I was awoken by a strobe of orange light flashing through the bedroom windows.  I looked out and saw a human caravan making their way to my backyard.  By the time I had dressed and made my way out the deck door, I saw two men hammering wood stakes into the wet ground, and a woman stringing what looked like crime-scene tape around the stakes.  Another half-dozen people were talking on phones and writing on clipboards while a lone woman was collecting water in test tubes.

The grass was sodden from the recent rains. As I approached the group a guy built like a linebacker approached me and asked, “Where do you think you are going Skippy?”

“Why is everyone in my backyard and standing around my puddle?” I asked.

“It was your puddle, now it’s a wetland.  Go back inside voluntarily,” he said as he reached for what looked like a Taser.

To my left was another puddle, one they had yet to rope-off.  I flopped into it on my back and started moving my arms and legs.  The Taser was now pointed at my head.  “What are you doing? He screamed.

“Making wetland angels,” I replied.  “I think I may have just been bitten by a rare, yellow-bellied newt.”

The world is changing faster than I can yell tree-sloth, and I didn’t even get the email.

Several of you wrote asking me to give an example of the differences between a well-functioning call center and the scheduling centers found in most health systems.  This may help.

I pulled together a meeting with James and Betty.  James works for your scheduling center; you probably seen him in the cafeteria—tall, lanky…parts his hair on the left.  Betty works for Nordstrom.  I asked them to tell us what their job is like and what they do during their shift.

James began. “My job reminds me of one of those people I’ve seen at a driving range,” he said.  “If you’ve ever hit balls at a driving range, you may have seen a person driving around on the range in what looks like a metal birdcage.  It looks like a wheeled metal box wrapped in wire, and it is pulling a long, rubber, grooved cylinder.  The grooves pick up the driving range balls, and they are dropped into a collection basket.”

“I’ve seen those when I golf,” I said.  “Everyone tries to hit the cart with their shots.”

“Exactly.  That is what it feels like answering calls at the scheduling center.  Everyone is shooting at me and I just have to sit there and take it.  I bet you didn’t know that only about twenty percent of the calls I answer are from someone trying to schedule an appointment.”

“What do you do with the rest of the calls?”

“Sometimes I try to answer them, but I don’t have any of the tools or information I need.  So, I either tell them to call another number—that may or may not be the right number—or I transfer the caller to someone who may or may not be able to answer their call correctly.  Sometimes I find myself giving basic medical advice.”

“Don’t you have a nurse that can do that?”

“You’re kidding, right?  Heck, we don’t even have a decent scheduling system to be able to enable me to do my job.  I bet I am only able to schedule sixty percent of the people who need an appointment.”

That was James. Betty’s response was just as interesting.

“Have you ever been to a big city park where they have dozens of chessboards set up?” I nodded affirmatively.  “Well sometimes a master chess player will play dozens of games simultaneously, the master against all of the others.  That is what my job at Nordstrom’s call center feels like.  No two questions are the same, and I am expected to give the right answer to every caller the first time, every time.  But I have a CRM systems that lets me know the answers to every question.”

“So, let’s say I call you about a problem I had with a suit I purchased and had tailored at one of your Seattle stores.  Could you help me with that even though I bought it in Philly?”  I heard her enter my phone number into her system.

“The one you bought June 3^rd, the Ted Baker pinstriped?  I see you called once before.  It looks like the alterations to the pants were incorrect, and they applied a credit to your account.  You shipped it back to be re-altered on the 11^th.  The alterations were finished on the 23^rd.”

“I still have not received it.”  More keyboard clicks.  It shipped yesterday, overnight, along with a tie picked out by your personal shopper; no charge for the tie.  May I help you with anything else?”

There is a world of difference between what a health system’s scheduling center can do and what a real call center can do.

I just realized that I was supposed to have scheduled my MRI yesterday.

What should I do?  What would you do?  I dialed the phone.  “Betty, there is one more thing you can help me with…”