Ronda V. Wicks
When it comes to customer service, it really is only as good as the customer says it is. But what do you do when your customers think your service is great, but you know it could be a whole lot better? Think Lean! We did, and we were able to reduce our abandoned call rate from 28 percent to 9 percent in ten weeks.
Before we implemented Lean, Akron Children’s Hospital’s Information Services Service Desk supported the approximately 4,300 computers and peripherals used by more than 4,000 employees, in addition to a number of desktop and server applications. While 65 percent of the issues reported were resolved on the first call by four service desk analysts, the abandoned call rate averaged over 28 percent, well above published industry targets of 5 percent.
There were a number of reasons why our abandoned call rate was so high. First off, ACH’s Beeghly Campus had opened in December 2008, in addition to multiple specialty departments at the main campus and remote sites, which greatly increased the number of calls coming into the service desk. Our total call volume jumped 23 percent from 2008 to 2009, and we knew weren’t keeping pace with the growth of the organization.
Next, we began looking at staffing and scheduling. With four analysts working staggered shifts, we provided service from 7 a.m. to 7 p.m. After identifying our highest call-volume period, we adjusted our core hours and transferred existing staff to earlier shifts. We believed that bringing in an extra person during our busiest periods would automatically bring the abandoned rate down. And although it did reduce it, it was still not within the range that we felt would enable us to deliver the best customer service, which was our ultimate goal.
We also had to contend with incidents rejected by other support teams. We call it “ticket pong,” where incidents are kicked back to the service desk after being escalated. Even though analysts had a ten-minute window (or less) to resolve or escalate incidents, it took longer because they were “ping-ponging” those incidents to other teams or different team members. This was likely due to the lack of support transition knowledge and documentation available to the service desk. Although we had some support documentation, we were frequently challenged with supporting new equipment and applications with little or no training prior to implementation. Therefore, we would often spend time learning with (and at the expense of) the customer, which meant more time on the phone and more abandoned calls.
We found that clinical staff responsible for providing critical patient care would usually just hang up when faced with having to hold. It was very important for us to effectively support those customers, as their inability to chart or print out a label directly affected the timing of a patient’s care. This alone was enough to make us take a good, hard look at our service.
Akron Children’s Goes Lean
“Lean thinking,” generally associated with the Toyota Production System (TPS), is the process of minimizing waste and distinguishing the difference between value-added and non-value-added steps in the workflow. By utilizing Lean tools and applying the DMAIC (define, measure, analyze, improve, and control) process, organizations can greatly improve productivity. The key principles of Lean Six Sigma are:
- Focus on the customer.
- Identify and understand how the work gets done (i.e., the value stream).
- Manage, improve, and smooth the process flow.
- Remove wasteful steps that don’t add value.
- Manage by fact and reduce variation.
- Involve and equip the people in the process.
- Undertake systematic improvement activities.
To improve its healthcare processes throughout the organization, ACH created the Mark A. Watson Center for Operations Excellence (COE) and implemented a Lean Six Sigma initiative. The Center’s mission is to develop and utilize in-house talent to improve the healthcare experience of patients and families, while simultaneously improving the working experience of our staff. One component of this initiative involves the use of kaizen events, also known as rapid improvement events.
Kaizen comes from the Japanese meaning “good change.” Any point improvement to a process can be called a kaizen. Some organizations, such as ACH, encourage the development of a culture where all staff are empowered and expected to not only do, but also improve their work. However, sometimes processes are of such a nature that it takes many individuals, often representing several departments, to affect significant improvement. If these individuals make a concentrated effort, they can accelerate that change. At ACH, we call these larger efforts kaizen events, which can last anywhere from two to five days, depending on the particular problem and the availability of the participants needed to solve it.
At the service desk, we had tackled at the abandon rate from every angle, but a high volume of customers were still hanging up before we could answer their calls. At a loss for new ideas, Sandi Troyer, the customer service manager at the IS Service Desk, decided to call on the COE team, which she had worked with on a number of kaizen projects. After meeting with the COE team, we agreed that the service desk could benefit greatly from a kaizen event. Initially, the service desk analysts had mixed feelings about having the spotlight on their performance, but they knew, as we all did, that providing the best service possible to our customers and patients was our highest priority.
In February 2010, the IS Service Desk and COE launched a kaizen event, the goal of which was to reduce the average weekday abandoned call rate from 28 percent to 15 percent by March 30. Although our target goal was still well above industry targets, we knew that we had more variables affecting the abandon rate than did service desks in other industries (i.e., customers in patient care areas were often pulled from the phone to attend to patient needs).
To prepare for the kaizen event, we surveyed our customers—internal and external—so they could rate and review our service. Our internal customers are the IT support teams that receive ticket assignments from the service desk, and of the thirty-five representatives who responded, 64 percent were satisfied with our service. However, the survey also revealed that most of our internal customers needed clarification on the responsibilities of the service desk and wanted more detailed information on the ticket. Of the 625 responses we received from our external customers, 89 percent reported satisfaction, although 32 percent reported being unable to reach an analyst on the first attempt. Overall, we were surprised by the satisfaction levels reported—they were higher than we expected. However, we believed that we still had a lot of work to do if we were going to deliver great service.
The kaizen event identified several areas of improvement that would help reduce our abandon rate. We needed:
- Standard work instructions for support transitions;
- Workflow processes to help analysts multitask when working with customers;
- Emergency broadcast messages for systems issues/outages affecting the organization;
- Direct support access for select issues;
- Priority call processes, for dealing with calls that didn’t get priority attention (i.e., they ended up in voicemail and were not responded to as a priority);
- Faster access to voicemail (i.e., the ability to opt out to voicemail instead of holding) quicker voicemail response; and
- More quickactions, or scripts for entering tickets for the most common FCR calls (e.g., password resets).
To address ticket rejections, we implemented a support transition process that required our technical support partners to develop support plans and train the service desk analysts prior to rolling out any new applications or systems. They were also required to provide standard work instructions for new and existing applications that would enable the analysts to better process specific issues. This included escalation instructions that identified the issues that would be resolved on first call, those that would require immediate escalation, and the details that were required prior to escalation. This allowed for faster issue processing and resolution, which decreased the number of times each ticket was handled (less “ticket pong”).
We also issued the analysts additional monitors, which gave them the ability to extend their desktops. With this additional workspace, they could troubleshoot via remote access, enter trouble tickets, and research issues without having to constantly flip screens. Not only did this decrease the time spent on the line with the customer, it also allowed them to monitor the queues on their extended screens and track each other’s availability.
To prevent abandoned calls during major system outages and issues, we implemented standard work instructions that gave the staff the ability to record and activate an emergency broadcast message. This message is played for callers as the initial greeting, informing them of the existing problem, any actions they may need to take to effect a workaround or resolution, as well as an ETA for either resolution or the next status update. However, we did find that calls that related to critical patient care issues and came in during these outages were presenting to the same queue as noncritical calls. This meant that these “priority” calls were waiting behind noncritical calls. To ensure that priority calls were being given priority status, we moved them out of the normal queue and redirected them to an “always answer” line. The customer calls the same number, selects the option for priority, and is redirected to the priority line, which rings on all analysts’ lines, enabling them to respond more quickly to critical calls. In addition to the priority bypass line, we also decreased the time customers had to wait before given the option to leave a voicemail message, from 120 seconds to sixty seconds.
Finally, we implemented quickactions to decrease the time it took to enter common first-call-resolved issues into the ticketing system. Once the customer information had been entered manually, these quickactions automatically filled in data specific to the issue type, closing the ticket automatically and decreasing the time spent entering tickets after the call.
Implementing these changes improved our performance tremendously. We decreased the abandon rate on our normal queue to an average of 9 percent, surpassing our goal of 15 percent, and we were able to always answer incoming priority calls. Now that we were on the right track, we continued to look for areas where we could apply these techniques, to maintain our successes and continuously improve our customer service.
During our ninety-day wrap-up meeting after the kaizen event, we discussed the benefits of daily huddles. A daily huddle is a five- to fifteen-minute meeting where team members share information. We use the same agenda every day, we meet at the same time each day, and we focus on any issues, resolutions, roadblocks, ideas, and metrics from the previous day. We also created a standard template for communicating status updates to our management staff. We are quite proud of the fact that our daily huddle has become the model for other huddles throughout ACH.
ACH After Lean
By following through with the countermeasures identified in the kaizen process and surpassing our stated goal, we demonstrated a commitment to eliminating wasteful processes and using our personnel resources wisely. This commitment was instrumental in successfully obtaining approval for an additional staff member. While we were implementing the improvements, two of our service desk analysts transitioned into different areas in the department and we had to backfill those positions. Though we expected minor setbacks, by recruiting experienced service desk analysts, we were able to effectively manage our call volume with minimal interruptions, largely due to the improvements made during the kaizen event.
With additional staff and improved processes, we further reduced the service desk’s abandoned call rate (for the regular queue) to a daily average of 6 percent, which is steady and holding. Also, by redirecting the priority calls, we significantly reduced the customers’ wait time, allowing them to get back to providing exemplary patient care. We have readjusted our core hours to provide extended support coverage, added another staff member, and implemented a metrics dashboard and self-service, all of which have helped to maintain the successes we achieved through the kaizen event.
The key to successful continuous improvement is developing the people who do the work to change the work for the better. ACH’s journey through process improvement never ends, as we continue to develop our staff and improve our customer service, from the inside out.
Ronda V. Wicks is the service desk team lead at Akron Children’s Hospital. With eighteen years of experience as a computer technician, she implemented and is responsible for the daily operations of the service desk and ITSM. Ronda led her team’s successful Lean process improvement initiatives and presented a storyboard at the WCBF Lean Healthcare Summit in May 2011. She has received training in ITIL Foundations and is a certified HDI Support Center Team Lead and HDI Support Center Manager.