Public Health Care Appointments without the Wait

View PDF version

Health Care Appointment Scheduling

Since 2002, SACYL has been the organization responsible for the Public Health Service in the “Comunidad Autónoma de Castilla y León.” Castilla y León (CyL) is a region located in northwest Spain, with approximately 2.5 million inhabitants. The CyL region has two distinct characteristics that present particular challenges to its Health Service providers:

• Its population is quite sparsely populated with roughly 26 inhabitants per square kilometer (1/3 of Spain's average)
• Its population is elderly, with 22.6% of citizens over 65 years of age -- the highest among all regions of Spain, where the average is 16.7%.

SACYL manages 14 hospitals, 241 health centers and 3650 local clinics spread across its territory, and its appointment service receives approximately 20 million calls per year.

SACYL wanted to implement a call scheduling service for all of their facilities which would allow users to manage their appointments through both an automated speech-enabled IVR system and interactions with live attendants. They required a solution capable of handling high call volumes, especially during peak times. They also needed to intelligently route calls to call centers or health centers according to the call type and other relevant information. The solution management should be outsourced – to avoid large personnel costs of maintenance, and paid for on a pay-as-you-go model. It also had to be quickly scalable to support growing applications, and new functionalities needed to be easily implemented.

The Challenge

A primary patient complaint had been that it was difficult to arrange medical appointments by phone. This is a common problem in all “Comunidades Autónomas” in Spain.

SACYL has a centralized appointment software application capable of managing the schedules of all health services at every location. However, each hospital or health center was responsible for its own appointments, handled by that facility’s personnel -- either face to face or by telephone. This fragmented infrastructure was an inefficient way to use valuable resources, so SACYL implemented several initiatives. They encouraged scheduling via the Internet, and brought in an outsourcer to assist with telephone appointment scheduling. However, the volume of calls during peak hours overwhelmed their response capability.

In addition there were other problems to be solved, among them:

• Service Operating Hours - The human-based appointment service was not available 24 x 7, leaving evening hour calls unattended. Problem: Citizens had to wait for an appointment longer than the authorities’ target
• Monday's Peak Traffic - Every weekend there was an accumulation of people's health problems that caused a large spike in appointment requests on Monday mornings. Problem: The cost of allocating the required number of agents was extremely high
• Complex Appointments - There was a significant percentage of calls that required simultaneous appointment setting of a complex sequence of medical exams. This kind of appointment(s) could only be handled by qualified resources, so citizens were asked to make a second call directly to the hospital.  Problem: The citizens’ perception of the quality of the centralized appointment service was low

The deployment of new physical call centers for the whole health system would have meant huge investments in technology, human resources and management. Therefore, SACYL required a cost effective, scalable and reliable integrated solution that would also free up essential hospital personnel to perform their dedicated higher priority services.

The new approach had to heavily rely on the automation of appointment calls to alleviate congestion during peak hours, while providing seamless interconnectivity between all of the healthcare facilities and 24x7 service availability.

The Answer - Custom Contact Center Solution from Telefónica

Telefónica, the world's fourth largest telco, developed a solution that integrates Interactive Voice Response on Demand (IVRoD) + Contact Center on Demand (CCOD) services with a custom-tailored networking solution unique to the public health sector. This solution also includes the capability to manage appointments using SMS or an Internet interface. The solution manages the whole appointment process, and routes other types of calls to the appropriate location. 70% of the calls are automatically handled via self-service. The solution is based on Telefónica's VoIP MacroLAN service whose integration with CosmoCom's CosmoCall Universe (CCU) contact center technology allows rapid deployment to all SACYL Health service locations, including unlimited consolidated virtual call center sites as well as remote teleworkers.

The heart of the solution is the unique combination of Natural Voice recognition technology and CCU's routing capabilities. The IVR is so sophisticated that even elderly or foreign speaking people (with a variety of accents and pronunciation nuances) pose no problem. All calls are resolved without difficulty on the first try. If the caller requires specialized attention, the call is forwarded to the appropriate health center. In any case, if the caller has any difficulty with the IVR, the call is immediately forwarded to a call center agent for special attention. The service is being expanded to handle specific health campaigns such as flu vaccinations. SACYL is also planning the extension of the service to include medical specialist appointments, health card changes, assigned health center changes, and more.

The system database provides a unique consolidated vision of the whole service’s key performance indicators. This strategic view allows the Health Service to continuously improve caller satisfaction while optimizing performance and productivity..