maintain it in an environment where technology is rapidly advancing.  While most physician offices are still using a paper-based medical record, they use cell phones and pagers to extend their activity beyond their office walls.  Many other industries have adopted new ways of conducting business that will provide a whole host of new options for medical providers.  Many of these changes involve communications and the transfer of information from one source to another.

With the explosion happening in communications technology, most medical call centers will be performing a broader array of services in the near future.  Instead of just being limited to standard telephone interactions, there is the potential for communications of all types to be funneled through call centers.  The very term "call" center will transition into "communications" center, and nurses will likely be responding to both voice and electronic (such as email and text chat) communication.

The type of communication possible will get more sophisticated as more medical information becomes available in a digital or electronic format.  One important future role for call centers will be to direct the flow of information on behalf of clinics.  For example, if an on-call physician is asked to call a family, the pertinent information from the electronic medical record could be forwarded to the physician's digital phone that has a text messaging capability.  Or imagine if the call center could forward an electronic copy of an x-ray to a physician's PDA that the ER had just obtained on a patient with chronic lung disease who has now developed respiratory distress.  The communications technology exists today to do this, and it is only a matter of time before the medical information becomes available electronically.

Another important role of call centers in the future will be in assisting clinics with management of their patients with any sort of chronic disease or ongoing medical condition.  Any number of conditions, ranging from asthma to diabetes to tobacco cessation to obesity, can be better managed through the assistance of a call (or communications) center.  As there becomes a more public emphasis on the quality of care that patients with chronic conditions receive, there will be a renewed emphasis by medical providers on how to most effectively and efficiently manage them.

Going for the gold - are you up for the challenge?  While it may not be easy, the assistance that you provide patients and families will make it all worth it.  If you are at this highest level already, how are you going to stay there?  With the rapid advancement in new technologies, staying at the top will likely be even more challenging and more rewarding.

The Children's Physician Network Triage Service has been in operation since January 1997, serving the Minneapolis - St. Paul metropolitan region of Minnesota.  It currently provides coverage for over 250 pediatric providers in 20 independent pediatric clinics.  It also provides nurse triage coverage for the two Children's Hospitals' Emergency Departments and subspecialty clinics in Hematology - Oncology, Endocrinology, and Infectious Disease.  It currently handles over 60,000 triage calls per year, with a total of over 300,000 since beginning operations.