Quality Control: Why It’s Essential for your Healthcare Contact Center!

In the next edition of our Consultancy & Advisory thought-leadership series, we take a deep-dive into Quality Management Systems with our Director of Quality Assurance, Mary May. An experienced and knowledgeable expert in all aspects of quality solutions, Mary tells us about the subtle but important distinction between Quality Assurance and Quality Control, and why understanding this difference is key to a fully comprehensive and robust quality program.

Can you tell us about the role of Quality Management in general?

The overall Quality management solution is about ensuring your product or service is delivered to the highest standards, and that all the aspects that encompass your product or service are measured and monitored to guarantee that excellent standard is reached every time.

Quality Specialists are tasked with evaluating all elements of the services being provided, to audit excellence at each stage of the service and to ensure that the services are in alignment with Best Practice Industry Standards.

Can you explain about the difference between Contact Center Quality Assurance and Quality Control?

Contact Center Quality Assurance (QA) refers to the auditing of pre-determined business process standards.  Quality Specialists evaluate Patient Service Representative (PSR) call interactions to measure adherence to specific business requirements to ensure compliance and the achievement of an ideal caller experience.

Contact Center Quality Control (QC) focuses on PSR accuracy, technical knowledge and the skills demonstrated to ensure that the caller’s request is actioned correctly to avoid any negative impact on either the caller or business.

Quality Specialists audit documented actions of a PSR against specific error criteria and provide feedback to highlight the error and assist in changing the behavior demonstrated.

The ISO 9000 standard defines Quality Assurance as “a part of quality management focused on providing confidence that quality requirements will be fulfilled.” Quality Control, on the other hand, is: “A part of quality management focused on fulfilling quality requirements”.

In combining a QA and QC approach to PSR interactions, it is possible therefore to ensure the correct actions and steps are completed, thereby achieving both the best possible caller interaction, in addition to compliance and accuracy adherence.

How would this look in terms of Patient Access and Healthcare Contact Center activities?

RelateCare’s Quality focus is on contact center activities within healthcare organizations. One aspect of these activities would be in appointment scheduling services, whereby patients contact their healthcare provider to schedule an appointment suitable for their needs.

This is an extremely important and yet under-appreciated aspect of the patient journey.  Completing this process accurately can create strong levels of patient engagement and loyalty. However, should the patient encounter any roadblocks or if errors are made during the scheduling process, both the patient and provider can be impacted, resulting in potential lost revenue for the Healthcare system.

How does the QC solution work in this setting?

Data relating to scheduled appointments is collated and extracted daily, with each appointment listed being screened for accuracy against specific error criteria.  Where an error is identified, details of the error is documented within an error tracker which is a shared document with the Team Manager.  At RelateCare, Quality Specialists provide error feedback directly to the PSR concerned.  The Team Manager then engages with the PSR to ensure that the error is corrected and to provide coaching to avoid recurrences of the error.

Just in time screening is crucial to ensure that errors are identified in as close to real time as possible and that corrective action is taken as soon as possible to avoid Patient and Provider impact.

QC reports are collated on a daily, weekly, and monthly basis and distributed to the Operations Team.  This assists the Operations Team in detecting error trends and patterns for each PSR and in turn, is encompassed within the performance management process.

Is the QC process limited to appointment scheduling only?

The QC process can also be applied to most aspects of patient interactions for example, accurate capture and documentation of patient demographics and insurance, call routing, telephone encounters, medication refills, etc.

What is more important, QA or QC?

The optimum approach is to implement both QA and QC to ensure a comprehensive quality management approach.

While a PSR can have a positive call interaction and achieve HIPAA compliance with excellent service behavior, if the patient’s request is not processed correctly, the resulting impact may be patient dissatisfaction, provider scheduling issues and ultimately, the potential loss of revenue for the Healthcare system.

Can you give us an example of the impact of RelateCare’s Quality Control program?

A large Healthcare system we recently worked with demonstrated a high level of errors, with an error rate of 50%+.

RelateCare engaged a full Quality Control review, with 100% of scheduled appointments being screened for accuracy.  The main error drivers were identified for both individual PSRs and the scheduling team overall.  Over a number of weeks and with consistent appointment screening, error identification and direct PSR feedback, the QC Team working with the Operations Team noted a significant reduction in the error rate to ≤6%.

While it is not feasible or practical to consistently perform 100% QC due to the high level of resources required, it may be advantageous for short periods of time to address adverse error rates.  Ultimately regular and consistent QC screening will better support both Operations and PSRs in achieving accuracy in their scheduling interactions.

A flexible approach to the QC process is essential as there may be instances where certain PSRs may need additional focus to assist them in achieving and maintaining accuracy in both QA and QC.


Mary May has over seven years experience in contact center management and advisory services. Mary leads RelateCare’s Quality Assurance division, focused on designing and optimizing partner specific quality assurance and quality control programs for both RelateCare’s  consulting and outsourcing engagements. Mary is an expert in the development of  industry leading best practice QA/QC scorecards with a focus on data capture (QC) and exceptional patient experience (QA) and has completed study with the National Association of Healthcare Access Management (NAHAM) and Epic.

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