From the January 2006 Issue

On Track

Mobilizing Materials Management: Case History

Out With the Old, In With the New:  Case History

Predictive Analytics and the New  World of Retail Healthcare

Power to the People

Identity and Access Management:  the Starting Point for a RHIO




Making the First Call Count

Utah health sciences center uses knowledge management software to improve customer service as demand increases.

By Greg McFarlane

Greg McFarlane is a customer advocate at University Health Care at the University of Utah Health Sciences Center. Contact him at gregory.mcfarlane

Physicians, nurses and other healthcare professionals expect from their computer systems what patients expect from them: absolute accuracy, full availability and fast response. Without fast IT support for hospital operations, hospital costs can rise dramatically. While the problem of slowed operations has a significant financial cost, the more serious cost is in patient care, health and safety—making our help desk role at University Health Care mission critical.

University Health Care is part of the University of Utah Health Sciences Center, which includes colleges of medicine, nursing, health and pharmacy, and supports administration, business and research for these colleges. The Health Sciences Center includes four hospitals and a variety of research facilities on the university campus, and 11 community clinics throughout the Salt Lake City area. University Health Care generated $492 million in total revenue and other income last year.

The IT department at University Health Care manages a full network environment, from a physical network to the PCs, terminals and mobile devices in use at the hospitals, in offices throughout the campus, and in the clinics. The department relies on more than 500 servers and supports more than 319 applications. The range of desktop configurations we support covers rolling stands in operating rooms, desks in faculty members’ offices, laptops in helicopters and counters in clinic exam rooms. Our help desk handles 5,000 telephone calls from 18,000 users and generates 500 Web trouble tickets a month. The IT department offers three levels of support:

University Health Care in Salt Lake City.

Help Desk: Front-line skilled agents who answer most calls from users and are expected to solve most issues on the first call. Currently, our staff of 16 supports this 24/7 help desk.

Applications Teams: Our applications experts are responsible for continuing to advance IT throughout the campus, including installing version upgrades for software and implementing new software. They are focused on projects, but team members also handle calls that knowledge agents escalate to them. There are four to six members on each team, which are based on various departments and functions, such as admitting, billing, Medicare/Medicaid and our health plans.

Operations Teams: Our four teams of approximately five members, who deliver applications and maintain our infrastructure, also back up the help desk when appropriate.

Too Little, Too Late
When I joined University Health Care in the winter of 2003 as manager of the operations teams, we had a problem. The number of applications and our customers’ expectations were increasing, yet the help desk’s ability to meet demand remained the same. Based on customer feedback, we knew we had relatively long hold times—an average of nearly five minutes—before users got a live person to resolve their problems. For example, some calls about password issues, were easy to resolve. Other calls, such as patient care calls and financial admission questions, were more difficult, leading to longer than acceptable hold times for other callers. Twenty-seven percent of callers gave up and abandoned the call, and if users made it through to an agent, only 58 percent of their calls were resolved on the first try.

Help desk agents told us we had little information available for them to successfully handle customers’ issues quickly, and what was available was difficult to find. Our ability to resolve problems as quickly as we can on the first call is critical to keeping patient care running smoothly and critical to keeping costs down. We needed to make more information accessible to our agents, thereby increasing first call resolution and decreasing the average hold time for each call.

Also, new agents took a whole month to train and our back-up teams were getting bogged down in problems forwarded to them from the help desk. We needed to get new agents up to speed quicker and to free up the applications and operations teams to concentrate on what they primarily were hired to do.

At the root of our problems was an ineffective knowledge infrastructure. Our knowledgebase was still in its infancy, and while new applications were implemented every week, the applications teams were not documenting the new information in the knowledgebase. Therefore, a growing amount of information was not available to flow through to the help desk. We needed a new emphasis on continually authoring new information to build and strengthen the knowledgebase.

Since the late 1990s, University Health Care has used ServiceWare’s KPX knowledge management product and a Remedy product for trouble-ticket management and to track our “close” rate. Agents create a work log in Remedy when they answer a call, look the problem and solution up in Knova, then switch back to Remedy and close the call.

Sharing Knowledge and Experience
To increase the capabilities of the help desk, in March of 2004 we upgraded from ServiceWare’s KPX to their Knowledge Desk product. In February 2005, the product became Knova Knowledge Desk when ServiceWare and Kanisa merged to create Knova Software Inc. based in Cupertino, Calif. Regardless of what we call it behind the scenes, our customers at University Health Care call it “FirstCall.”

Implementing the upgrade not only enabled our operations staff to share information more interactively, but it ranks problem resolutions, so agents share not only knowledge but also experience. The application does this itself, which means that agents can effortlessly help one another and maintain a relevant, highly fluid body of information. When root causes of problems change daily, for example if an application is down versus a server being down, an agent can see that six or seven other agents have used one solution within the hour as the correct solution. This increases the chances that it is the right answer for their call.

The new knowledge management software also makes it easier for our agents to author new knowledge when new applications or upgrades are in place. This reduces the need for our agents to escalate calls to the applications team—decreasing costs and length of calls, but more importantly, getting calls answered more quickly. In addition, the new diagnostic search functionality helps resolve customers’ issues quickly and accurately. Its ability to pull answers from any data source we connect it to, gives our agents the right information at the right time. Lastly, the automation of key resolution processes enables new agents to get up to speed more quickly. By prepopulating case notes, pre-establishing workflows and other techniques, we created an environment that enabled agents to operate as effectively as possible, regardless of their experience.

In the spring of 2005, we further upgraded Knova Knowledge Desk 6.0 to 6.5. This consolidated information on one screen for agents, instead of on multiple screens, making it even easier for agents to access information and problem solve.

Service and Demand Up
Since 2003, the IT department has grown tremendously from basic network and application support. We now support data warehousing, interface development, traditional and electronic medical records and clinical charting systems. In addition, we support physician billing, a statewide telehealth network and complete ancillary systems. During this time, we reduced our call abandonment rate, increased our first call response resolution and significantly increased the effectiveness of our training process. Here’s how our results stack up:

  • The number of abandoned calls was reduced to 4.5 percent from 27 percent;

  • First-call resolution rate increased from 58 percent to 74 percent;

  • Average hold time decreased from around five minutes to less than two minutes (4:43 to l:49).

Prior to Knova Knowledge Desk, new agents trained with experienced agents for 30 days. After we implemented the application, training time dropped to five days. “Rework” for the IT staff also was reduced and problems were resolved for users in less time. Operations and applications staff documented and posted solutions once to help desk agents, instead of repeatedly searching for and e-mailing files to them. The database provided an organization standard to help agents find the correct information, helping them learn faster and resolve more calls.

Sharing information easier helps advance entry-level help desk agents along their career paths. Agents can join the applications and operations teams sooner, because they already know the environment and are familiar with the applications. Finally, by continuing to upgrade our knowledge management software, we have enabled the entire IT department to meet an increased demand for its services. In the next year, we will link the information in Remedy and Knova more effectively to further reduce troubleshooting time on the phone and solve problems more quickly.

For more information on Knova’s service resolution management solutions,

© 2006 Nelson Publishing, Inc