For many healthcare organizations, the massive shift to virtual care sparked by the pandemic was a trial by fire.
Facing unprecedented demand for telehealth and hybrid care services, organizations were forced to rethink their tech infrastructure, develop new operational protocols, and hire and train additional staff virtually overnight.
Two years on, the tech, teams and workflows many organizations pulled together as stop-gap solutions are struggling to consistently yield quality care at scale. Meanwhile, even seasoned telehealth leaders are sometimes so busy keeping the wheels turning that they’re in the dark as to whether their team is meeting their organization’s quality standards.
Are patients having a positive telehealth experience? Are staff feeling fulfilled and empowered in their new or newly-demanding roles? Do managers have the visibility and resources they need to develop staff and reward top performers?
All too often, the answer to these questions is simply, “I don’t know.” And even when the answer is known, the why behind it may not be clear.
In this post, I’ll give a quick overview of three of the key challenges that keep organizations from maintaining quality standards and measuring performance via telehealth QA. Call them the three T’s: time, talent and training.
Time: Overcoming a deluge of manual work
Unless you’re on the front lines at a contact center, it’s easy to forget just how much of the average staff member’s day is eaten up by tedious, repetitive, manual administrative tasks.
Scheduling appointments, coordinating referrals, searching knowledge bases for information, seeking authorizations — it all adds up. That’s not to mention all of the prep, note-taking and other formal documentation staff members need to do before, during and after each call. Oh, and remember: A decent chunk of that work goes to waste due to cancellations and no-shows.
While such tasks may be a necessary part of any quality telehealth workflow, piling them all onto a staff member’s plate inevitably draws their energy and attention away from what should be their central focus: their patient. This can result in shorter, shallower interactions peppered with distraction and missed information, compromising patient experience (and an organization’s bottom line) over time.
The admin time sink doesn’t stop with front-line staff, either. Often the only option for managers looking to gauge how well staff are meeting quality standards is manually reviewing call recordings — a huge, impractical time sink for even the most experienced operations specialists (more on this later).
Thankfully, technology can be a big — and relatively easy-to-deploy — difference-maker here. Whether you keep things basic with automated call transcription software or opt for more advanced conversation intelligence tools that are able to extract key details from calls and provide documentation support from pre‑charting through post‑encounter, any relief from the admin burden can go a long way.
While building a quality telehealth program is much more about people than technology, it’s important to remember the outsized impact thoughtfully-chosen tools can have on staff performance and morale. The right technology can not only save people time, but also help them re-focus their energy where it’s most valuable.
Talent: Finding and keeping quality clinicians
As is the case throughout the healthcare industry, attracting and retaining quality talent is a major challenge for telehealth organizations in today’s tight labor market.
Indeed, one telehealth leader recently told me that at any given time, their team has over 30 full-time openings they can’t fill, describing their hiring challenges as being “on steroids” post-pandemic.
Telehealth is still a relatively new discipline, so it makes sense that qualified candidates can be tough to find. Plus, those most experienced with clinical charting and note-taking (registered nurses and nurse practitioners) demand higher salaries and better perks than the medical assistants and licensed vocational nurses often employed in telehealth roles.
But I’d argue the talent is worth the cost.
Not only can short staffing on the managerial side make ongoing telehealth QA a pipe dream, skilled frontline clinicians are perhaps the most important piece of the puzzle in ensuring calls consistently hit quality standards and fuel a positive patient experience. That’s no longer a “nice-to-have” when it comes to improving an organization’s bottom line.
Telehealth optimization consultant Christian Milaster makes this point in a terrific post on measuring telehealth program success. Milaster cites clinician satisfaction as the most important metric healthcare leaders need to pay attention to, calling it the “most critical metric of all (and the one most health systems ignore).” Because of its outsized impact, Milaster even ranks clinician satisfaction above technical and financial performance.
The good news is that a slight majority (54 percent) of clinicians polled in the American Medical Association’s 2021 telehealth survey reported that the move to telehealth has improved the satisfaction of their work, with flexibility one of the key themes highlighted in respondents’ additional comments.
Still, nearly a quarter (24 percent) disagreed or strongly disagreed with this sentiment. Another 21 percent remain neutral on the question.
With this in mind, a key priority for every telehealth organization looking to consistently meet its quality standards should be creating working conditions that appeal to talented external candidates and boost job satisfaction for current employees.
But where should you start?
New training programs that promise to give clinicians the skills they need to create and run their own telemedicine practices as independent contractors may give us a clue. If the marketing messaging behind these programs is any indication, two major sources of dissatisfaction with traditional telehealth jobs are lack of organizational support and, again, that heavy admin burden.
One such program, the Institute for Telemedicine Mastery, features these sentiments prominently in its marketing bullets, offering its training as a fit for clinicians who feel “isolated, alone and that no one is looking out for [them]” and “forced to look at [their] screen more than [they] look at [their] patient.”
To attract and retain the sort of talent that helps an organization reliably hit its quality standards, leaders need to invest in building workflows that make life easier for frontline clinicians and be more proactive about offering ongoing training and support.
Management should also review performance evaluations and patient experience surveys when determining whether the cost-savings offered by hiring less-experienced or credentialed clinicians are worth a potential trade-off in quality standards.
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Training: Impractical audits, limited insight and coaching
One of my favorite quotes on management comes from famed business consultant Peter Drucker: “If you can’t measure it, you can’t improve it.”
It’s simple, easy to remember and hard to argue with: If you want to know how your organization is doing and improve, you need to be able to track performance, see where you’re falling short and adjust accordingly.
Telehealth teams want more feedback, too. Over 55% of clinicians in the AMA’s telehealth survey cited additional staffing resources to support workflows and telehealth-specific training as key opportunities to improve telehealth workflows in their practice.
Unfortunately, however, many organizations have failed to effectively operationalize the telehealth QA audits and performance evaluations needed to ensure teams are hitting their quality standards. Operations managers lack the time, tech and other resources needed to effectively measure performance and offer supplemental coaching and training to staff members who need it.
Managers can glean some top-level metrics like hold time and missed calls from typical call center software, but without taking a deep dive into call logs and transcripts, it can be next-to-impossible to effectively assess individual performance. And who really has the extra hours needed to add auditing on top of regular team meetings, one-on-ones and other everyday operational challenges?
Without consistent, sustainable auditing and coaching, staff are forced to rely on checklists and constant retrainings. Coaching is generalized, high performers aren’t acknowledged and quality standards slowly start to dip.
Again, the right tech investments can be a big help. A number of SaaS companies offer conversation intelligence tools designed to empower managers with data-driven insights into staff performance while making it easier for managers to offer real-time feedback.
Instead of manually reviewing call recordings or transcripts, managers can tap into the power of AI and natural language processing (NLP) to analyze calls and other communications at scale and identify where additional training or coaching could be helpful.
Bottom line: Telehealth QA needs to be prioritized
Tracking and maintaining telehealth quality standards was challenging even in normal times, but it’s become exponentially more difficult given the new demand for telehealth that’s come out of the pandemic.
But difficult doesn’t mean impossible.
While organizations deserve credit for adapting to extraordinary circumstances, telehealth leaders need to recognize that simply keeping the ship afloat won’t be enough in the long run. Organizations need to invest in the people, technology and processes that will make telehealth a better experience for staff and patients. That includes lightening the admin load, investing in skilled clinician and doubling-down on timely feedback and performance evaluations to ensure quality standards are met.
The tools and expertise are out there — they just need to be prioritized.
