The Ideal Patient Experience

1
The Ideal Patient Experience

• Case Study University of Pennsylvania Health
  System
• Carolyn Gorman

2
Agenda

• The Experience Economy
• Case Study University of Pennsylvania Health
  System
• The Ideal Patient Experience
• Improving Ambulatory Access
• Ambulatory Call Management
• PSR Role Design

3
The Experience Economy

• Competing for Service Why Important?
• Advanced economies such as the U.S. are
  increasingly based in services.
• Accounts for upwards of 70 of both employment
  and GDP.
• Is recognized as a key competitive weapon and
  critical to customer retention.

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The Experience Economy

• Competing for Service Why Important?
• The bar is rising. As markets become more
  competitive, ever-higher levels of performance
  are required to retain customers.
• Other health care institutions are thinking about
  it - they want your patients.

5
The Experience Economy

• The Experience Economy is the new stage of
  economic offering (the fourth offering).
• Coined by Joe Pine and Jim Gilmore
• The progression of economic offerings
  commodities, goods, services, and experiences.

Pine, J. Gilmore, J. (1999). The experience
economy.
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The Experience Economy

• With each offering, value and profits increase
  exponentially.
• Coffee bean 0.50/lb
• Can of coffee at Supermarket 3.00/lb
• Cup of coffee at Starbucks 230/lb

7
The Experience Economy

• Consumers seek to spend less time and money on
  goods and services (they have been commodified).
• Consumers want to spend more time on money on
  compelling experiences.
• When a person buys an experience, they are paying
  to be engaged in a personal way.
• Companies can engage customers by connecting with
  them in a memorable way (Disney, Southwest
  Airlines, Starbucks, the Mayo Clinic).

Pine, J. Gilmore, J. (1999). The experience
economy.
8
The Experience Economy

• Customer experience has become one of todays
  great frontiers for innovation.
• May decide the winners and losers in almost every
  industry imaginable.
• Ruthless focus on the customer.

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The Experience Economy

• Heres Why?
• Raving Fans buzz in the marketplace
• Loyalty stable revenue base
• Premium Pricing customers will pay for an
  experience
• Differentiation standing out from the crowd
  assures a better likelihood of getting picked

Jeneanne Rae, Business Week July 2006.
10
The Experience Economy

• Why Now?
• Technology powers so many experiences with
  increasing competitive intensity, which drives
  the search for differentiation.
• Nature of economic value and its natural
  progression from commodities to good to services
  and then to experiences (coffee bean to
  Starbucks).
• Rising affluence

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Experience Economy

• Industries Waiting to be Invented
• Entertainment established
• Financial Services to wealth care experience
• Travel Shopping to retail tourism
• Health Care to life tending

12
Case Study University of Pennsylvania Health
System

• Patient Access Initiative, October 2005
• Launched effort to make it easier for patients to
  get an appointment.
• Improve experience with the outpatient visit
• Excellent patient access is the cornerstone to
  achieving goal of exceeding patient expectation.
• Critical before the opening of the Center for
  Advanced Medicine in FY 2008.

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Easy Access, Low Volume
Easy Access, High Volume - Desired
3rd Available Appt (Days)
Difficult Access, High Volume
Difficult Access, Low Volume
Note Dept C located behind Dept H
Arrived Patients
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Improving Ambulatory Access

• Ob/Gyn Challenges
• Limited capacity for routine gyn
• Reaching capacity for routine ob
• High bump, cancellation and no show rates
• Dickens Clinic high volume, yet site for resident
  training
• Operational infrastructure barriers are
  challenging for physicians to provide care

15
Case Study University of Pennsylvania Health
System

• Improved Ambulatory Access
• Created an Office of Patient Access
• Worked directly with sites to improve all aspects
  of access
• Identified way to measure good access
• Improved Ambulatory Call Processes
• Redesigned the Patient Service Representative
  Role (PSR)

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The Ideal Patient Experience

• When I call, I am able to reach a live person and
  am on hold no longer than 30 seconds.
• I am easily able to get an appointment with the
  appropriate provider for a time that is
  convenient for me within two weeks.
• I am well informed prior to my visit. I have
  information on time, location, parking, and
  instructions pertinent to my visit.
• I am welcomed and treated by a courteous, engaged
  and professional staff who make me feel that my
  concerns are important and anticipate my needs.
• There are no unnecessary delays at any point in
  my visit. If there are unforeseen problems, I am
  updated frequently.
• When I leave the office, I understand my care
  plan, prescriptions and next steps.

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Improving Ambulatory Access

• Access is the starting place for the patient care
  process.
• Access to appointments is recognized as a
  critical component of the ideal patient
  experience.
• Patients cannot have any kind of experience with
  you if they are unable to gain access to your
  physician and services.
• The quality of your health systems access shapes
  the patient experience.

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Improving Ambulatory Access

• Performance Metrics (weekly reports)
• Implemented user-friendly tool that provides
  information in a timely manner to impact
  performance.
• CBNS Percentage
• Third Available New
• New Appointment Lag
• Bumped Appointments
• Unserved Call Percentage

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Improving Ambulatory Access

• CBNS Rate (Canceled, Bumped, No Show)
• Weekly monitoring of attendings, residents and
  CRNPs
• A high CBNS rate indicates significant
  limitations to patient access.
• Aim for a CBNS rate of 25 - indicates prompt
  access.

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Improving Ambulatory Access

• CBNS Rates
• CPUP goal
• CBNS rate 34
• 2/19 - 2/25/06
• CPUP 42
• OB/GYN 42 1386/3748
• 8/20 - 8/26/06
• CPUP 40
• OB/GYN 43.2 1581/3660

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Improving Ambulatory Access
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Improving Ambulatory Access

• Bumping Patients
• Result is a decrease in patient arriving for
  every visit.
• Average administrative cost of rescheduling
  estimated to be 21 for each bumped appointment.
• Strong correlation between bumping appointments
  and an increase in chronic no-shows.

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While visits are rarely bumped in the Dickens
Clinic (3 of visits), bumping has a corrosive
and persistent effect on the patients likelihood
of no-showing for a visit.
Impact of Bumping Patients No-Shows Per
Patient FY2005
59 Higher
37 Higher
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Improving Ambulatory Access

• Bumping Patients UPHS Initiative
• It is the policy of the Clinical Practices of the
  University of Pennsylvania to require that all
  bumps, any appointment whose cancellation is
  directed by a provider, occur no sooner than six
  weeks prior to the date of the scheduled
  appointment.

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Improving Ambulatory Access

• Bumping Patients Department Policy
• All schedule changes occurring in less than 6
  weeks must be approved by the Chair or his/her
  designee.
• Inform practice manager if gt6weeks. All bumped
  appointments should be requested recorded via
  an Appointment Schedule Change form (via email).
• Rescheduling of appointments will occur no later
  than 30 days from original appointment.

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Improving Ambulatory Access

• Appointment Lag
• There is a high correlation between
  cancellation/no show rate and how far out a
  patient is scheduled (lag time).
• Patients tend to keep their appointment when the
  visit is scheduled within 30 days.
• To decrease backlog consider adding a session on
  a low volume day for new patients only or seeing
  additional 1-2 new patients in your session.

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Improving Ambulatory Access
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Ambulatory Call Management

• Telephone Access
• First point of contact
• Frequently cited as the lowest score on patient
  satisfaction surveys
• Inability to get through
• Long hold times
• Need to call several times
• Confusion with auto attendants

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Ambulatory Call Management

• To convey a professional image to patients,
  families and referring physician
• Assess your telephone technology
• Develop service standards goals
• Implement call protocols

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Ambulatory Call Management

• Telephone Technology
• Identify issues that may be impacting the ease in
  which patients and referring physicians are able
  to access your practice.
• Implement automated technology to track, measure,
  analyze and report call data
• Call volumes
• Staff productivity
• Hold times
• Abandoned calls

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Ambulatory Call Management
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Ambulatory Call Management

• Service Standards and Goals
• Does the department have sufficient personnel
  dedicated to answering calls.
• Reconfigure/optimize PSR coverage to provide
  improved telephone coverage.
• Create a centralized float pool of expert
  telephone schedulers.
• Create a department-based float pool.
• Develop an overflow mechanism during peak times
  (shifting staff during peak times).

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Ambulatory Call Management
Range will depend on patient population, level
of automation and work processes utilized
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Ambulatory Call Management

• Service Standards Goals
• Telephone calls
• Unserved Call Rate 5
• Average Time to Answer 3 rings
• Expectation 100 Compliance with Protocol

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Ambulatory Call Management

• Service Standards Goals
• Clinical Questions
• Same business day for calls received before 3 PM.
  Next day for calls received after 3PM.
• Prescription Refills/Renewals
• 1 business day
• Test Results
• 1 business day after department received
  interpretation/result or per department specific
  protocol, e.g., at next appointment.
• Expectations All calls acknowledged by the end
  of the day.

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Ambulatory Call Management

• Call Protocols
• To convey a consistent, professional image.
• Scripted standard greetings, call flows and
  closures.
• Reduces variability in staff customer service
  skills
• Streamlines the length of time for calls
• Concise approach to scheduling requests and
  patient instructions.

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Ambulatory Call Management

• Standard Greeting Script
• Department of XYZ, this is ltltstaff first namegtgt
  speaking, how may I help you?
• Standard Closure Script
• Ms./Mr. ltltcustomer namegtgt, is there anything
  else I can help you with today? Thank you for
  choosing the University of Pennsylvania.

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Ambulatory Call Management

• Scheduling Calls Script
• Scheduler identification
• Appointment information (provider, date, time,
  location)
• Reminder to bring
• Proper identification
• Insurance cards
• Copay and/or referral
• New patients next step for registration
  information.
• Parking recommendations
• The Platinum question, Is there anything else I
  can help you with today?
• Thank you for choosing UPHS.

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Ambulatory Call Management

• Other Standard Scripted Protocols
• Doesnt speak English
• Is having a medical emergency
• Has the wrong number
• Has a clinical question
• Requests a prescription
• Asks to speak to a physician or staff
• Asks to have the results of a test
• Has a complaint

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PSR Role Design

• PSR Impact on Patient Experience
• First and last point of contact
• Patients perception of experience influenced by
  interaction with PSR.
• PSR work significantly impacts practice flow and
  operations.

41
PSR Role Design

• PSR Role Matters!
• Enhance presence and effectiveness in practices
• Provide a consistent definition of the PSR role.
• Provide a career path to support their
  development and commitment to career.

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PSR Role Design

• Current Experience
• Patients experience varies from practice to
  practice
• Inconsistent fragmented training
• Scrambling to find coverage during absences
• Important practice tasks not completed
• Unclear career paths

• New Role Redesign
• Consistent definition of the PSR role
• A more consistent experience for patients,
  regardless of where they are served
• New PSR float pool to cover absences
• Enhanced training support
• Increased staff satisfaction
• Greater career opportunities

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PSR Role Design

• New Tiered System
• Tier 1 Patient Access Representative entry
  level position
• Tier 2 Patient Access Specialist financial or
  billing track
• Tier 3 Patient Access Coordinator lead
  position
• Core competencies common to all three tiers
  (scheduling, call management, insurance, billing,
  customer service)

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PSR Role Design

• New Training Program
• Core Training (Basic Training for PSR)
• Scheduling
• Registration 101
• Roles Processes
• Ritz Carlton

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Questions?