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Articles from AnswerStat

Case Study: QEII Health Sciences Centre’s Communications System

By Jane Doucet

In 1996 six hospitals in Halifax, Nova Scotia, merged to become the Queen Elizabeth II Health Sciences Centre. The largest adult academic health sciences center in Atlantic Canada, the QEII Health Sciences Centre occupies 10 buildings on two sites and provides tertiary and quaternary-care services for patients across Nova Scotia. In 2000 it became part of the province’s Capital District Health Authority (CDHA), an integrated health authority that covers a territory that stretches from Windsor to Sheet Harbour.

Before the merger each hospital was site specific. After the merger, the QEII’s staff expanded to 6,500 and administration of the formerly individual hospitals became centralized. As a result, some logistical problems occurred; the amount of information flowing through the system doubled and systems that were operated manually in the past were now “impossible” to handle.

For example, Greg Jeans, the manager of Voice Services at CDHA, his colleague, Betty Bouchie, CDHA’s voice administrator, and call center staff had to manually co-ordinate 200 different on-call schedules for 2,000 medical-staff members. It was a nightmare. According to Jeans, any print information became out of date as soon as a duty roster was posted and staff members inevitably would call in with schedule changes. At one point it took three full-time employees to handle scheduling. Keeping the rosters up to date was a time-consuming task and inaccurate information was often posted to some schedules.

In 1999 Jeans and Bouchie tried to create an internal system and database to address the problems, but soon realized the complexities to create this type of system were well beyond their capabilities. They decided to take serious action researching communication strategies at other Canadian hospitals and examine supplier options in the marketplace.

Bouchie contacted the communications department of every major Canadian hospital and discovered that all of them were experiencing similar, if not worse, problems, as the QEII’s. She made a list of what she wanted a new system to do and began searching for the answer on the Web. That’s when she found an interesting system from a US based manufacturer. After a Web/teleconference presentation, she was very interested. In the spring of 2000, she found a hospital in New Hampshire that was using this product, the 1Call Infinity System produced by Wisconsin-based Amtelco, and paid them a visit. After that, she knew it was exactly what her organization needed.

In October of 2002, 1Call went live at the QEII. Prior to that date Bouchie, with a team of five, spent five months organizing and programming the relevant data into the system. Initially, the transition was tough. One of the biggest challenges was the resistance of the switchboard operators to embrace the new system, but 98% of the staff successfully made the transition to the 1Call Infinity System.

Today, the QEII’s communications system links doctors, nurses, staff, and customers by providing a single source for information and communications from one location. When connected as a call center or switchboard, information is presented to the operator on a PC screen in a consistent and logical manner, allowing operators to handle more calls in less time. The system handles such things as patient and staff directories, on-call scheduling, call priority, distribution, statistical information, appointment scheduling and paging or locating services.

The system has improved efficiency notably. With the old paper-driven system, only one operator could be trained at a time in a process that took approximately four months. Now, two call center attendants or locators, as they are also called, can be instructed simultaneously in just five weeks. Each of the 12 call center locator positions conduct all functions through the PC; answering, dialing, paging, messaging and call recording.

Although the QEII has been using the 1Call Infinity System for eleven months, they are not yet using it to its fullest capability; however its accuracy rate is significantly higher than the old paper system’s rate of 95 percent. Jeans hopes to reach maximum effectiveness in 2004. A year after that, he expects to have received a full payback in operating-cost expenses followed by long-term savings while offering several new or improved messaging/information movement services supporting the Nova Scotia medical community.

Another advantage the system offers is accountability. Since every call that comes in is recorded and monitored, when something goes wrong, it is possible to trace backward in the system to reveal the error. For instance, the QEII’s communications center acts as an internal 911 system, receiving and processing a wide variety of emergency response codes, for such things as fires, chemical spills, external disaster, and patient distress. The system prioritizes all emergency calls, overriding any less urgent calls

Any of the average 6,000 daily incoming calls the locators process can be thoroughly investigated. Administrators find out who called, who answered the call and at what time, and what keystrokes were made in the process. This can identify whether a problem was a communications error or the result of something else, like a pager that wasn’t working.

While there have been some kinks in the system to iron out, the QEII’s communications team hasn’t been left to deal with them alone. In the beginning, Amtelco’s field-service technicians were called on regularly, but now only occasionally. Jeans is impressed with the service the company provides. He cites a hardware problem that was discovered 10 months after commissioning 1Call. Amtelco sent a technician to fix the problem, armed with all new system hardware – at its own expense.

Now that the system has been operating for a year, QEII staffers wonder how they ever managed without it. Many operators initially resisted implementing 1Call. Now they believe a hospital even half the size of the QEII could not work efficiently without this tool.

This article is reprinted with permission from Longwoods Publishing Inc.

[From the Winter 2004 issue of AnswerStat magazine]

What is Six Sigma?

By Jim Long, MBA

One of the most dynamic processes in the field of quality control over the last thirty years has been Six Sigma as pioneered by Motorola. Six Sigma is a quality control standard in which the goal is to reduce variability in every business practice within an organization.

The Six Sigma quality control standard was originated by the Motorola Company in the 1980s and was designed to help eliminate the rate of defects perceived to be caused by manufacturing variation. An organization that achieves Six Sigma is required to have, at the most, 3.4 defects for every one million customer requirements.

To illustrate how strict the tolerance for errors are in Six Sigma, consider the following. Many would consider having 90% quality to be pretty good. Certainly, many more would consider 99% quality to be excellent. But, how about 99.73% quality? Would this level of quality be acceptable or even above the expectations of the pickiest consumer? If the pharmaceutical, healthcare, and public sanitation industries met a 99.73% quality standard the following statistics may provide us with an accurate illustration. There would be at least 54,000 drug prescriptions filled improperly in the pharmaceutical industry annually. The healthcare industry would be responsible for dropping over 40,500 newborn babies every year. Additionally, there would be a period of two hours every month in which the public sanitation industries would allow the water quality to become unsafe.

Now, if Six Sigma were to be achieved in each of these industries, quality would be improved to the following level. There would be only one improperly filled drug prescription every twenty-five years in the pharmaceutical industry. Only three babies would be dropped every one hundred years in the healthcare industry. Finally, the public would only have to endure one second of unsafe drinking water every sixteen years.

Six Sigma strives to remove variability in all facets of an organization and challenges each member of the company to become committed to this culture. Six Sigma is much more than a way of removing flaws in the manufacturing process and the product. For Six Sigma companies, process improvement needs to be included in every business practice, including those jobs that are considered indirect labor or non-revenue producing. Six Sigma has been applied to unconventional business practices such as the percentage of properly filed paperwork, customer complaints, and even effectiveness of solvents used in restrooms.

Implementation of Six Sigma: The implementation of Six Sigma follows a strict protocol. First, projects are selected starting with those that are thought to have the highest organizational priority. For many years the process of Six Sigma implementation followed a five-step process referred to as DMAIC. However, there is a new eight-step Six Sigma Breakthrough Process that many organizations are using to rework quality issues. The eight steps include: Recognize, Define, Measure, Analyze, Improve, Control, Standardize, and Integrate.

Member evolution: The Six Sigma training process is very organized and structured. This structure serves two purposes. Corporate decision makers can see progression at each level of implementation. Most importantly, the Six Sigma training process incorporates a climate of employee involvement. This employee involvement is very important as it ensures that the transition to Six Sigma has the best possible chance to succeed. When employees are involved, transitional management is much easier. As employees go through Six Sigma training they earn belts, similar to those earned in the martial arts. These belts signify the employee’s Six Sigma skill and knowledge.

  • Yellow belt: The yellow belt is the starter level of Six Sigma. When an employee goes through yellow belt training they are taught the essentials of Six Sigma and discover how the process works. Yellow belt training normally takes one week to complete. Upon completion of yellow belt training, the employee can serve as an organizational leader in simple projects or support green and black belts in implementation of more complex projects.
  • Green belt: Green belt training can normally be completed during a two-week seminar. Upon completion of this training the employee can lead Six Sigma projects with estimated returns greater than $25,000 annually. In this training program, potential green belts learn about various methods of measuring data, including many quantitative models that can be used to diagnose organizational inefficiencies. Most Six Sigma projects are led by green belts. A Six Sigma organization should have one green belt for every $100,000 in annual revenue.
  • Black belt: Whereas green belts fully understand the concepts of data collection and interpretation, black belts have an equal or greater knowledge of these statistical tools in addition to the knowledge of how to lead many groups of Six Sigma projects simultaneously. A Six Sigma organization should have one black belt for every $1,000,000 in annual revenue. Black belts serve as leaders and points of reference for green and yellow belts. Green belts will need to report to black belts regarding the status of their Six Sigma projects.
  • Six Sigma champions: The highest level of Six Sigma training is the Six Sigma champion. These employees are those who have proven to be effective as black belts. The champion training differs from the black belt training in that the employee focuses on organizational leadership and the strategic decision making process. A Six Sigma champion is often times connected with a member of the organization’s senior management in order to identify and lead projects of vital importance. Six Sigma champions are also referred to as master black belts.

Six Sigma Challenges: Certainly, the process of implementing Six Sigma is a challenge for any organization. The implementation process introduces a huge time of adjustment which is one of the primary challenges of Six Sigma. Many of the Six Sigma organizational implementations that don’t stick have to do with these companies not being fully committed to the process.

In addition, many organizations are faced with challenges regarding implementation of Six Sigma because they fail to assign metrics to all business functions. One of the necessities of Six Sigma is to quantify all business functions in order to improve on them. Even when it comes to support functions such as paperwork, quality of this function must be analyzed quantitatively. Stating that peripheral business functions are good or bad is not precise enough. It is essential to determine how many errors are made per million attempts.

Six Sigma Benefits: The division of Motorola that oversees their Six Sigma services is known as Motorola University. Motorola University claims that the return on investment for properly implemented Six Sigma projects ranges between 10:1 and 50:1. Few organizations would not be interested in learning more about a process that can offer that level of return on investment.

The popular literature is filled with the benefits that Six Sigma can provide organizations in which its principles are incorporated. Many of these benefits can be associated with how an organization must be aligned towards continuous improvement in everything it does.

  • Teambuilding: Teambuilding is an essential element of Six Sigma. Many organizations wish that their workforce would communicate effectively across functional silos. However, they have no idea how to initiate this communication. The Six Sigma process requires just this kind of cross-functional communication in order to succeed.
  • Constant improvement: One of the most basic tenets of Six Sigma is constant improvement. Six Sigma supporters state that while 3.4 defects per million attempts may be unattainable for the vast majority of companies; this goal serves as a constant reminder that there is no such thing as good enough. The only constant is the need for improvement.
  • Mandated training: Many organizations never seem to have time for training. Either these organizations do not properly prioritize training or they see it as an unnecessary expenditure of capital with no obvious correlation to revenue. The Six Sigma Quality Control Program mandates training in all aspects of organizational processes. Any business process that incorporates Six Sigma must be refined and this refining process requires training.
  • Return on investment: One of the greatest advantages that the Six Sigma Quality Control Program offers organizations is the reported return on investment. According to its 1997 annual report, AlliedSignal reported a $1.5 billion savings due to Six Sigma. GE chairman Jack Welch has been credited with claiming savings in the billions of dollars that directly correlated to Six Sigma implementation. Yet, in order to achieve these levels of return on investment, organizations must be willing to commit significant time, energy, and resources to the process. There is no such thing as partially committing to Six Sigma as it is an all or nothing proposition.
  • Increased aptitude for organizational change: Finally, Six Sigma can introduce an increased aptitude for change. Six Sigma is devoted to constant improvement and continual change in all business processes. All members of the organization are continually asked for examples of processes that can be improved and recommendations of solutions to these inefficiencies. This constant solicitation of input creates a corporate culture in which change is sought after and implemented with relative ease.

Jim Long, a former contact center general manager, holds a Masters in Business Administration, a Masters in Management, and is a Certified Professional in Human Resources. [For more, refer to Six Sigma Your Contact Center]

[From the Fall 2003 issue of AnswerStat magazine]

Voice Logger Vendor Information

The following vendors provide voice logging equipment and software. Contact them directly for more information.

1Call, a division of Amtelco: The Infinity voice logger is a software-based call recording solution that automatically records all operator involvement with incoming and outgoing calls. The voice logger records the call audio, agent screens, account name, account number, agent, and call number. It can search for specific call recordings and comes with playback, backup, and archival capabilities, along with tools and reports to track recordings. The Infinity voice logger is useful for healthcare organizations that need to maintain call records for historically accuracy and want to ensure they are providing excellent customer service 24 hours a day.

Contact 1Call at 800-356-9148,, or visit

OnviSource‘s OnviCord voice logging system is the voice and data logging component of OnviCenter, a suite of vertically integrated customer interaction management applications. OnviCord provides all the functionality required to engage in call recording, quality monitoring, and compliance management. OnviCord logs 100% of voice data and video recordings while engaging in agent evaluation, quality assurance, liability protection, and call archiving. OnviCord captures activity in single or mixed telephony environments. The system records calls and on-screen transactions for a virtually unlimited number of users, with protected Web-based access for convenient management on- or off-site.

For more information, go to or call 800-537-1827.

Record/Play Tek, Inc. provides the SCL 8900 Simple Computer Logger, which records nine, eighteen, or twenty-seven channels of audio from operator headsets, DID lines, POTS lines, and room microphones. The nine-channel system has 150 days of conversation recordings on an 80 GB hard drive, regardless of the activity level. Call center agents can search by customer account number (on Startel ®, Amtelco®, Telescan®, Morgan® systems) or by SMDR/DID information. The system runs on a standard computer or server and is easily installed on a standard telco punch block. The normal delivery time is two weeks.

For more information, contact Record Play/Tek at 574-848-5233,, or visit

[For more information, see our Voice Logging feature article and the Legal Requirements of Voice Logging.]

[From the Fall 2003 issue of AnswerStat magazine]

Voice Logging Overview

By Peter Lyle DeHaan, Ph.D.

Peter DeHaan, Publisher and Editor of AnswerStat

Voice logging is an important and valuable call center technology, considered by many to be an indispensable support tool. Voice logging allows calls to be recorded for quality assurance, training, self-evaluations, verification purposes, and dispute resolution. Because of the terrorist attacks in the United States on September 11, 2001 there has been a surge of interest in voice logging. Although voice logging cannot be viewed as a detriment to terrorism, it is deemed as an essential part of everyone’s overall goal of increased security and safety.

Some centers record calls at random, many record all calls, and some continuously record all headset audio – both during and between calls. Past forms of voice logging equipment have ranged from reel-to-reel tape machines, to specialized audiocassette recorders, to modified VCR units, to today’s state-of-the-art computer-based implementations.

How Loggers Work: Voice loggers can be either external stand-alone systems or internal integrated software. Many of today’s CTI-enabled switches and call-processing platforms have voice logging as a built-in option, inherent in the system’s design and architecture. This provides for optimal performance and often allows the call record or captured data – be it a patient call, a telephone triage session, or a doctor’s instruction – to be directly linked to the voice file. This allows for a holistic review of all components of a particular call, as both the audio interaction and the information gathered can be easily accessed and reviewed congruently and simultaneously.

For other situations, stand-alone voice loggers can be interfaced to the switch or call-processing platform, tapping into audio paths at the agent headset, the switch destination port, or the source port. These later two configurations provide the ability to record voice mail calls as well. The advisability and desirability of doing so, however, is questionable and should be pursued only after careful thought and consideration of the ramifications and legal consequences.

Often vendors of stand-alone systems have designed universal interface adapters that allow audio to be easily tapped into at the handset or headset connection without affecting or degrading the audio level. For these external systems, a typical method includes tapping into the headset audio at the agent station and feeding it into the PC’s sound card.

For both internal and external voice loggers, the speech is digitized and often stored on the agent station hard drive, usually as wave files. At some point (either immediately or at a preset time or condition), the wave files are sent over the network to a central voice logging server where they are indexed and stored.

Indexes are commonly applied to all header field data, such as time, date, station number, agent login, source port, destination port, call completion code, and project ID. If needed, queries can be established to fine-tune the search even further. Searching by agent or time are the most common parameters. However, in the course of troubleshooting system problems, searching by specific ports, completion codes, or station numbers can be most informative.

The retrieval interface is a database, such as Access or SQL. As such, records of calls can be quickly sorted, filtered, and presented. Wave file access is then fast and efficient. If needed, archiving of voice files can be accomplished easily and quickly to CD-ROM or DVD.

Uses of Voice Logging: As mentioned, there are several possible reasons to record calls. These include quality assurance, training, self-evaluations, verification, and dispute resolution. Any one of these options often justifies the expense of implementing voice logger technology. The other features then become pleasant bonuses.

  • Quality assurance is the most often cited use of voice logging. With voice logging, supervisors and managers can easily and quickly retrieve, review, and evaluate agent calls. By integrating a program of silent monitoring, with side-by-side coaching and statistical measurements, an agent’s overall effectiveness can be evaluated and verified. Voice logging allows areas of deficiency to be discovered and items of excellence to be celebrated.
  • Training can be greatly facilitated using voice logging. One application is to capture examples of exemplary calls by seasoned representatives for trainees to review and emulate. Conversely, less than ideal calls can also be showcased for discussion and critique. Although both of these scenarios could be accomplished using fictitious examples or staged calls, there is great benefit in being able to demonstrate real-world examples.
  • Self-evaluation is a powerful tool of introspection whereby agents use voice loggers to retrieve their own calls and through a process of self-discovery learn how they can handle calls or situations more effectively. Although this is valuable during the training phase, it is also beneficial for seasoned representatives, as it allows them to keep their skills sharp and helps sloppy actions from becoming bad habits. Even more importantly, agents may specifically seek and review a specific call that had a less than ideal result so that a more desirable outcome can be determined and implemented.
  • Verification is another worthwhile use of voice logging, especially in an environment where critical information is shared and communicated, such as in telephone triage. By recording all conversations, the symptoms and nurse’s instruction to the patient is captured and verified that proper information was conveyed. Normally, the recording is never listened to unless there is an argument about the transaction.
  • Dispute resolution then comes into play. Whether it is a message, a medical emergency, or an accusation of improper phone behavior, the voice recording of that call essentially becomes an independent third party account of what happened and avoids the “he-said/she-said” disputes in which neither party can corroborate their own account of what happened. Though the agent is sometimes found to be in error in such situations, the consensus is that in the vast majority of cases the agent is vindicated; once the aggrieved party hears the recording, the problem resolves itself quickly and with little further effort.

User Input: It is rare to find a voice logger user who is not overwhelmingly positive about the benefits and value of the technology and what it means to their call center. “I wish I had a logger years ago,” is a sentiment commonly made within weeks of a new voice logger installation.

Others see how voice logging allows call centers to improver customer service. Interestingly, call center staff often initially view the recording of calls as a negative development, threatening the work they do and attacking their competency. It is only after voice logging technology is implemented that the agents begin to see it as a tool to protect their work and validate their quality. The reality is that only representatives with something to hide have a legitimate reason to fear voice logging.

Accounts abound from call centers that have increased the quality of their service, improved their training, and avoided a potentially costly lawsuit or a lost patient all because of voice logging. Although it may seem difficult to cost-justify a voice logger before it is bought, a high percentage of users indicate that it is one of the most important pieces of technology in their call center.

Peter DeHaan is the publisher and editor-in-chief of AnswerStat magazine and a passionate wordsmith. Connect with him on his personal blogs, social media sites, and newsletter, all accessible from

[From the Fall 2003 issue of AnswerStat magazine]

It’s all Virtual: A Virtual Publishing Company

By Peter Lyle DeHaan, Ph.D.

Author Peter Lyle DeHaan

When I started publishing AnswerStat’s sister magazine, Connections Magazine, it operated as a virtual company. This wasn’t intentional. It just worked out that way and continues to be the case. Not only am I the only one working in the “corporate office,” there are no local suppliers either. Indeed everyone who takes part in the production of this magazine is from out of state – different states!

Dave, our graphics designer and creative genius, is in Pennsylvania. Articles and ads get mailed or emailed to him and his staff. His work gets sent via the Internet to our printer in Ohio. They work up the proofs and put them on an FTP site for Dave and me to approve. For each issue, I output the mailing list to a file and email it to our list processor. They massage the data, sort the list, and forward it to our printer. The printer inkjets the addresses on the magazines and delivers them to the post office, which happens to be next door to them.

Another important team member is Valerie Port, our New York-based media representative. She handles the advertising sales that generate the revenue to produce this magazine. As editor, I plan, solicit, collect, and edit the articles and press releases. A team of proofwriters in North Dakota review each article, performing the final edits, correcting grammar, checking punctuation, and ensuring that each piece is clear and understandable. Finally, our website ( is hosted by a company in Arizona but I update content remotely from Michigan.

I have never met any of these people in person, except for Valerie who, after a year and a half, I recently had the privilege of meeting. We maintain contact via the telephone and make frequent use of email. Each issue is produced without any face-to-face interaction. At first this was somewhat disarming and disconcerting, but I am convinced that the results are better than if we all worked together in the same office. True, we miss out on some synergy, incidental communication, and camaraderie, but we are also each free to do what he or she does best and to do so with minimal outside distraction and interruption. For us, it is all virtual.

A Virtual Call Center: A call center (or contact center, if you prefer) is by definition, a centralized operation. Although the concept of a decentralized call center initially seems oxymoronic, technology has brought us to the place where virtual call centers are not only feasible, but also exist with increasing frequency. Although most decentralized call centers have a mix of local and remote agents, a few have gone completely virtual and have no agents in their call center. Indeed, their “office” may merely house a switch and network servers. But before someone takes issue with this statement, let me assert that these functions can be outsourced, completely fulfilling the vision of a virtual call center, one with no office, no location, no real estate, and no equipment.

The completely virtual call center, however, may be too futuristic for many to seriously consider. Nonetheless, aspects of a virtual call center are concepts that every manager who desires job security should be contemplating and investigating.

Distributed Agents: The first and foremost consideration for a virtual call center is a distributed staff, be it home-based agents, a satellite office, or outsourcing. Because of advances in computer and telephony technology, coupled with the ubiquitous Internet, all of these options are readily available.

As the name implies, a home-based agent is one who works from his or her own home. There are many reasons to consider home-based agents.

  • Expand your labor pool: Many capable and qualified workers are not part of the workforce because by choice or circumstance they do not leave home. Why let positions go unfilled or under-filled, when quality, albeit nontraditional, staff is readily available?
  • Expand your labor market: Home-based agents are viable wherever the Internet is. Therefore you can hire and employ call center staff in other cities and states. Plus you will never lose an employee to relocation again!
  • Respond to overcrowding: What happens when there is an agent station squeezed into every inch of your call center and every station is in use during peak times? How can you grow and expand without moving or remodeling? Quite simply, begin hiring home-based staff. A remote agent does not take up any space in your office, allowing you to process more calls without incurring a capital expense.
  • Eliminate commuting: In areas where commute times are long or the infrastructure congested, using home-based representatives is an ideal response. In some areas there are even mandates and incentives for organizations to take steps to minimize commuter traffic.
  • Facilitate split-shifts: Call center traffic demands never correspond to eight-hour work shifts. Unless you are prepared to be overstaffed part of the day and understaffed much of the rest, an eight-hour shift is a rare commodity in a call center. This means shorter shifts and even split-shifts to optimize labor to traffic. Unfortunately there is often resistance to split-shifts. However, when the employee is home-based, many of the objections (commute time and dress code) evaporate. In fact, some employees would enjoy split-shifts if they could do so from the comfort of their home.

A satellite office is a great option to tap into a labor market in another area while maintaining on-site supervision and control. In this case, a mini-call center is set-up, but it runs off of the switch and network at the main location. Although real estate and supervision is duplicated, hardware and software is not. This is also an option when the physical space in a call center is maxed out.

Outsourcing: A parallel consideration is call outsourcing. This can be manifested in four ways: all calls, overflow traffic, certain call types, or by time-of-day/day-of-week. Some of the types of calls that can be outsourced include telephone triage, medical answering service, physician referral, class registrations, and PBX/console calls.

Conventional wisdom says that you don’t outsource your “core competencies.” However, there are those who advocate that you can farm out your core competencies, too. What if someone else can do it better or cheaper? What if your labor market has low unemployment or if you’re just plain tired of the staffing ramifications of running a call center? All of these are prime reasons to consider outsourcing your calls. Since no one can master everything, it is pragmatic and wise to consider outsourcing the less strong areas or unmet demand.

Certainly, no outsourcing agreement should be entered into lightly or without due diligence. You should scrutinize an outsourcing partner just as you would any other vendor. “Look before you leap.” Referrals are valuable; check references. Unless they come highly recommended, visit them in person. What does their facility look like? Are they big enough to handle your traffic? Are they small enough to care about your account and your calls? Do you have a good rapport with and respect for the key people in their company? Is there the potential for a long-term business relationship? Lastly, find out who will be your primary contact on a day-to-day basis. How well do you mesh with that individual? What is their anticipated future tenure with the call center? If this contact leaves, will your satisfaction with the outsourcer’s service disappear as well, or will someone else be able to take over without negatively affecting your organization?

Conclusion: All of this is discussion is not to advocate that everyone needs to go virtual or to outsource, but there are some intriguing opportunities worth considering as you plan and consider how to make your call center better. Lastly, be aware that every outsource consideration is a dual opportunity. For some it is an option to off-load work (or costs) to another call center, while for others it is an occasion to pick up work (and hence revenue) from other sources. When properly structured, both perspectives can be beneficial.

Peter Lyle DeHaan, PhD, is the publisher and editor-in-chief of AnswerStat. He’s a passionate wordsmith whose goal is to change the world one word at a time.

[From the Fall 2003 issue of AnswerStat magazine]

Telephone Triage for the Medical Call Center

By Peter Lyle DeHaan, Ph.D.

Peter DeHaan, Publisher and Editor of AnswerStat

Of all the exciting advances in medicine, there is one that falls outside the traditional scope new drugs, innovative procedures, or revealing research. This development is in the application of telephone technology to facilitate the provision of healthcare. Lumped into the broad category called telemedicine or telehealth, the telephone is cost-effectively improving patient care while increasing patient satisfaction. The application of technology to cut costs and improve quality in any industry is noteworthy; in medicine, it is critical.

One of the most exciting developments in telemedicine is telephone or nurse triage. The history of telephone triage dates back three decades. For Dr. Barton Schmitt, arguably the father of telephone triage, it was born out of the practical necessity of ensuring consistency and accuracy among those who interacted over the phone with parents concerned about a child’s well-being. His initial telephone protocols have been refined, expanded, and validated for the past 30 years. More than 400 call centers are using computerized versions of his work and an estimated 10,000 pediatric offices refer to the printed version. Others have independently developed similar protocols.

Telephone triage will be a reoccurring theme in AnswerStat, as we believe it is an important development, not only for medical related call centers, but also for healthcare as a whole. Our goal in this issue is to introduce the subject and provide some initial resources. Look for more information and articles in upcoming issues.

Telephone Triage Call Centers: There are several call centers that provide telephone triage on an outsource basis, or for a fee, to hospitals, clients, individual practices, and medical answering services. View our current list.

Telephone Triage Vendors: Lastly, here is a list of vendors who have integrated telephone triage protocols into call center software.

Books on Telephone Triage: As a primer for learning more about telephone triage, you might want to refer to some of the many books available on the subject. Here is a list of some of them (let us know your favorites and we will add them to our list):

  • Pediatric Telephone Advice by Barton D. Schmitt (Spiral-bound)
  • Pediatric Telephone Protocols: Office Version by American Academy of Pediatrics, by Barton D. Schmitt
  • Quick Reference to Triage by Valerie G. A. Grossman, et al.
  • Telephone Health Assessment by Sandra M. Simonsen
  • Telephone Medicine: Triage and Training: A Handbook for Primary Care Health Professionals by Harvey R. Katz, Harvey P. Katz
  • Telephone Triage: Theory, Practice, and Protocol Development by Sheila Q. Wheeler, Judith Windt
  • Telephone Triage for Obstetrics and Gynecology by Vicki E. Long, Patricia C. McMullen
  • Telephone Triage of the Obstetric Patient by Deborah E. Swenson
  • Telephone Triage Protocols for Adult and School Age Populations with Women’s Health and Infant/Child Protocols by Sheila Wheeler, RN, MS
  • Tele-Nurse by Marijo Baird, Sandi Lafferty

Additional Resources: In addition to information on the websites of the preceding vendors, also consider:

Peter DeHaan is the publisher and editor-in-chief of AnswerStat magazine and a passionate wordsmith. Connect with him on his personal blogs, social media sites, and newsletter, all accessible from

[From the Fall 2003 issue of AnswerStat magazine]

Vendor Spotlight: 1Call, a Division of Amtelco

Providing the one complete communications system designed to bring it all together

1Call Division of Amtelco provides call center services, PC-based PBX consoles, soft agent, secure communications, emergency notification (HICS), event notification, appointment reminders, and communication systems for healthcare organizations.The 1Call Division of Amtelco, formed in 1997, is dedicated to serving the unique call center and communication needs of healthcare organizations. 1Call focuses on delivering tools to allow patients, physicians, and staff to communicate together as a well-synchronized team.

Exceeding Customers’ Needs: Every patient deserves the best care possible. 1Call’s goal is to provide healthcare organizations with the tools to efficiently handle caller’s requests with a single phone call, saving time, eliminating confusion, and providing patients with the best service possible.

By continuing to meet and exceed customers’ needs, the list of 1Call customers continues to grow. 1Call has hundreds of healthcare customers throughout the US and Canada, both large and small. A snapshot of 1Call customers include: Allina Health System, Anmed Health Medical Center, Bassett Healthcare, Bethesda Healthcare, Billings Clinic, Fairview Health System, Hennepin County Medical Center, Queen Elizabeth II Health Sciences Centre, Sherman Hospital, St. Francis Hospital, University of Augusta Health Care System, University of Nebraska Medical Center, and University of Washington Medical Center.

Innovation: 1Call designs high-performance software applications to offer robust systems that provide hospital-wide communications. Frequent software releases give customers access to the newest features and technology. The 1Call systems furnish seamless integrations with existing legacy IT and PBX networks to save costs and bring information together in a single location, as well as including VoIP and SIP integrations.

The 1Call Modules Include:

  • Call Center Systems: The Infinity system is used by hundreds of hospitals and healthcare organizations. Infinity can be designed for small or large organizations with as few as three to as many as 200 agent/operator stations.
  • PC-Based ACD Agent Stations: Infinity agent/operator stations allow users to make the most of triage, scheduling, physician referral, appointment taking, and other IS programs by adding essential functionality, including ACD call routing, call recording, statistics and reporting, desktop access to all IS modules, screen-based speed dialing, on-call schedules, and Web-based directories.
  • Flexible Call Scripting: Script calls for operators for any hospital-wide application, including patient-to-physician referral, physician-to-physician referral, appointment taking, and class registration.
  • On-Call Scheduling: Allows physicians and staff members hospital-wide to enter their own on-call schedules; the information that operators see is always current.
  • Directories with Individual Contact Methods: Paging, text messaging/SMS, email, and however staff needs to receive communications.
  • Pro Show Appointment Reminders: Automates appointment reminders for patients to help keep physicians’ schedules full. Reminders are sent via email, cell phone, PDA, text-to-speech phone call, and IVR.
  • “Just Say It” Speech Recognition: Gives internal and external callers an easy way to reach the correct person or department when they “just say it.”
  • IVR: Uses Interactive Voice Response (IVR) to automate routine phone calls, such as appointment taking, appointment reminders, class registration, help desk, and physician referral.
  • Call Conferencing: Easily creates multi-party conferences, with or without operator assistance.
  • Voice Logger: Automatically records all calls with screen captures, giving the data needed to ensure accuracy and compliance.
  • Browser-based Applications: Provides convenient access to on-call schedules, directories, patient census, and paging.

Speeding Response Times: When every second counts, organizations need to respond quickly. 1Call’s Red Alert emergency and event notification system has proven to help organizations get personnel to the right place at the right time. Red Alert issues automated alerts by phone, mobile phone, SMS, email, pager, or other methods, ensuring that responders quickly receive alerts. Red Alert is ideal for use in every department for handling code calls, staff shortages, meeting reminders, contingency planning (JCAHO), emergencies (HICS), network outages, scheduled – or unscheduled – events, and weather emergencies.

Featuring 5-Star Service and Support: 1Call works closely with each healthcare and higher education organization and has a reputation for complete, professional system support, offering training, installation, and technical support staff on-call 24/7. 1Call’s 5-Star Service and Support is more than just a slogan; it’s included with every 1Call system:

  • An Informed Customer Care Group: Project managers and the innovation development team work with customers before, during, and long after the installation of 1Call equipment.
  • Experienced Trainers and Installers: Receive detailed training and a smooth installation to help streamline communications for the entire organization. Continuing education opportunities ensure customers are able to utilize the newest features.
  • Knowledgeable Field Engineers: Call or email for field engineering specialists to assist with technical questions.
  • On-Line Resource Library and Tech Helper: Available 24/7 for instant answers.
  • Healthcare Call Center User’s Group: The NAEO (National Amtelco Equipment Owners) group gives valuable support and a creative community for sharing ideas.

Early History: 1Call has a strong history in the telemessaging industry. Amtelco, the parent company of 1Call, was founded in 1976 to provide computer-based telemessaging solutions to the answering service and medical messaging industry. Bill Curtin, the founder of Amtelco, first received a telecommunications patent in 1951. Since then, Amtelco has added an additional 28 patents.

Amtelco Today: Under the leadership of Chairwoman of the Board, Eleanor Curtin, and President, Tom Curtin, Amtelco currently employs over 150 personnel in solutions development, customer care, field engineering, manufacturing, and administrative staff located at Amtelco’s main office in Wisconsin.

Amtelco also has twelve sales offices throughout the U.S. and Canada. In addition to the healthcare and higher education industries served by 1Call, the Amtelco TAS group handles the telephone answering service industry, and the Amtelco XDS group provides computer telephony boards to developers around the world.

The Future: 1Call is dedicated to continuing to provide healthcare and higher education organizations with the modules and features needed to offer more services while containing costs. By working closely with customers, 1Call will continue to develop innovative features and products.


  • 1954: Bill Curtin, Amtelco’s founder, receives a US patent on Telesignal, the first concentrator/identifier.
  • 1976: Amtelco is founded to develop, install, and service products in the commercial telephone answering service market.
  • 1977: Amtelco installs its first computer telephony integration (CTI) system named Video III.
  • 1983: Amtelco develops EVE (Electronic Video Exchange), the first paperless ACD and CTI product.
  • 1988: PC-MX, Amtelco’s first-generation PC-based ACD CTI product, is introduced. PC-MX is a patented product that featured paperless messaging and voice processing features.
  • 1993: The Infinity system is introduced. Infinity is the third-generation, PC-based CTI product. Evolving from the PC-MX system, the open architecture Infinity system allows users to take advantage of off-the-shelf PC technology.
  • 1997: Amtelco launches 1Call Division to develop products and service healthcare and higher education markets.
  • 1998: 1Call develops over 150 new features on the Infinity platform.
  • 1999: Infinity software version 5 is introduced.
  • 2000: The eCreator system is introduced, using scripts to simplify complex calls for appointment taking, class registration, and physician referral. Infinity Software Version 5.1 and Voice Logger are introduced.
  • 2001: 1Call offers eLink Hosted Services, and Infinity introduces eResponse, giving organizations an easy way to respond to email messages.
  • 2002: eCreator Software Version 2.0 is introduced, including IVR and appointment reminders. Infinity adds conference bridge.
  • 2003: 1Call introduces Red Alert emergency notification, “Just Say It” speech recognition, and Infinity software version 5.2.
  • 2004: Infinity IS (Intelligent Series) is introduced with Infinity software version 5.3. Infinity IS features innovative enhancements for messaging, on-call scheduling, directories, and dispatching. The Resource Library is also introduced, allowing customers to share Infinity, eCreator, and IVR scripts.
  • 2006: Infinity software version 5.4 is released, with Infinity IS enhancements. Red Alert adds mapping capabilities, making it easy to trigger alerts for specific areas.
  • 2007: 1Call introduces Discovery Forums, which are led by customers and give participants another way to network and share ideas.
  • 2008: 1Call introduces Infinity software version 5.5 with Infinity IS enhancements, the Infinity IS soft agent, and receives a patent for “A System and Method for Intelligent Script Swapping.”
  • 2009: 1Call introduces Synergy HL7, which instantly communicates HL7 data to the personnel who need it. Synergy HL7 is a performance improvement tool that provides advanced, automated notification technology. Red Alert adds ESRI® and Google™ mapping capabilities. 1Call receives a patent for “System and Method for Dynamically Creating Records” for IS scripting which creates a record in the CMI database

Contact 1Call at 800-356-9148,, or

[From the Fall 2003 issue of AnswerStat magazine]

Six Sigma Your Contact Center

By Dr. Jodie Monger

The contact center is one of your organization’s most valuable assets. Ninety percent of your callers base their image of your organization on their experience with your call center. The contact center is (or should be) the center of the corporate universe. Why, then, is so much time spent by managers justifying its existence? Too often, high-level executives do not understand the value of the contact center to the company’s brand image or its contribution to shareholder wealth. Education within your company is your responsibility. How do you gain the positive attention to move the contact center into the center of the universe?

Many companies have been or are beginning to use the Six Sigma methodology to improve quality throughout their organizations. The beginning, middle, and end of this cycle of the Six Sigma process is the voice of the customer. A logical place to look for such information is in the contact center. Where else can the green and black belts, who are responsible for driving continuous improvement in the Six Sigma system, find the pulse of the customer?

Six Sigma provides a framework to identify your customer critical-to-quality metrics that lead to customer satisfaction and quantify the cost of poor quality. When routine customer interactions are not handled in the customer-correct standardized way, it is a defect and customers will be dissatisfied. As you identify and correct defects, resources are saved and the savings can be reinvested back into your processes to continue to increase customer satisfaction and organizational income. The cycle is quite powerful and is a competitive advantage.

Herein lies an opportunity to leverage the contact center. Make a connection with your company’s master black belt to let him or her know that the contact center is a Six Sigma resource and that you have opportunities for Six Sigma projects as well. Next to a manufacturing line, there are no other functions in an organization where the operational data is more readily available than a contact center. The ability to measure aspects of the function is critical to the Six Sigma effort – define, measure, analyze, improve, and control.

A Six Sigma project team requires the voice of the customer to determine a need for a project and to then determine the success of a project. In our effort to provide the mechanism to measure the quality of service delivery, completely automated telephone surveys of real-time customer feedback has provided the needed measurement for many Six Sigma projects.

The automated surveys also provide the channel for additional projects focused on other organizational aspects by also implementing additional fully automated telephone surveys in parallel. This ability affords the contact center the right to claim its status as the focal point of the organization. The contact center can implement a Six Sigma project related to call resolution while also fielding surveys to measure satisfaction with the billing process and the product quality/repair process. Essentially, you should become the go-to group for customer opinion measurement.

Be prepared for a change. The ability to measure customer opinion with a sound, inexpensive option has catapulted the status of contact center teams within the organizational hierarchy finally giving credit where credit is long overdue.

Jodie Monger, PhD, is the President of Customer Relationship Metrics, L.C. Prior to joining Metrics, she was the founding Associate Director of Purdue University’s Center for Customer-Driven Quality. For more information about completely automated telephone surveys contact Jim Rembach at 336-288-8226 or or call their demo line at 866-537-8500.

[For more information about Six Sigma, see What is Six Sigma?]

[For many organizations Six Sigma is simply means a measure of quality that strives for near perfection. It is a disciplined, data-driven approach and methodology for eliminating defects (driving towards six standard deviations between the mean and the nearest specification limit) in any process. The statistical representation of Six Sigma describes quantitatively how a process is performing. To achieve Six Sigma, a process must not produce more than 3.4 defects per million opportunities. A Six Sigma defect is defined as anything outside of customer specifications.]

[From the Fall 2003 issue of AnswerStat magazine]

The Six Cardinal Rules of Customer Service

By Nancy Friedman

International Customer Service Week was October 6. That’s good, but we like to celebrate customer service all year long. Here are the Telephone Doctor’s “Six Cardinal Rules of Customer Service.” Any one of these tips will enhance your customer service reputation.

  1. People before paperwork: How many times have you stood and waited while someone tallied up a batch of figures or counted a pile of money? Then, only after they were done were you asked, “Now, how can I help you?” How many times have you waited while someone “fiddled” with something or wrote up a note, before he or she acknowledged you? Paper can wait. People should not. Paper won’t walk away, but the customer might. Drop what you’re doing and pay immediate attention to the customer.
  2. Don’t be too busy to be nice: In most interviews, managers and owners hear something like this from the applicant: “I love to be busy. If I’m not busy I get bored and unhappy.” Then we hire them and one of the first things we hear is the complaint, “Wow, I am so busy.” Well, being busy does not give you carte blanche to be rude. Let’s not be too busy to be nice. It’s not worth it.
  3. Rushing threatens customers: Whether it’s on the telephone or in person, avoid rushing people. Make each experience a great one. Remember, one word answers make you sound cold and unfriendly. Slow down. Stop rushing people. It threatens them.
  4. Don’t use military language on civilians: Simply put, company jargon should stay within your company. Mistakes and miscommunications thrive on company jargon. You’ll be far more familiar and comfortable with the terms and abbreviations than your customer will. Some companies seem to have words and abbreviations that would make the CIA green with envy. Use simple, easy to understand words with the customer. They’ll appreciate your thoughtfulness.
  5. Be friendly before you know who it is: Have you ever been a customer and been treated in a rather average, maybe even below average, manner? Later, when they realized you were a friend of the boss or someone other than an “average” customer, they brightened up? Why wait to be friendly? Why discriminate? If you’re friendly before you know who it is, you’ll make a good impression. When you’re friendly before you know who it is, you’re delivering the same great service to everyone. That’s the way it should be. Don’t discriminate.
  6. “There ya go,” is not “Thank you.” “Uh huh,” is not “You’re welcome.” Count for one day, how many times people forget to say, “Thank you,” and “You’re welcome,” to you. “There ya go,” just doesn’t hack it. When customers spend money, they want to hear a big smiling, “Thank you, we appreciate your business.” When we, as customers say, “Thank you,” we don’t want to be grunted at with the old, “Uh-huh.” Speak clearly. “You’re welcome,” is a wonderful phrase. Please use it more often, and don’t be a grunter. When your customer tells you, “Thank you,” give a great big smiling “You’re welcome,” right back at them.

Nancy Friedman is a keynote speaker at association conferences and corporate gatherings. She is also the author of four best selling books on Customer Service. Contact her at 314-291-1012 .

[From the Fall 2003 issue of AnswerStat magazine]

Legal Considerations of Voice Logging

Compiled by Peter DeHaan, Ph.D.

Peter DeHaan, Publisher and Editor of AnswerStat

Legal issues regarding the recording of phone calls must be considered before embarking on voice logging. This varies on a state-by-state basis. Some states and countries require “one-party notification” in which only one of the two individuals needs to be made aware that the call is being recorded. This, of course, is most easily done by notifying the call center agents and staff.

This notice should be included in the employee handbook they receive when hired. By signing off on the handbook, it has been documented that employees have been duly notified that the recording will take place.

Check with a local attorney familiar with state employment law, as it may be advisable to have a separate sheet signed by each employee, which explicitly notifies him or her that calls will be recorded. (At least thirty-seven US States, the District of Columbia, the US Federal law, Canada, and England only require one-party notification. Note that there is some disagreement over the determination of the requirements for a few states.)

The other scenario requires that both parties be made aware that the call is being recorded; these are called “two-party notification” states. (Depending on the source, ten to thirteen US states fit this category.) This can be accomplished by playing a preamble recording on every call or inserting a periodic beep tone.

The preamble recording is common, but may prove to be a technical challenge to accomplish in a call center where multiple types of calls are taken and for various departments or clients. There is also the concern of how to respond to clients who object to an automated announcement before every one of their calls. Typical verbiage for the announcement or preamble recording is, “Thank you for calling ABC Clinic, your call may be monitored for training or quality assurance purposes.”

Alternately, many voice logging systems provide an optional beep tone. There are specific parameters to which this beep must adhere. According to VLR Communications, the beep tone needs to be a 1260 to 1540 Hertz tone, lasting 170 to 250 milliseconds, and broadcast for both sides to hear every twelve to fifteen seconds when recording is taking place.

The interesting part of this requirement is that both parties must be able to “hear” the beep tone; there is no measurable audio level specified. Therefore, it makes sense to set the beep level at a low volume, while still being audible to both parties. Still, many people find this beep tone to be disconcerting and distracting. Although call center agents typically grow accustomed to the beep tone, eventually tuning it out, this is not the case with callers, who generally find the ongoing beeping to be an annoying vexation. Callers may even discuss the beep tone or voice recording with the agents, thereby lengthening call time and decreasing the quality of service.

Several websites contain information about notification; unfortunately, they are not in complete agreement. This is shown in the chart below. Regardless of this information, be sure to consult a local attorney before recording any telephone calls.

Also, there are privacy concerns and issues. In general, one should take every possible precaution to avoid recording personal phone calls. A practical way of doing so is to only record conversations in the call center (and explicitly not in the breakroom or on any common area telephone) and to have an enforced policy against placing or receiving personal phone calls while in the call center.

These steps will help to ensure that personal phone calls are not inadvertently recorded and that privacy rights are not encroached. Again, obtain legal counsel before recording any phone calls. Voice logging is best used for quality assurance, training, self-evaluation, verification, and dispute resolution.

[For more information, see our Voice Logging feature article and Voice Logging Vendors.]

Peter DeHaan is the publisher and editor-in-chief of AnswerStat magazine and a passionate wordsmith. Connect with him on his personal blogs, social media sites, and newsletter, all accessible from

[From the Fall 2003 issue of AnswerStat magazine]