Patients' perceptions of how a healthcare organization handles their telephone calls significantly affect their overall level of satisfaction with the organization. Not surprisingly, surveys have shown that patient satisfaction is undermined by transfers to voice-mail systems and long waiting times. The retail industry addresses these problems by routinely tracking the "call-abandonment" rate as a measure of customer dissatisfaction. The most highly regarded customer-service operations strive to keep this rate below 2 to 3 percent. These operations invariably use the call-center model. In essence, a call center is a dedicated team supported by various telephone technological resources to provide responses to customer inquiries.

Increasingly, customer-focused PFS departments are implementing call centers as a means to process incoming patient calls more efficiently. To be successful, a PFS call center should be supported by adequate technological resources and appropriately staffed.

Call-Center Access

Patients expect their healthcare providers to offer around-the-clock service. In developing a call center, therefore, PFS professionals should seek an approach that meets that expectation. If a provider's research confirms that the volume of routine inquiries or requests for access outside normal business hours is large enough, it may justify expanding the number of staff on duty to respond to those calls. Another solution might be to have calls automatically forwarded to a contracted vendor or to PFS employees working at home.

Patients also should be offered alternatives to traditional telephone contact. Answers to many frequently asked questions, such as account balances, can be provided through the Internet. In addition, Internet access can provide a means for patients to respond to provider requests for insurance or other information.

Staffing Call Centers for Customer-Service Excellence

The challenge of finding and retaining the right staff for a PFS call center is increased by high turnover rates in such units, as well as by the shrinking pool of job seekers reflected in today's very low national unemployment rate. Employee turnover in call centers throughout the retail industry averages more than 30 percent and often exceeds 60 percent,(a) and healthcare providers have experienced similar rates. This costly situation has been attributed to employee dissatisfaction with factors such as:

* A stressful work environment and arbitrary, unrealistic productivity, quotas;

* Low and noncompetitive compensation levels;

* High inquiry volumes and hostile customer attitudes;

* "Empathy distress" - personal anguish resulting from trying to respond to people in difficult personal situations;(b)

* Inadequate technical and customer interaction training;

* Lack of independent authority to resolve issues without management or other approvals; and

* Absence of an organizationwide, accountability-driven commitment to customer-service excellence.

To ensure that the call-center staff deliver the highest-quality customer service, the PFS professionals who manage the call center must work to improve the recruiting process and reduce employee turnover. To realize these objectives, these PFS professionals need to analyze existing call volumes to determine their core categories and root causes of the customer-service questions and problems (eg, inefficiencies or quality issues in internal processing or information gathering) and then take steps to eliminate the root causes,

The PFS professionals need to identify the starting levels required to support the improved customer-service processes, exploring flexible and alternate work arrangements. They should define the required competencies of PFS call-center employees to establish appropriate compensation levels, set objective team and individual performance targets, and create associated incentive opportunities. To ensure call-center staff are qualified, objective initial screening and ongoing competency assessment instruments and protocols should be implemented and an effective plan to provide staff with initial and ongoing education should be developed. The call-center staff also should be provided a means for ongoing input, problem solving, and stress reduction. To perform their jobs effectively, they should be given some authority to resolve patients' problems independently. Finally, PFS professionals should regularly evaluate the effectiveness of the call center by monitoring employee performance through routine observation of customer-service interactions and analyzing PFS customer satisfaction via follow-up interviews of patients whom the PFS call center has served.

Conclusion

A high level of customer satisfaction can significantly enhance an organization's financial well-being. A study of 50 of MasterCard's largest call centers by the Technical Assistance Research Project of Washington, D.C., found that MasterCard's customer loyalty was tied directly to the customers' level of satisfaction with the service they received. Moreover, accounts of customers who had expressed satisfaction were determined to be three times more profitable than those of customers who had not.(c) In particular, these customers tended to access more special MasterCard offerings, such as credit-card protection services.

In contrast, research has found that a dissatisfied hospital or primary care patient can cost a healthcare provider $238,000 in potential revenue over the patient's lifetime.(d) Moreover, it also has been found that 75 percent of all healthcare litigation stems from patients' feelings about how they were treated.(e) Thus, any contact with a healthcare organization that causes a patient to feel dissatisfied, including contact with uncaring call representatives, can have costly ramifications to a healthcare organization. PFS professionals therefore should inspire call-center staff to make patient satisfaction a top priority. Patients expect and deserve to have their questions and problems resolved, and they should leave every encounter with their healthcare provider believing that the organization has striven to meet all their needs.

HEALTHCARE FINANCIAL MANAGEMENT Thanks Reviewers

The staff of HEALTHCARE FINANCIAL MANAGEMENT thanks the following individuals for completing technical reviews of articles between February 19, 1999, and May 26, 1999. An asterisk designates individuals who reviewed more than one manuscript during this period.

Every effort has been made to identify all reviewers who were active during this period. Any errors should be brought to the attention of Sharon Malik, HFM editorial associate.

Scott Abram, CHFP

Suzanne T. Anderson, MBA

Vicki L. Anderson, CHFP

Laurence S. Appel, FHFMA, CPA

Robert L. Barber, FHFMA

William R. Barnes, CHFP

Cathanne O. Bart, FHFMA

Jeffrey Brad Beck, CHFP

Marc Benoff

John T. Bigalke, FHFMA, CPA

Philip Birnbaum

Brian Black, CHFP

Katie Black, CHFP

Rebecca Black, FHFMA, CPA

Paul J. Blaser, FHFMA

Duane H. Bluemke

David A. Bolen, FHFMA, CPA

Robert Bruckner, FHFMA

David Burik

Cynthia B. Butler, CHFP

Robert W. Camarena, FHFMA

Mark B. Carter, FHFMA, CPA

George L. Cato, CHFP

Thomas J. Cawley, CHFP

Melody Chancy, FHFMA

Deborah A. Chanen, CHFP

Thomas Cole, Jr., FHFMA

Terry L. Conrad, FHFMA

W. Seth Crone, FHFMA, CPA

Richard G. Crowley, FHFMA

Philip L. Cusa, FHFMA

Martin J. D'Cruz, CHFP

Linda M. Davidson, FHFMA, CPA

Scott J. Davis, FHFMA, CPA

Robert E. Delawder, FHFMA, CPA

Paul R. DeMuro, FHFMA, CPA(*)

William L. Devoney, Jr., FHFMA, CPA

Roger J. Dix, FHFMA

Richard J. Donoghue, CHFP, CPA

Ray Dziesinski, FHFMA

Christine Ergen, FHFMA, CPA

Joseph Evans, FHFMA

Nina Feero, CHFP

Bernard S. Fellner, FHFMA,

CPA Joseph J. Fifer, FHFMA, CPA

Beth W. Foote, FHFMA

Justice Gaba, CHFP

David B. Gaither, CHFP, CPA

Martha Garner, CPA

Christopher J. Goike, FHFMA, CPA

Laurie H. Gombert, FHFMA, CPA

Paula L. Greeno, CHFP

Paul Grimaldi, PhD

Errol P. Hankin, FHFMA

Jay Harris, MBA

Sherri Harris, CHFP, CPA

Melinda L. Hayes

James P. Henshaw, FHFMA

Mary L.F. Hensley, CHE, CMPE, CHFP

Eric Holzberg, CHFP, CPA

Geraldine Hoyler, FHFMA, CPA

Sarah G. Hull, FHFMA

Keith Hullender, CHFP

Robert E. Hughes, CHFP

Deborah B. Hunt, FHFMA

Michael J. Jacobs, FHFMA, CPA

Marian C. Jennings

Robert S. Johnson, CHFP

Shana Jacobs Jones, FHFMA

Sandra J. Jones, CHFP

Christoper Kaiser, FHFMA, CPA

Frank E. Kania, FHFMA

Harvey Kasdan, FHFMA

William L. Kennedy, FHFMA

Howard G. King, FHFMA

Ronald J. Kintz, FHFMA

Kenneth J. Klein, CHFP

William Koprowski, FHFMA

Karen C. Krug, FHFMA, CPA

Andrew Kussoy, FHFMA

Kevin F. Lawlor, FHFMA

Ray B. Lefton, FHFMA, CPA

Glenn M. Lohrmann, FHFMA, CPA

Randall W. Luecke, CPA, CMA, CPM

Bill MacFarlane, CHFP

Alan MacQuarrie, FHFMA, CPA

Farrell Maier, CHFP

Phillip R. Manz, FHFMA, CPA

David L. Marcellino, CHFP, CPA

William E. Marois, FHFMA

Cynthia B. Marquart, CHFP, CPA

Cheryl Mason, CHFP, CPA

J. Michael Mauldin, FHFMA

John J. Mayerhofer, FHFMA, CPA

Mark T. McQuillan, FHFMA

Dudley Medlock

Jean Mellett, FHFMA, CPA

Julie Micheletti

Pamela S. Mitchell, CHFP

Carolyn Moffit, FHFMA

Victoria M. Morgan, FHFMA

Thomas E. Muller, FHFMA

Craig C. Mullins, CHFP, CPA

David A. Neuendorf, FHFMA

Michael S. O'Connor, CHFP

James F. ODonnell, CHFP, CPA

Jill B. Oliver, CHFP, CPA

Janice G. Osborne, CHFP

Dennis S. Palkon

Jonathan W. Pearce, MBA, CPA

Bonne Phipps, FHFMA, CPA

Gina Pruitt, CHFP, CPA

Jackson Rainer, PhD

Charles A. Rehberg, FHFMA

Wendy Daily Resnick

Ann M. Rice, FHFMA, CPA

Daniel J. Rinaldi, FHFMA(*)

J. Bruce Ryan

James V. Ryan, CHFP

John St. George, FHFMA

Roger D. Sarao, CHFP

Alissa Schaub-Rimel

Margaret E. Schwantes, FHFMA

Denise R. Smith, FHFMA, CPA

Ellen E. Stewart, JD, FHFMA

Karen Teitelbaum

Howard Tepper, FHFMA

Robert P. Thames, FHFMA

Marci S. Thomas, CHFP, CPA

Margaret A. Thompson, CHFP, CPA

Pamela J. Townsend, FHFMA

Beatriz Trejo, CHFP, CPA

Brett Trusko, FHFMA

J. Larry Tyler, FHFMA, CPA(*)

Rory L. Ward, FHFMA, CPA

Suzanne Ward, FHFMA

Robbi-Lynn Watnik, JD

Stephen T. Whelan, CHFP

Jeffrey L. White, FHFMA

Lynn W. Whitteker, FHFMA, CPA

David A. Williams, FHFMA, CPA

Mark Woodard, MBA

Robert E. Wooden, FHFMA

James Patrick Wright, CHFP, CPA

Delwyn J. Ziegler, FHFMA, CPA

Steve H. Zook, FHFMA

* reviewed more than once

a. Stuller, Jay, "Performance and Profits," Training Magazine, April 1999.

b. Goleman, Daniel, Working with Emotional Intelligence, New York, New York: Bantam Books, 1998.

c. Stuller, Jay, "Performance and Profits"...

d. "The Economic Ramifications of Patient Satisfaction," Group Practice Journal, May-June 1999.

e. O'Malley, John F., Ultimate Patient Satisfaction, Next, York, New York: McGraw Hill, 1997.

Bobette M. Gustafson is president, Gustafson & Associates, Inc., Port Washington, Wisconsin, and a member of HFMA's Wisconsin Chapter. Her phone number is (414) 268-9216, and her e-mail address is solutions@gustassoc.com.