Let’s build better patient experiences from the ground up

When asked about their top patient access priority for 2023, 64% percent of medical leaders named access/scheduling. Establishing a high-performing, centralized patient access center creates consistently positive patient experiences. But improving scheduling, registration, and other front-office functions doesn’t just benefit patients. Clinicians and staff can work more productively with a centralized, well-managed front office, and organizations save time and resources.  

How should organizations begin to work toward patient access and acquisition goals? Here’s how to develop and sustain a standardized, centralized patient access center that will create better experiences for patients and those who provide care. 

Why Centralize Patient Access Services? 

Services such as registration, appointment scheduling, and referral management can be optimized and consolidated, which moves them to the top of the list of things to address when searching for efficiencies. In Prescription for the Future: The Twelve Transformational Practices of Highly Effective Medical Organizations, oncologist and bioethicist Ezekiel Emanuel details the benefits of centralizing patient access services: 

“Among many, direct benefits of centralizing front-office services include increased operational oversight with a singular point of accountability, consistent pathways for communicating and maintaining a brand experience, and ultimately, cost efficiencies. Indirectly, centralized services also provide an avenue for challenging conversations about provider availability and individualized scheduling rules that tend to limit access to appointments whether intentionally or not.”

Direct Benefits of Centralizing Patient Access

A prevalent misconception is that creating a centralized patient access center will inherently improve patient access. However, simply co-locating existing, often siloed, operations and personnel without foresight and intentional design will never achieve the efficiencies or on-brand experiences that an organization seeks. Assessing, standardizing, and optimizing workflows before centralizing operations will set an organization on the correct path to achieving its access and efficiency goals.  

Sample Patient Access Organizational Structure

Five Key Steps for Centralizing Patient Access 

There are five foundational steps needed to begin centralizing patient access.  

1. Gain Leadership Support: A centralized patient access center must have strong buy-in and support from clinical and administrative leaders. The strategic initiative is different from process improvement efforts and should be communicated throughout all levels of the organization.  
2. Establish Guiding Principles: A set of guiding principles to drive and govern the design of centralized services should be created in a multidisciplinary setting and be strong enough to hold up against opposition. 
3. Create a Cultural Change Management Strategy: A comprehensive change management plan tailored to the organization’s level of cultural acceptance should precede any centralized services implementation and work in parallel throughout the implementation period. 
4. Implement Reporting and Analytics: Measuring and tracking data throughout the design and implementation process will help leaders benchmark, forecast, and make better decisions. 
5. Determine an Investment Strategy: While patient access centers are traditionally considered cost-cutting vehicles, the industry recognizes long-term value proper investment yields. 

Leadership Support of Standardization & Centralization

Just as an organization would not leave branding and patient experience strategies to individual medical offices or departments, a patient access center impetus and design will never succeed if it is department-based. A brand and experience strategy must be singular and deliberately driven from the top down. The same is true for a patient access center. Standardization and centralization discussions are often met with serious opposition from clinical staff. When provider practice and clinic operational differences are streamlined, the perception (and sometimes reality) is loss of control. However, most custom templates and approaches do not work in a centralized environment.  

Consider a hospital with 10 primary care practices, each employing 10 providers. At the clinic level, it might be reasonable for a front-office employee to manage 10 different ways of scheduling a new patient appointment. In a scaled patient access center environment, however, a single agent who is taking calls for those 100 providers would never be successful in managing 100 different pathways for a single workflow. 

Because a minimum level of standardization must be achieved to effectively centralize services and realize economies of scale, the concepts of standardization and centralization must have proactive and unwavering support from the highest levels of the organization. As current state operations begin to change with the initiative, hospital and provider leaders should be prepared to address adverse feedback. Leaders should proactively communicate their support of centralization to all levels of the organization starting with the “why” and reasons behind the transition. Answers to these questions should remain consistent, and realistically address what individual preferences a centralized center can and cannot accommodate.  

Another key component for leadership is to make a high-functioning patient access center a strategic priority. Early engagement with providers and staff who can help generate early adopters will dramatically increase the likelihood that the effort succeeds. Furthermore, establishing the patient access center leader at the Vice President or Executive Director level will demonstrate the level of value placed on the patient access center. 

Finally, leaders should be prepared to enforce adoption of the centralized center rather than allow groups or departments to opt-out. A hybrid model of centralized and decentralized processes loses economies of scale and minimizes the gains it can deliver. Additionally, a hybrid model perpetuates an inconsistent patient and brand experience. The ability to measure the centralized center’s effectiveness and return on investment hinges on the organization going all-in.

Guiding Principles Created by a Multidisciplinary Team 

Once the concepts of standardization and centralization are endorsed, a set of guiding principles to drive the design of centralized services should be created in a multidisciplinary setting that includes influential provider leaders. The guiding principles will be the source of truth when workflow design requests conflict with the project goals, and help to ensure the final operational design meets the organization’s mission. 

Guiding principles should be detailed enough to assist in decision-making when an impasse is reached and should span from operational workflows to technology use. They should also highlight any deviations from standard work that will be accepted and the rationale for that acceptance.

In other words, standardization paves the way for enhanced access and timeliness.

Think about the experience you are trying to create. For example, when a patient calls to schedule an appointment, the agent should be able to book that appointment at a convenient time and within a period that meets the organization’s access goals. If that is a guiding principle, designing streamlined scheduling rules and removing non-essential barriers to appointments become tactical ways to meet that principle.

The vision statement and guiding principles below are examples developed by a multidisciplinary team at a large, academic health system. These statements drove the design of a comprehensive, centralized patient access center and were pivotal to the long-term success of the program. 

Guiding Principles 

• Build a world-class patient access center that supports all providers and ambulatory locations within our health system. 
• Focus on a consistent, standard service delivery model that provides optimal access for patients and families. 
• Create a patient-centric experience that supports and promotes the delivery of high-quality clinical care. 
• Build upon the organization’s current capabilities, using and expanding processes already proven to be successful. 
• Deliver patient support services in a consistent and seamless way, regardless of the location or specialty. 
• Help patients and families navigate all aspects of their care process. 

Cultural Change Management 

Relocating services out of the providers’ offices is uncomfortable. Although organizations differ in their level of readiness for this effort, many leadership teams use the same “get it done” approach, sacrificing critical investment in the time to gather buy-in and understanding from their clinical teams. Guided by a strong medical director, a comprehensive change management plan tailored to the organization’s culture and engagement can prevent backlash. The plan should also act as the platform for providers and clinical staff to participate in the effort. It is important that the change management plan lives and breathes in parallel with the implementation process. After the implementation is complete, revisit the revisit the plan to gather feedback and learnings. 

A change management plan should address anticipated pain points like loss of control, shifting from independent to team-based care, adjusting to new visit types, visit type definitions, and scheduling algorithms. It should also offer outlets for discussion and provide an escalation pathway to a multidisciplinary decision-making body that can and will protect provider scope of practice requirements while also upholding the guiding principles. 

This step is one of the hardest and most time-consuming, but one of the most important to ensuring a smooth implementation and strong program. Gathering feedback across the design, implementation, and post-implementation continuum is tedious and will require dedicated support to manage. But the return on investment in the form of provider and staff engagement well worth the time and resources.  

Sample Implementation Workstream Structure

Dedicated EHR and Analytical Support 

Patient access centers are inherently data rich, and there is power in that data. Many organizations struggle to harness the ample information at their disposal and present it in meaningful ways. That said, the most successful patient access centers employ a dedicated analytics team, allowing them to stay nimble and adjust to environmental changes in real time. 

Dedicated analytical support from the beginning of the patient access journey is the fourth critical element of a standardization and centralization effort. As with most transitional projects, assessing pre- and post-performance against benchmarks is important for creating the project’s initial burning platform, and subsequently measuring progressive change along the journey.  

A return-on-investment analysis may also be required because some level of investment in the centralized center will be necessary. Employing an analytics manager and report writing staff will allow for continuity across the centralization effort. These team members will also be able to support sensitivity and “what-if” analyses that may be requested by the organization’s financial and operational departments for major staffing decisions.  

Access to the appropriate IT systems to garner the data is paramount. As a result, the analytics manager and report writing staff should have direct data access, or at least a single point of contact within the broader IT department, who can quickly assist with data queries and interpreting the data into actionable insights. Without dedicated staff and data access, assessing both ad hoc and longitudinal performance will be increasingly challenging and time consuming. 

Finally, centralizing front-office departments requires full support from the organization’s EHR team. Often, the EHR can support greater automation and functionality than is currently enabled. Solutions and capabilities that were previously unknown also come to light when operational teams can brainstorm an optimal workflow with the EHR team. Moreover, as the patient access center operation evolves, updates to the EHR will iterate into the future. 

Expect to Invest

It is true that centralized services can lead to significant operational and staffing efficiencies. However, efficiencies tend to materialize further into the future and only after proper investment is allocated.  

Underinvesting in the patient access center is a common mistake that frequently derails the effort. Organizations must carefully measure their existing patient access infrastructure against the minimum requirements for launching and maintaining a patient access center. Metric goals and Service Level Agreements (SLAs) should also be part of that assessment. Understand that only hitting the minimum requirements may hinder the development of best practice workflows. Executive leadership and project sponsors should review the following items and be prepared to dedicate resources to them if not already in place:  

• Modern telephony platform and internal telecom support.
• Internal support for new EHR system build and optimized workflows.
• Medical directorship to partner in leadership and change management.
• Leadership team for the centralized patient access center.
• Telephonic nurse triage and advice services.
• Front-line staff to support existing and future-state operations.
• Training staff to design, implement, and provide recurrent training.
• Quality assurance staff to measure adherence to workflow decisions.
• Reporting and analytics staff.
• Intra-day coordination staff.

Of these ten items, staffing is a top challenge understood by both project and executive leadership. Staffing a patient access center is unlike traditional inpatient and clinic staffing calculations or unit of service models. Dedicated analytical support and workforce management technology can help organizations calculate the true need for agents and full-time employees (FTEs). 

Avoid believing the myth that because phone work is moving to patient access centers, FTEs from those clinics can be reallocated too. Although that might be the case in some instances, shifting staff members does not guarantee that the patient access center will be staffed to meet desired service levels. Most organizations are missing data that demonstrates actual demand for their services. For example, just because a clinic’s main phone number rings 100 times every day does not necessarily mean only 100 people are trying to reach the office. The phone platform may be dropping calls or governing how many calls can be answered within a given time. As a result, the true phone demand is unknown, and staffing the access center to match that call volume may fall short of meeting call metric benchmarks.  

Patient access center support services should also be considered. Dedicated trainers who can build and maintain curriculum are critical to staff performance and ensuring first-touch interactions are top-notch. Similarly, a quality assurance team should be in place to monitor performance and highlight workflow improvements opportunities. Lastly, a workforce management team to manage both long-term and intra-day staffing will ensure the patient access center is well-staffed to meet service level goals. 

Antiquated technology platforms will also hinder an organization’s ability to realize desired efficiencies. Technology should facilitate the most effective and satisfying experience for all stakeholders. Most high-performing patient access centers have implemented omnichannel solutions to enable automated calling, texting, chatting, and online scheduling. Although initially expensive, robust technology can move a portion of patient contacts away from human intervention, which creates a more cost-effective, long-term strategy for managing year-over-year volume growth. Modern telephony platforms can allow for remote agent work and reduce the cost of physical facility builds and expansions.

Centralizing scheduling and other front-office functions can increase access to appointments while also providing more focused care for patients while they are seen in clinic.

Ezekiel Emanuel, MD

According to Ezekiel Emanuel, MD, centralizing patient access centers is a best practice and is cited as one of his twelve researched practices that leads to transformational change for healthcare organizations. Because establishing centralized patient access will impact nearly every department or unit within a healthcare organization, leaders should approach the initiative by considering both immediate and long-term objectives, expectations, and metrics for success. Following these guidelines will help organizations avoid missteps as they move toward a more unified, consistent patient experience that improves efficiency, productivity, and patient loyalty.