The Journey from Push Communications to Two-Way Conversations



Elissa Nelson, M.A., Senior Director, Systems Transformation, Office of Access Management, Mayo Clinic

Courtnie Garteski Bergler, Director, Innovation Contact Center, Office of Access Management, Mayo Clinic

Brenda Johnson, M.S., Senior Business Analyst, Systems Transformation, Office of Access Management, Mayo Clinic

Ashley Powell, Business Analyst, Innovation Contact Center, Office of Access Management, Mayo Clinic

In 2022, Mayo Clinic invested in an Innovation Contact Center to experiment with new tools and technologies to discover the pathway to an effective, patient-centered scheduling journey. The learning lab consists of a team of nine: a director, supervisor, business analyst and six schedulers. The Innovation Contact Center has prioritized solutions such as bi-directional texting and call technology with automated call logging and disposition. The team is testing patient communication solutions to discover the most effective modes and methods to elicit the highest contact success rates with patients.

In the Innovation Contact Center, experiments are conducted on requests for appointments that come in through Mayo Clinic’s digital appointment request form. The experimentation process for the Innovation Contact Center begins with design/hypothesis, then we test our experiments in three-week pilot sprints, after we measure outcomes. Subsequently, this may lead to changing variables and re-testing.

The Innovation Contact Center has currently conducted seven experiments related to two-way texting. The initial outbound messages being tested were designed with the goal to convert to a phone call to continue the scheduling and registration process. The initial outbound text, at a base level, asks the patient “are you available now?” From there, we tested different versions of the initial outbound message. Subsequent messages are related to negotiating the time that works best to reach the patient, therefore, converting the text message to a scheduled phone call visit to further the conversation.

Mayo Clinic started with a minimal viable product to use as a platform during the two-way texting experimentation phase. This allowed us to find what we value in a tool long term in terms of reporting, scheduler and chat administration, and overall ease-of-use features. Characteristics we found to be valuable with a texting platform are automatic distribution of incoming chat to available agents and analytics that include average handle time. Both are important to appropriately staff for chat volumes and the patient experience.

Key findings and recommendations include:

1. The response rates of text messages could be overwhelming, so having a text management tool that can distribute and throttle messages is important to operational success.

2. Texting proved to have the highest contact success rates versus phone or email.

3. Content matters; test the verbiage that elicits the strongest response rates.

4. Ensure staff messages to patients reflect the brand and tone of organization: “text-pectations”.

5. Engaging patients and agents for feedback is an important part of a successful implementation and iterative approach.

The Innovation Contact Center has allowed our team to explore key questions for patient access leaders. For example, what is the right balance of information to share in a single outbound text? Is not providing a call back number okay to do to encourage continued engagement via text and not phone? Is a final contact attempt text message that encourages a reply to “cancel” the request if not interested appropriate to conclude the interaction? These are all message iterations that we tested in our pilots. We found that less is more. Patients do not need to know our office hours and call back number in the initial outbound text message. We also worked with our communications department to ensure outbound text messages were written with proper structure and appropriate grade level; for example, not using “Thx” but rather “Thank you.” It is important to train staff and monitor text transcripts to ensure timely and professional responses occur. Texting may seem like an informal means of communicating in our personal lives, but when texting as a representative from a healthcare organization, we want to ensure brand standards are upheld. Mayo Clinic has call quality guides specific to phone interactions, so we had to develop quality guides specific to texting called “text-pectations” to guide agents.

After consultation with our legal and compliance department, we designed the next phase of our experimentation, which begins this spring.  We will move the texting conversation into a “secure” encrypted environment where agents will gather some basic registration and demographic information. The goal is to gauge the comfort level and engagement of the patient during the extended two-way conversation. Before extending and expanding the texting interaction, we will need this foundational information to know how to adjust staffing and what the common drop off point is, if any, with a full text encounter.

Texting is a journey.  As you think about moving into texting at your healthcare organization, Mayo Clinic’s CEO Gianrico Farrugia, MD, advises: “Think Big, Start Small, and Move Fast.”