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The evolution of a call center at Sarasota Memorial Hospital.

Health services health services Managed care The benefits covered under a health contract  call centers have come a long way since the early days of physician referral physician referral A physician's recommendation to a Pt to consult another physician for a 2nd opinion. Cf Self-referral. . As competition and managed care penetration have increased, call centers have evolved significantly from the reactive, physician referral call center which had the primary goal of generating revenue.

Today, the "Health Management Call Center" has become the focal point focal point
See focus.
 for comprehensive health information designed to improve the health status of the entire community.

These super centers are highly proactive in simultaneously meeting the often conflicting goals facing health care providers. Such objectives typically include harvesting remaining fee-for-service revenue, reducing costs, partnering with physicians, reducing utilization and managing demand and disease.

Sarasota Memorial's experience

Sarasota Memorial Hospital, a public, not-for-profit 855-bed facility located on Florida's Gulf Coast, has seen its call center continually evolve since its inception in August, 1994.

Prior to this time, Sarasota Memorial had call center components consisting of a PBX (Private Branch eXchange) An inhouse telephone switching system that interconnects telephone extensions to each other as well as to the outside telephone network (PSTN).  center, an employee performing physician referral duties and class registration conducted through the educational development department. However, the service delivery process was fragmented.

Under the direction of John Cottillion, vice president of planning and marketing and Jim Turnbull, vice president and chief information officer, the Health Resource Network was established.

The initial goals of the call center were to realize economies of scale through centralization cen·tral·ize  
v. cen·tral·ized, cen·tral·iz·ing, cen·tral·iz·es
1. To draw into or toward a center; consolidate.

, add a nurse advice-line component and develop a brand name that would help SMH SMH Sydney Morning Herald (Australia)
SMH St Michael's Hospital
SMH Shaking My Head
SMH Strong Memorial Hospital
SMH Sanders Morris Harris Inc.
SMH Screening for Mental Health, Inc.
 strengthen its competitive position in the market.

The Health Resource Network is supported by Centramax.Mplus, a software application developed by National Health Enhancement Systems in Phoenix, Ariz. Centramax provides call center RNs with the triage triage

Division of patients for priority of care, usually into three categories: those who will not survive even with treatment; those who will survive without treatment; and those whose survival depends on treatment.
 protocols necessary to direct patients to the appropriate level of care. The software also includes standard physician and service referral components necessary to support those initiatives.

From theory to practice

The initial vision for the call center was that of "one-stop shopping" for the health care consumer.

PBX functions would be fully integrated with all call center operations, with one phone number providing access to the system. Any staff member would be able to assist clients regardless of their needs, and the process would be consistent with the hospital's commitment to customer service.

While seemingly seem·ing  
Apparent; ostensible.

Outward appearance; semblance.

seeming·ly adv.
 simplistic sim·plism  
The tendency to oversimplify an issue or a problem by ignoring complexities or complications.

[French simplisme, from simple, simple, from Old French; see simple
 in theory, the practice of having an attendant console An attendant console is a telephone station that is generally part of a private branch exchange (PBX) or Centrex or other private telephone system. An attendant console generally is a regular PBX telephone station with one or more additional modules each bearing numerous buttons  product, access to the hospital's mainframe, and the Centramax system all operating on the same desktop did not work well.

The staff found the constant switching between systems too cumbersome and time-consuming. The incompatible nature of the calls were also difficult to handle, because physician referral calls do not require immediate attention, unlike hospital codes or alarms.

The solution to this problem was to split the functions, publish two telephone numbers and put more emphasis on cross-training the staff in the call center.

In a true demand management call center, the staff consists solely of nurses who can answer all types of calls.

At Sarasota Memorial, however, the call center had evolved from a physician referral service and it wasn't cost-effective to pay a nurse to handle simple referrals and general health information calls. Therefore, callers are routed to the most appropriate staff member depending on their needs. This makes effective use of the technology in a call center with a blend of clinical and non-clinical staff.

The staffing vs. marketing paradox

One lesson that was quickly learned was that call volume disappears unless marketing campaigns are maintained. Call centers need to keep their target markets informed and aware of new service offerings. Otherwise, the call center is faced with low productivity and management will want to reduce staff numbers to meet organizational standards.

Once this happens, it becomes extremely difficult to operate the call center effectively. Management won't hire staff until call volume increases, but marketing won't promote services unless the call center is operationally ready 1. A unit, ship, or weapon system capable of performing the missions or functions for which organized or designed. Incorporates both equipment readiness and personnel readiness.
2. Personnel available and qualified to perform assigned missions or functions.
 to handle the increase in volume.

One method to solve this dilemma is outsourcing (1) Contracting with outside consultants, software houses or service bureaus to perform systems analysis, programming and datacenter operations. Contrast with insourcing. See netsourcing, ASP, SSP and facilities management. , which allows marketing to drive call volume and operations can staff accordingly. Sarasota Memorial is currently outsourcing overflow and after-hours calls to the National Health call center located in Phoenix.

Customer satisfaction

Besides the obvious benefits associated with economies of scale and the redirection Diverting data from their normal destination to another; for example, to a disk file instead of the printer, or to a server's disk instead of the local disk. See virtual directory, symbolic link, shortcut, redirector and DOS redirection.

 of callers to the most appropriate level of care to avoid unnecessary expenses, call centers can have a significant impact on customer satisfaction and provider preferences.

At Sarasota Memorial, every caller receives a follow-up survey in their fulfillment ful·fill also ful·fil  
tr.v. ful·filled, ful·fill·ing, ful·fills also ful·fils
1. To bring into actuality; effect: fulfilled their promises.

 package that is mailed after completion of the call. Returned surveys help identify where physicians on the referral service send their patients for care.

Any caller who is directed to the competition is further researched to determine the reasons behind the decision. Typical reasons include insurance considerations, location and physician preference.

However, whenever a physician seems to develop a trend to drive business away, the returned surveys are sent to the hospital's vice president of Medical Affairs to take appropriate action.

The surveys also have become a method of documenting patient education and knowledge levels. This quantifies outcomes in a manner that is consistent with JCAHO JCAHO Joint Commission on Accreditation of Healthcare Organizations, see there  standards.

Continual expansion

The services of the call center have expanded over time to include membership program management, appointment scheduling, and after-care follow-up upon discharge from the hospital.

As services grew and the market scope broadened to include counties outside the primary market area, management focused on creating a regional call center that would serve the entire Southwest Coast of Florida. The planning phase In amphibious operations, the phase normally denoted by the period extending from the issuance of the order initiating the amphibious operation up to the embarkation phase. The planning phase may occur during movement or at any other time upon receipt of a new mission or change in the  of this project began in October, 1996.

Establishing a true partnership between independent hospitals is a difficult task, especially when the potential partners are all at different stages of call center development.

One of the most difficult things to accomplish is reaching a consensus on what services should be offered and how much each partner should be charged. The task force for the regionalization regionalization Managed care The subdivision of a broadly available service–eg, a blood bank, into quasi-autonomous regional centers, capable of making decisions and providing more cost-effective and/or faster service to hospitals and health care facilities,  project went around the table several times on this issue alone.

In order to manage such a diverse project, the implementation team consisted of five major areas, including medical affairs, risk management, information systems, operations and marketing.

Each group was charged with creating solutions to the challenges associated with regionalization. Because the groups were so diverse and senior staff members were part of each team, it was a constant challenge for the project manager to hold each group accountable to deliver their solution to the larger group.

Together but separate

While centralization made good economic sense, there were several user requirements that were solved using the latest technology.

The partners wanted to ensure that the origin of each caller would be identified so the initial greeting would be customized for each organization. The information systems group developed a process for separate greetings.

Further, each organization wanted its database to be kept separate and distinct to reflect the different market characteristics that make up the Gulf Coast of Florida. National Health helped customize the software so call center staff members would select the appropriate database in the initial introductory screen on their desktops.

With their requirements met, the partners forged ahead and the Southwest Florida Southwest Florida is a region of Florida located along its gulf coast, south of the Tampa Bay area, west of Lake Okeechobee and mostly north of the Everglades. It consists of five coastal counties from Manatee County south to Collier County, although it sometimes is considered to  Regional Call Center became operational on Oct. 1, 1997.

One of the most significant benefits for Sarasota Memorial is the call center can transition to a 24-hours-a-day, sever-days-a-week operation with no additional costs. Outfitted with the latest technology and ergonomic ergonomic - Concerning ergonomics or exhibitting good ergonimics.  furniture, the call center is designed to bring consumers and partners closer together.

New triage protocols from National Health provide specialized modules for pediatric pediatric /pe·di·at·ric/ (pe?de-at´rik) pertaining to the health of children.

Of or relating to pediatrics.
 calls and seniors that help accomplish this task.

Future plans

The regional call center was designed to be secure, cost-effective, scaleable and manageable so more "partners" can be brought on board in the future.

Also, if the call center outgrows its current space, the software and the information system can simply be picked up" and moved into a new, larger location with little interruption INTERRUPTION. The effect of some act or circumstance which stops the course of a prescription or act of limitation's.
     2. Interruption of the use of a thing is natural or civil.
 in service.

Eventually, the partners could be "fully connected" and have on-line access to scheduling appointments at each of the different organizations. In addition, each partners' internet site could be linked to the center, so someone reading the hospital's home page can dial into the call center for information.

Regardless of what the future holds for the call center at Sarasota Memorial Hospital, one thing is certain -- the center will continue to evolve and adapt to an everchanging marketplace.

Brent Ballard is a marketing consultant for Sarasota Memorial Hospital, Sarasota, Fla. The hospital's Web site is At his request, his honorarium HONORARIUM. A recompense for services rendered. It is usually applied only to the recompense given to persons whose business is connected with science; as the fee paid to counsel.
 for this article will be forwarded to the American Cancer Society American Cancer Society, established in 1913, this national volunteer-based health organization is committed to the elimination of cancer through prevention and treatment and to diminishing cancer suffering through advocacy, scholarship, research,
COPYRIGHT 1997 Nelson Publishing
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 1997 Gale, Cengage Learning. All rights reserved.

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Title Annotation:Technology Information
Author:Ballard, Brent
Publication:Health Management Technology
Date:Oct 1, 1997
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