Don’t let the labor shortage hurt your patient access

The Great Resignation. The Big Quit. The Great Reshuffle. Call it what you will, but there’s no denying the lingering impact of COVID‑19 on the workforce. With more than 10 million job openings across the United States, every industry is experiencing staffing shortages.1

The healthcare sector has been especially hard hit: Health systems are running on razor-thin labor margins. From contact centers to operating rooms, from the front desk to the back office, from X-ray technicians to orthopedic surgeons, seemingly every area of a health system is desperate for more workers.



The labor shortage is impacting access to care so drastically that most health systems have had to reduce hours or adjust service-level expectations. Ambulatory leaders have begun to accept that their practices won’t be able to answer phones quickly, respond to patient messages efficiently, or fill schedules fully — and in the worst-case scenario, they will have to limit capacity until more staff are available.

Recent examples are plentiful, including at several organizations we’ve worked with:

• A leading academic medical center is so short-staffed in its outpatient radiology centers that it stopped contacting patients to schedule orders received. Now staff wait for prospective patients to call them, amounting to a potential revenue loss in the millions of dollars.
• A nationally ranked pediatric health system’s front desk shortage is so extreme, it consolidated clinics to maintain appropriate staffing — forcing physicians to reduce their clinic time.
• A county health system is struggling so profoundly to retain centralized employees that phone wait times routinely exceed an hour at the beginning of the week.

 
Instances such as these can be avoided. The above examples are the outcome of health systems being reactive to the labor shortage. Proactive systems have been purposeful about how they position technology and processes to reduce the impact of fewer staff.

Health systems don’t have to be fully staffed to provide patients appropriate access to care. In 2020, health systems were forced to invest in consumer engagement and a digitally enabled patient journey. The labor shortage presents a similar opportunity, and the way organizations respond will dictate their position in the market for years to come.

The shift to proactive patient access

Amid the labor shortage, healthcare organizations should focus on three primary strategies that will help them increase volumes and revenue, improve patient access, and expedite patient communication with their care team despite being short-staffed.

1. Strategy 1: Implement patient self-service tools: Give patients the opportunity to independently take care of their health needs at their convenience.
2. Strategy 2: Reduce touches per appointment: Operational improvements can eliminate extra work for staff.
3. Strategy 3: Expand patient outreach: Contacting the patient before the patient needs to contact their care provider can minimize extra work and urgent patient care coordination.

1. Implement patient self-service tools

Tasks such as purchasing groceries or scheduling a flight are completed with the touch of a button on a smartphone. Accessing care can be just as easy. The rapid growth in healthcare technology should encourage organizations to reevaluate the role of tech in the patient journey. Self-serve solutions exist for most needs, from enhancements to existing EHRs to the addition of third-party, bolt-on software.

Allowing patients to independently access care is a patient satisfier and benefits healthcare organizations by reducing the need for staff to perform manual duties, thereby optimizing operations and creating efficient workflows for care.

A seamless, integrated, and navigable patient journey is achievable in several tech-enabled areas of healthcare organizations: (Click image for larger view)

2. Reduce touches per appointment

Despite the advantages offered by self-service tools, health systems have been slow to adopt them — even throughout the pandemic. Whether the limitations are technical, cultural or process-related, the reality is that not all organizations can offer self-service to patients. That doesn’t mean they lack opportunities to be faster, more efficient and smarter with pre-access functions.

Proactive health systems have focused on creating lean, patient-friendly processes that reduce or remove the administrative burden from common pre-access tasks such as scheduling an appointment, communicating with the care team, ordering and managing a referral or requesting a prescription. With a bit of up-front work, clinics can easily reduce pre-access staffing needs by 10% to 25%.

Contact center effectiveness

Take, for example, a contact center that fields scheduling and messaging calls for a medical group. Regardless of the age, maturity or scope of the contact center, leadership teams tend to concentrate more on reducing staff than on reducing calls. Some patients call their clinic as many as five times per appointment scheduled.6 Although this includes clinical questions and refill requests, the volume illustrates contact center inefficiency.

Using a combination of refined workflows, added services, and supplemental communication channels, contact centers can reduce their incoming calls to best practice levels. Tactics may include:

• Implementing a robust internal knowledge management system that allows representatives to answer care-related and administrative questions and schedule appointments without messaging the clinic
• Instituting open appointment availability with minimal scheduling restrictions
• Expanding centralized services to include nurse triage, after-hours answering service, referral coordination, and prescription refill support to promote first-call resolution and avoid phone tag between the contact center, practice, and patient
• Adding communication channels beyond the phone, such as chat, chatbot, patient portal and e-visits to expedite requests.

Template optimization

Many medical groups have focused on optimizing their EHR to find efficiency in workflows. Scheduling an appointment should be made as easy as possible for staff. Template optimization is typically the first step in this process. By optimizing templates, clinics can make use of the EHR’s automated scheduling tools and reduce complexity in matching patients to the appropriate provider, visit type and time.

Optimizing templates is best achieved by beginning with group–wide guiding principles that serve as guardrails for specialty-specific design. Guiding principles allow specialties the flexibility needed for their individual nuances while still conforming to a system standard that promotes patient access and improves automation of appointments. Guiding principles may include concepts such as:

• Number of allowable visit types
• Accessibility of templates to staff outside of the practice (e.g., contact center, emergency department) and use of guided scheduling to drive effective scheduling
• Use of blocks, session limits/quotas and other EHR tools
• Openness of the template.

 
With these principles in place, specialties can design their templates in a way that reduces the time and training required to book an appointment. Additionally, the templates can more easily be translated to online scheduling. With simplified templates, clinics can reduce the time staff spend scheduling appointments, which can ease the burden of being short-staffed, especially in a centralized environment.

Point-of-service scheduling

Specialty practices are often resistant to having other staff schedule into their physician templates. Even a medical group’s contact center is often perceived as posing too much of a risk for scheduling errors. But in light of the staffing shortage, this attitude needs to change. If templates are set up appropriately, practices should allow anyone — practice staff, a contact center, patients, referring providers and staff in other areas of the health system — to book most appointments into their schedules, given the appropriate parameters.

Take, for example, a surgery practice that treats 10,000 new patients per year. If 50% of these new patients are referred internally from the medical group’s primary care practices, letting those staff schedule the new-patient appointment upon checkout can save 5,000 instances of phone tag. Expanding this to external practices using digital applications (including some native to certain EHRs) can even further reduce the time staff needs to schedule new patients.

These strategies have common themes: empower the patient, support the employee, automate the process, and simplify the rules.

3. Expand patient outreach

Proactive communication can also reduce unnecessary patient communication and appointments. By reaching out to patients before they require an urgent appointment, health systems can save time, resources and prevent “fire drills,” all while providing seamless service to patients.

Proactive outreach about patient care can help manage last-minute demand. Conducting emergency room, hospital, urgent care or surgical follow-up calls can help address patients’ clinical questions before they schedule an unnecessary visit. When a five-minute call can save a 20-minute visit — and the registration, scheduling, check-in and checkout processes that coincide with the visit — it gives staff more flexibility.

The same outcome can be achieved for health maintenance checks for preventive care, chronic care or clinic/emergency room “frequent fliers.” While proactive outreach requires valuable staff time, it will equate to more time saved later.

These strategies may not always lead to a reduction in visits, but a switch from an inbound call to an outbound call is also valuable. Outbound calls can be made during times of reduced staffing needs — typically in the afternoons later in the week — whereas inbound calls are not as predictable and require increased staffing. As a general rule of thumb, 1.0 FTE spent on outbound calls can replace 1.5 to 2.0 FTEs spent on or waiting for inbound calls.

Technology can automate this outreach and reduce staffing needs as well. With the increased focus on population health, value-based care, and tightening margins, technology companies have a heightened emphasis on solutions that automate outbound capabilities. Population health companies have created tools with predictive analytics that can help organizations proactively provide care to patients before they require urgent or emergent care. Combining these tools with automated outbound texting, phone, or email platforms allows these outbound needs to be met with little or no staff.

Even without the sophistication of a population health tool, health systems with phone personnel should invest in automated dialers that conduct outbound calls on behalf of staff and alert them when the patient picks up. Outbound staff can be significantly more efficient when they don’t have to scrub lists, dial numbers and wait for patients to answer.

Strategy in action: Contra Costa Health Services (CCHS)

CCHS, a county health system in California serving the surrounding area’s most vulnerable populations, offers an example of how a team can be proactive about patient access strategies despite a decline in staffing. CCHS and ECG Management Consultants have been working together to address ongoing challenges with patient access, including long wait times on the phone and poor appointment availability.

After a rapid assessment, ECG and CCHS developed and implemented a future-state model for centralized services and patient access operations that supported and balanced the needs of patients, physicians, clinics and the county while reducing the burden on administrative staff. Implementation of this model included:

• Optimizing templates, including expanding capacity, introducing guided scheduling, and removing barriers to access
• Offering online scheduling in primary care and all specialty departments
• Reconfiguring contact center staffing and introducing shrinkage reduction and productivity tracking management
• Streamlining and optimizing the referral management and new-patient specialty scheduling processes
• Optimizing and digitizing clinic-based processes, including preregistration, check-in and checkout
• Introducing strategies to reduce and streamline clinic cancellations, patient rescheduling and no-shows
• Configuring the telephony platform, online scheduling, electronic registration, and other digital tools to expand self-service and consumer-centric options.

Outcomes

These optimization efforts led to increased revenue, decreased costs and an improved patient experience.

Increased revenue: Provider productivity

The contact center was able to keep provider schedules full by improving the scheduling process, including introducing online scheduling, revamping the referral management process, using additional communication channels, simplifying provider templates, and optimizing use of its EHR to better organize work. This led to a 2.7% increase in provider fill rate in the first six months, which equated to $2.2 million in additional annual revenue.

Decreased costs: Labor efficiencies

Three separate patient access teams were combined to reduce fragmentation and promote efficiency in completing tasks. To improve employee productivity, CCHS implemented shrinkage monitoring and coaching protocols. CCHS also updated the training program and created more efficient processes through workflow and template optimization sprints. These efforts led to a reduced reliance on staff, including:

• 4.1% decrease in inbound call volume, primarily due to online appointment scheduling
• 5.2% decrease in time employees spend on the phone
• 4.0% improvement in scheduling efficiency from cross-training staff, introducing automation and standardizing workflows.

Improved patient experience: Digital options

Patients can now schedule or register for an appointment online. Just six months after its launch, 18% of new CCHS patients are scheduled online. This digitization of patient access services has begun CCHS’s efforts to empower the consumer and establish a digital front door. Additionally, improvements to the contact center have reduced phone wait times by more than 25%.

Rethinking the approach to patient access

The labor shortage is not going away any time soon. Trying to wait out the storm, employ temporary labor or reduce clinic capabilities are not financially viable options. Health systems that are proactive about their patient access strategy are able to do more with less if they invest in the right technology and operational improvements.

Across the front desk staff, the outreach team, the contact center and the clinical team, every area of the clinic can be smarter about how they approach their communication and pre-access functions with patients. Just as the pandemic forced medical groups to rethink their approach to patient care, the labor shortage should make us all rethink our approach to patient access.

Notes:

1. Ferguson S. “Understanding America’s Labor Shortage.” U.S. Chamber of Commerce. Oct. 31, 2022. Available from: bit.ly/3gXv4S5.
2. Bateman T, Hobaugh S, Pridgen E, Reddy A. “U.S. Healthcare Labor Market.” Mercer. 2021. Available from: bit.ly/3fuTn9M.
3. Berlin G, Lapointe M, Murphy M, Wexler J. “Assessing the lingering impact of COVID-19 on the nursing workforce.” McKinsey & Company. May 11, 2022. Available from: mck.co/3foNWcz.
4. AAMC. “The Complexities of Physician Supply and Demand: Projections From 2019 to 2034.” June 2021. Available from: bit.ly/3Uh8kuF.
5. Tornetta J. “Patient self-scheduling is a necessity.” Physicians Weekly. Oct. 21, 2021. Available from: bit.ly/3SZ9wlp.
6. McMillen S. “How to measure contact center effectiveness: Start with calls per scheduled activity.” ECG Management Consultants. Dec. 11, 2019. Available from: bit.ly/3TYYTR3.