Context
A health services organization needed to improve patient-facing contact center reliability for appointment support and follow-up coordination.
Challenge
The organization was experiencing preventable service gaps in scheduling and follow-up operations, with added pressure to maintain strict compliance standards.
Observed gaps included:
- Missed follow-up contacts for time-sensitive cases.
- Inconsistent triage between administrative and clinical pathways.
- Variation in data-handling practices during patient interactions.
- Limited audit traceability for process exceptions.
Red Shore Solution
Red Shore Solutions introduced a care-navigation operating framework:
- Implemented triage rules aligned to urgency and case type.
- Defined controlled escalation paths for sensitive scenarios.
- Standardized scripting and documentation fields for key interaction types.
- Added QA calibration focused on compliance-critical behaviors.
- Established coaching loops tied to recurring documentation and workflow misses.
Operational Model Improvements
To improve consistency and readiness, the client adopted:
- Daily follow-up completion checks for open patient-contact tasks.
- Weekly compliance QA reviews and corrective action logging.
- Structured manager reviews of exception cases and escalation quality.
- Monthly process refinement cycles based on audit findings and frontline feedback.
Outcomes
The organization achieved stronger service and compliance performance:
- Missed follow-up contacts reduced by 34%.
- Scheduling completion rate increased by 22%.
- Compliance audit pass rate improved to 97%.
The operating model was later extended to additional care-adjacent service teams.