KPI Focus: AHT, FCR, CSAT, SLA
The Situation
A health services organization needed more reliable care-navigation support. Patients were contacting the team for appointments, follow-ups, and guidance, but the operation was struggling to stay consistent under compliance pressure.
What Wasn’t Working
Three issues caused most of the pain:
- Follow-up contacts were being missed in time-sensitive cases.
- Triage decisions varied between administrative and clinical pathways.
- Documentation quality was inconsistent for audit-sensitive workflows.
What We Changed
We helped the team introduce a tighter operating model:
- Set triage rules aligned to urgency and case type.
- Clarified escalation paths for sensitive patient scenarios.
- Standardized scripting and documentation fields for critical interactions.
- Implemented QA calibration focused on compliance behaviors.
- Added coaching loops for recurring workflow and documentation misses.
What Happened
The results were meaningful for both service quality and compliance confidence.
- Missed follow-ups dropped by 34%.
- Scheduling completion improved by 22%.
- Compliance audit pass rate reached 97%.
The organization later extended the same model to adjacent care teams.
A Real Moment From the Engagement
During an early review, managers identified that missed follow-ups were usually process misses, not effort misses. That reframed the work from “push harder” to “design better controls.”
Before vs After (Operationally)
- Before: Follow-up ownership changed hands without clear closure checks.
- After: Follow-up completion became visible and reviewable every day.
What Changed for the Team
Care-navigation staff had clearer triage boundaries and less uncertainty when handling sensitive scenarios.
Constraints We Worked Within
- Limited time to redesign workflows without disrupting live service.
- Existing tools and reporting structures that could not be replaced immediately.
- Need to improve performance while maintaining day-to-day SLA commitments.
Tradeoffs We Made
- Prioritized highest-impact workflows first instead of trying to fix every queue at once.
- Chose repeatable process controls over one-off optimizations.
- Deferred lower-priority enhancements until baseline stability was proven.
If We Were Starting Again Today
We would still start with ownership clarity and a fast governance cadence, but we would add earlier frontline shadowing in the first two weeks to accelerate practical workflow adjustments.