Surviving and Thriving in a Recession

By Julie Bruns and Sue Altman

June/July 2009

Healthcare is often cited as a safe industry during downward economic times, but we know that no industry is immune to the effects of a recession.  What may cause healthcare to experience difficult times in this current recession?  There are several theories:

• People may be deferring elective, self-referred procedures, like screening colonoscopies and mammograms, if these tests aren't fully covered by insurance.

• They may also be delaying "necessary" procedures, which are non-urgent: things like arthroscopy and other repairs, which would improve life but can be postponed until the economy is better (and a sense of job security returns).

• The number of uninsured and underinsured grows with the unemployment rate.  This, in turn, causes bad debt at hospitals to increase when patients can't afford to pay for the care they receive.

• Ongoing issues with cuts in government reimbursement (Medicare and Medicaid) have a significant impact on the hospital's bottom line.

The healthcare industry has not escaped layoffs and program cuts in recent months.  Thirty-three percent of call centers responding to a survey conducted by C3N attested to job losses in their organizations.  Another 71% reported budget cuts in the past few months.  So, is our call center industry safe?  With this in mind, the following article addresses selected strategies you can use to position your call center for survival and even long-term growth. 

Running a Tight Ship: Our first recommendation is to tighten up your processes and make sure you are operating at optimal efficiency.  Call center managers have mentioned belt-tightening strategies, from cutting specific budget items, such as travel and conferences, to really digging into efficiency.  Approximately 70% of any call center budget is spent on wages and benefits.  Therefore, to best leverage your contribution, you need to focus your staff on the right services, supported by efficient processes and performance.

Erlanger Health System in Chattanooga, Tennessee, went through an enterprise-wide belt-tightening in mid-2008.  During budget discussions, senior leadership asked for a 10% cut across all programs.  Beyond this first measure, specific programs were examined more closely, with the pediatric call center being one of them.  Their challenge was to develop a strategy to become budget-neutral.

Chris Vaughn, RN, BSN, clinical director of marketing and medical call centers, worked on the business plan, pricing model adjustments and new service strategies.  Kathy Guidry, RN, lead technical nurse of their medical call center, knew she would have to reduce staff to achieve the immediate 10% reduction.  And with that, she realized the remaining staff would need to increase their efficiencies to maintain the center's service levels.  She and Rhonda Garth, RN, lead clinical nurse, evaluated their current metrics and developed a course of action.

First came communication.  The staff knew that FTE counts were being reduced in many departments.  The next step was to describe the "how" and "why" of improving productivity and efficiency.  They worked closely with the remaining nurses to evaluate areas for improvement and offer focused education.  The following tactics were helpful:

• Developing scripts to help nurses take greater control of the call from the beginning

• Encouraging more concise nurse's notes, eliminating details that were not necessary to make a decision on the current problem

• Encouraging greater use of initial assessment questions

• Having the nurses listen to call recordings and evaluate instances when a call could have been better controlled

The story has a positive ending: productivity has increased, more favorable pricing model was instituted, and the center actively pursued additional after-hours contracts. 

Proposed Actions:

• Examine your current service offerings.  Are there any that no longer make sense or provide less value to the organization?  How does each service rank in order of contribution?

• What service might you be doing "because you've always done it?"  Stopping these activities or finding another way to do them may free up valuable capacity for more important tasks. 

• Use Six Sigma or LEAN.  If you have trained staff in your organization, seek their help.  "Black belts" and "yellow belts" are trained specifically to analyze a process, review data, and lead you to ideas for improvement.

• If you don't have the luxury of Six Sigma trained staff, you can still look at call processes.  What can you do to safely reduce call times?  Are you using your software effectively?  Pull together a team of your top performers and challenge them to take a closer look.

• What staffing options do you have available?  Can you flex your staff to make your services more productive?  Are there hours when you are overstaffed and you could free up people for other work? 

• Look at call volume and staffing hour by hour, day by day.  This could be an exercise to reduce the budget and FTEs.  Instead, view it as a way to increase your capacity to accept new business, thereby making your service more vital. 

Communicating Your Value: If members of your senior leadership team were asked, "What does the call center do and why is it valuable?" what would they say?  Don't wait to be asked about the call center's contributions.  Be proactive and tell your story.  Here are four suggestions: 

• Invite senior leaders and service line directors to tour the call center and listen in on a few calls.  No presentation or report can describe your world like actually living in it, even briefly.  Moreover, they may come away with ideas for growth that haven't occurred to you.

• Design and distribute reports that concisely illustrate what value the call center provides.  Focus on results using action verbs and graphs that convey clear, positive messages.  Don't bury the reader with pages of data. 

• Prepare brief case studies or vignettes to highlight call center success stories.  Real examples, especially those that increased business or decreased cost or waste, can be more effective than charts or spreadsheets.

• Remember that your senior leaders come from varied backgrounds.  An executive meeting may be comprised of experts in information systems, finance, marketing, planning, medicine, nursing, human resources, operations, and support services.  Some may even be new to healthcare.  Be aware of any jargon you may use specific to telecom, call center services, or clinical processes.  If you provide a handout, be sure the information is clear and leaves no room for misinterpretation.

Look for New Growth Opportunities: Sometimes we lose sight of the fact that call centers were initially designed to centralize communication in order to reduce costs and gain efficiencies.  Before the recession, there was already a growing trend to centralize functions, such as scheduling, navigation, and outreach.  In the spirit of cost containment, now may be the time to move an idea forward. 

Managers are sometimes so focused on pet projects (such as post-discharge calls, nurse navigator services, and access management) that they may not recognize them as services that your call center could provide.  There is opportunity to proactively describe your capabilities, even if they are not services you perform today.  Consider the following approach:

• Schedule a meeting with planning or business development.  They usually have the pulse of the future of your organization and know what ideas and new service lines are in the pipeline.  It is crucial to make sure that planning knows how the call center functions and what it can do.  It is equally important is for them to know that you are willing to take on new opportunities.

• Look for committees or work groups you can join that will expose the call center to other departments. 

• Invite leaders in your organization to visit the call center and observe your operation.  Have them put on a headset and listen to calls with your staff.  Help them see the call center "in action."

• Design a capabilities presentation and ask for time on the agenda at leadership meetings, operations meetings, and key service lines that drive volume.

  • Your presentation should be brief and to the point.  Use no more than 8 to 10 slides and limit your message to 15 minutes. 

  • Focus on the value and results of your activities instead of merely reporting call volumes.  For example, describe the percentage of referral calls that are converted to appointments or how your center handled the XYZ project that resulted in X% volume growth for heart services.  The focus should be on the business-driven.

  • Offer your vision for the call center and your willingness to work with other departments to achieve success.

• Is your call center open outside of normal business hours?  Can you provide after-hours services for other departments, such as outpatient testing?  If you step up, will fewer callers go to voicemail?

• You have two things that perhaps no one else in your organization does: first-hand "voice of the customer" information and a rich database of people interested in your hospital.  Help planning and service line managers understand how your data can help them with target marketing and outreach.

• Expand your horizons outside of your organization.  Do you collaborate with any other businesses or community organizations that could benefit from your services?  Not only could you increase the revenue you're bringing in, you may also create indirect revenue by growing referrals.

Geri Hammes, RN, BSN, is the supervisor of the Franciscan Skemp Call Center in LaCrosse, Wisconsin.  "I know call centers can be considered money-pits, just another overhead expense," she stated.  "Well, we are becoming a spider's web in a good way, taking on as many operational functions as makes sense, until we are truly irreplaceable." 

One of the creative services the Franciscan Skemp Call Center has recently planned is collaboration with the system's clinics.  The 4 p.m. to 5 p.m. time slot has historically been less productive for the triage center but for the clinics, it's chaos.  "We will soon be taking over their phones to help sort out their remaining calls of the day.  While our staff is providing triage and customer service, the clinic staff will have a chance to get caught up on the referrals, paperwork, labs, and other necessary activities, without the added stress and distraction of the phones," states Hammes.  "Call center productivity will be optimized and our hope is that once the data is interpreted, the clinics will incur less overtime (over-budget) hours."

In exploring other growth opportunities, Mrs. Hammes realized that many departments in her organization did not understand the call center's services or their capabilities.  To address this, she and her staff wrote the call center's resume.

One growing theme, regardless of the economic conditions, is to claim a more mainstream role in scheduling and patient access services.  Through referral and wayfinding, most call centers fulfill a small piece of this larger picture.  Scheduling, order management, registration, and insurance verification continue being handled in other departments and other call centers.

Kathy Ingalls Hefni, RN BA, of Detroit Medical Center, serves as the corporate director of the Health Access Center & Central Region Operator Services.  She describes their evolution from a triage and referral call center to the central scheduling service for six of their seven hospitals.  Five years later, her team continues to learn and implement new ways to improve throughput and reimbursement not only for the health system, but also for their affiliated physicians. 

Julie Bruns, director, Call Center & Market Research, BJC Healthcare, was the lead writer of this article.  Sue Altman, president of Call Center Consulting Network (3CN) was a contributing writer and editor.