Ridgecrest Regional Hospital, One System, One Experience, Zero Missed Call Initiative
Discovery Phase:
Findings & Recommendations
For the first time, a hospital-wide investigation into how patient access actually works on the ground, what is holding teams back, and what a realistic path forward looks like.
Section 1
Why We Did This Work
For years, RRH has received consistent feedback from patients and staff about the same problem: calls go unanswered, voicemails pile up, and patients struggle to reach the right team. Until now, these complaints were addressed individually, a workflow tweak here, a staffing adjustment there, without a full picture of what was actually driving the problem across the organization.
This project was designed to change that. For the first time, we conducted a structured, hospital-wide investigation into how patient access actually works, what is holding teams back, what staff already know needs to change, and what a realistic path forward looks like.
The Core Finding
"Strong people are compensating for weak systems. That is not a strategy, and it is not sustainable. The path forward is to build the system that matches the people we already have."
Section 2
How We Went About It
Between April and May 2026, the project team conducted an in-depth discovery phase across 12 departments, combining staff interviews with direct workflow observation. Every team that touches patient access was included.
19
Staff Interviews
9
Shadowing Sessions
12
Departments
6
Weeks of Research
Departments and Teams Included
| Department / Area | Key Roles Included |
|---|---|
| PBX / Operator | Main-line operators, call routing and transfer workflows |
| Centralized Scheduling | Schedulers and authorization specialists across multiple service lines |
| South Plaza | Front desk, check-in, checkout, and voicemail workflows |
| North Plaza / Adult Medicine | Front office and scheduling, rural access challenges |
| North Plaza / Pediatrics | Front office and scheduling workflows |
| North Plaza / Cardiac Testing | Specialized scheduling and patient prep communication |
| North Plaza / Dental | Front office, Dentrix workflows, and dual-system complexity |
| Outpatient Plaza / Women's Health Clinic | Front desk, scheduling, and provider callout recovery |
| Outpatient Plaza / Surgery / GI | Surgical scheduling, prior authorization, fax intake |
| East Plaza / SSMC | Front office and scheduling workflows |
| Radiology Imaging | Front and back office, authorization and imaging scheduling |
| Medical Records / H.I.M | Records request intake and status communication to patients |
| Clinic Managers | Cross-clinic leadership, coverage, oversight, and visibility gaps |
Section 3
What We Found
Findings were organized into four categories. Every department touched more than one, which makes these system-level problems, not clinic-by-clinic issues. Click a card to read more.
A
Workforce Management
Staffing, coverage, roles, and leadership capacity. Who owns the work and when.
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A
Workforce Management
Staff are asked to do too many things at once. Phones, check-in, checkout, insurance, chart prep, and voicemail all compete for the same person's attention. Phone coverage is consistently the first casualty when everything else demands attention.
B
Patient & Employee Experience
The combined experience of patients reaching care and staff delivering it. Reducing friction, delay, and repeat effort.
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B
Patient & Employee Experience
The phone is the only reliable way most patients reach RRH. When that experience breaks down, patients do not disappear, they call back, walk in, or give up. Staff absorb the pressure through constant task switching and workarounds that depend on individual skill, not a reliable process.
C
Operations
Workflows, processes, handoffs, and daily execution standards. Callbacks, routing, scheduling, escalation.
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C
Operations
Workflows supporting patient access, voicemail, callbacks, transfers, provider callouts, reminders, and scheduling handoffs, are mostly manual, mostly undocumented, and mostly dependent on individual staff knowledge. No two clinics do it the same way.
D
Technology
Systems, integrations, automation, and reporting that enable access. Phone systems, EMR, reminders, data visibility.
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D
Technology
Teams work across Mitel, MightyCall Legacy, TeleVox, Paragon/Altera, Dentrix, and OneContent, tools that are not integrated, do not share data, and do not trigger workflows across each other, causing duplicate and manual work throughout the organization.
A
Workforce Management
Staff are asked to do too many things at once: Phones, check-in, checkout, insurance verification, chart prep, voicemail review, and patient follow-up all compete for the same person's attention. Phone coverage is consistently the first casualty.
- Most clinics have no designated phone owner, meaning no one is accountable when calls are missed.
- There are no defined backup models, so small staffing changes create outsized access failures.
- Managers and leads are pulled into daily recovery work, answering phones and rescheduling, instead of designing systems.
- Leaders have no visibility into call demand, queue depth, or callback aging by team.
Signal Moment
One clinic assigned a single staff member to own phones and voicemails. Their daily voicemail backlog dropped from 70 messages to 9.B
Patient and Employee Experience
The phone is the only reliable way most patients reach RRH. When that experience breaks down, patients do not disappear, they call back, walk in, or give up entirely.
- Patients call for appointments, prep instructions, referral status, records, and refills, many of which could be handled through other channels if those channels existed and were promoted.
- Callback expectations are inconsistent, triggering repeat calling before the first callback is even made.
- Transferred calls lose context, patients repeat their name, issue, and reason for calling at every handoff.
- Staff absorb the pressure through constant task switching and workarounds that depend on individual skill rather than a reliable process.
Signal Moment
One clinic reduced its no-show rate from 14% to 7% through staff-driven manual reminder calls, showing what is possible, but also how much is still being done entirely by hand.C
Operations
Workflows supporting patient access, voicemail management, callbacks, transfers, provider callouts, reminders, and scheduling handoffs, are mostly manual, mostly undocumented, and mostly dependent on individual staff knowledge.
- No standard exists for voicemail review intervals, callback documentation, or callback ownership. Each team has developed its own local approach.
- Provider call-outs trigger an all-hands manual process, blocking schedules, calling patients, documenting, and rebooking, with no automation support.
- Routing relies on staff memory. When staff do not know where to send a call, they use experience, not a reliable system.
- Cross-department handoffs, referrals, fax intake, and authorization follow-up, are resolved through direct calls, emails, or physical walk-overs rather than shared systems.
- Training is uneven. New staff learn by watching experienced colleagues. When those colleagues are out, quality and consistency drop.
D
Technology
The current technology environment is fragmented. Teams work across Mitel, MightyCall Legacy, TeleVox, Paragon/Altera, Dentrix, and OneContent, tools that are not integrated, do not share data, and do not trigger workflows across each other, causing duplicate and manual work.
- Voicemail transcription is not deployed across all clinic lines. Most staff manually listen to each message with no shared queue view and no record of who has responded.
- There is no unified view of call logs, voicemail queues, missed calls, or callback status for any clinic or for leadership.
- MightyCall Legacy provides voicemail transcription and missed-number capture where deployed, a capability that must be preserved through the Mitel CX transition.
- TeleVox reminders require manual correction when confirmations or cancellations do not sync cleanly with scheduling data.
- Paragon requires too many steps before staff can view availability, and system freezes during live calls force manual workarounds.
- Mitel's current setup does not support caller context through transfers, real-time queue visibility for supervisors, or click-to-call from scheduling screens.
Section 4
Issues Identified in the Field
Every issue was identified through interviews and shadowing sessions. Each has a reference code, the letter maps to its category color. Click any issue to expand the detail.
A. Workforce
B. Experience
C. Operations
D. Technology
A.1
No Voicemail Transcription on Most Lines
+
Voicemail transcription is only deployed on select lines through MightyCall Legacy. Most staff must manually call into voicemail and listen to each message individually, with no shared queue view, no way to assign messages, and no record of what has been handled.
A.2
Voicemail Queues Are Not Shared or Assigned
+
Each voicemail inbox sits with one person or one phone. There is no team view of what messages exist, who owns them, or whether they have been returned. When the owner is out, messages wait.
C.1
Incomplete Voicemails Slow Every Callback
+
Voicemails without a date of birth, callback number, or reason for call require staff to return calls with little context, adding time and effort to every interaction.
C.2
Patients Who Hang Up Are Never Recovered
+
Patients who disconnect without leaving a voicemail fall outside the callback workflow entirely. There is no systematic way to identify or return these contacts.
C.3
Callback Documentation Is Inconsistent Across Clinics
+
Callback attempts are documented through sticky notes, message books, chart notes, and verbal handoffs. There is no shared record of who was called, when, or what was resolved.
C.4
No Clear Escalation Path When Callbacks Are Missed
+
Phone ownership rotates informally. When a callback is missed, there is no defined owner and no escalation trigger.
D.1
Transferred Calls Display the Operator Number, Not the Patient
+
When a call is transferred through the operator, the receiving team sees the operator's number. If the call drops, the callback is impossible.
B.1
Patients Are Placed on Hold With No Managed Experience
+
Staff answer quickly but frequently place callers on hold to finish in-person service. There is no visibility into hold duration and no standard for how long a hold is acceptable.
C.5
Phone Hours and Callback Standards Are Not Consistently Communicated
+
Phone hours, expected callback timing, and voicemail greeting instructions are not standardized. Patients receive different information depending on which clinic they reach.
A.3
No Dedicated Phone Ownership in Most Clinics
+
In most areas, phone coverage defaults to whoever is available rather than dedicated phone call owners or a Scheduling Call Center. This creates gaps during busy periods and eliminates clear accountability when calls are missed.
A.4
Morning Call Surges Collide with Lobby Traffic
+
The highest call volume of the day arrives at the same time as in-person check-in. The same staff are expected to manage both simultaneously, which means one consistently loses.
A.5
Two-Person Coverage Creates Instant Backlog
+
When one of two desk staff is occupied with an in-person patient, the phone queue builds immediately with no overflow path or backup structure.
A.6
No Defined Backup Model for PTO, Callouts, or Lunches
+
When someone is out, the remaining team absorbs double-duty with no pre-defined coverage plan, a predictable, recurring access failure managed through improvisation.
A.7
Managers and Leads Are Used as Daily Recovery Support
+
When volume spikes, managers step in to answer phones and reschedule appointments, limiting their ability to manage performance, coach staff, or improve systems.
A.8
Language Access Requests Pull Lead Staff Off the Phones
+
When bilingual staff are pulled into translation support, phone coverage and scheduling work stop.
A.9
Scheduling and Inbound Calls Compete for the Same Staff
+
Outbound scheduling, inbound return calls, voicemail review, and authorization checks all fall to the same person at the same time, each competing with the others.
C.6
Patients Routinely Reach the Wrong Department
+
Patients frequently reach a team that cannot help them and must be re-routed, requiring re-identification and re-explanation at every handoff.
C.7
Operators Route by Memory, Not a Reliable Directory
+
Operators use local knowledge to route calls when the phone tree or directory does not cover the situation, creating inconsistent outcomes depending on who answers.
D.2
No Real-Time Performance Dashboard for Managers
+
There is no centralized view of call volume, queue depth, abandoned calls, voicemail aging, or callback status. Managers rely on complaints and delayed reports to understand what is happening.
D.3
Repeat Callers Create Duplicate Work With No Shared History
+
Prior contact attempts are not visible in one shared place. Staff cannot see whether a patient has already called, what was discussed, or whether a callback was attempted.
D.4
Operators Absorb Non-Patient Traffic With No Filter
+
Fax tones, robocalls, wrong-business calls, and other non-patient traffic route through the same operator lines with no triage or filtering capability.
D.5
No Caller Context at the Point of Transfer
+
When a call is transferred, the receiving team does not see who is calling or why before picking up. Every transfer starts from zero.
C.8
No Scheduling Call Center for Primary Care Clinics
+
Unlike diagnostic and imaging services supported by Centralized Scheduling, primary care clinics each manage their own appointment scheduling and authorization work independently. This creates inconsistency in workflows, uneven staffing loads, and a lack of standardized escalation or overflow support. Most hospitals of comparable size have moved to a centralized or hybrid scheduling model. RRH used to have a dedicated Scheduling Call Center in the past.
D.6
Scheduling Requires Too Many Steps Before Viewing Availability
+
Booking an appointment requires too many clicks before staff can see provider availability, extending every live call and increasing the chance of scheduling errors.
D.7
System Freezes Force Manual Workarounds During Live Calls
+
Paragon EMR freezes during scheduling force staff to reboot, restart questionnaires, or complete the booking manually while a patient is on the line.
C.9
Provider Schedules Cannot Be Compared Side by Side
+
Staff check one provider at a time when booking, no multi-provider calendar view, which lengthens every scheduling call.
C.10
Appointment Reminder Failures Default to Manual Recovery
+
When TeleVox reminders fail to sync with scheduling data, staff manually call patients to verify appointments, cancellations, and no-responses on the same day.
C.11
Faxed Orders and Authorizations Require Full Manual Processing
+
Faxed orders and authorizations require manual scanning and data entry before scheduling can proceed. Authorization knowledge is concentrated in a small number of people, creating a fragile dependency.
D.8
No Click-to-Call From Scheduling Screens
+
Outbound calls require manual dialing. There is no integration between the scheduling system and the phone, adding time to every outbound contact attempt.
C.12
Provider Call-Outs Require All-Hands Manual Rescheduling
+
Provider absences trigger a full manual process: blocking the schedule, calling each patient, documenting, and rebooking. There is no automated notification path.
B.2
Phone Is the Only Reliable Access Channel
+
Patients use the phone for scheduling, prep questions, referral status, results, medication refills, and general questions because no other channel is consistently available or promoted, concentrating all access demand on a single, manually operated channel.
B.3
No Approved Text Messaging Capability for Patient Communication
+
Patients regularly request appointment details by text. Staff do not have an approved tool to send them. Patient preference and operational capability are misaligned.
B.4
Verbal Prep Instructions Are Not Followed by Written Confirmation
+
Patients receive prep details verbally during discharge or scheduling calls with no consistent written follow-up, driving repeat calls from patients who forgot the details.
B.5
Patient Portal Is Underutilized Due to Inconsistent Promotion
+
FollowMyHealth exists but patients are not consistently told how or when to use it for results or how to interpret certain results. Portal adoption depends on which staff member the patient happened to speak with.
B.6
Same-Day Provider Changes Do Not Reliably Reach Patients
+
When a provider is unexpectedly out, patients who miss the initial call, do not check voicemail, or have limited cell service may still arrive for a cancelled appointment.
B.7
Spanish-Language Materials Are Not Consistently Available
+
Bilingual staff are the default workaround for language access gaps. When unavailable, patient communication quality drops and Language Line calls can take several minutes, pulling staff away from other work.
B.8
Patients Duplicate Requests Across Channels
+
When patients are unsure which channel will be worked first, they leave voicemails and submit online forms for the same request, creating duplicate work without improving their own access.
Section 5
What Teams Are Asking For
Staff and managers were asked directly what would most improve the patient and employee experience. These are not wish-list items from one or two vocal voices, they are recurring themes across every team we interviewed. Click any item to expand.
Section 6
What We Are Recommending
Recommendations are organized by category. Where scope or timeline is still being defined in partnership with IT, this is noted inline. Click any item to expand the rationale.
Scoping in progress
Scope and timeline being defined in partnership with IT
A
Workforce Management
Define daily phone and voicemail ownership per shift
+
Assign a named owner for each shift with a named backup. This alone will improve callback consistency before any technology changes are made.
Establish same-day callback as an organizational standard
+
Set and communicate a clear expectation: all voicemails returned by end of business. Managers track compliance and report it.
Design coverage models for lunches, PTO, and callouts
+
Define minimum staffing floors and backup rules for every clinic. Cross-train designated backup owners so access does not depend on a single person.
Evaluate and expand a Scheduling Call Center model
+
Most health systems of comparable size have moved to a centralized or hybrid scheduling model. Mitel's own implementation team has noted this structure is both common and recommended as part of telephony modernization. Assess which services and clinics are best served by a Scheduling Call Center, den on individual clinic front-office staff while improving consistency and access reliability.
Formalize a workforce management model for patient access
+
Define staffing ratios, role structures, and coverage standards for front-office and scheduling teams tied to call demand data rather than historical precedent.
B
Patient & Employee Experience
Standardize voicemail greeting language across all clinics
+
Patients should hear consistent instructions on callback timing, what information to leave, and hours of availability at every clinic.
Enable SMS patient communication capability
+
Allow text for appointment confirmations, reminders, and urgent provider-change notifications, reducing callback volume from patients who prefer not to use the phone.
Redesign appointment reminder workflow with texting
+
Move to staged reminders for appointments booked months in advance. Automate confirmation and cancellation handling where possible.
Expand omnichannel access across phone, SMS, chat, and portal
+
Create a unified patient access model where appointments, reminders, results questions, and prep instructions can flow through the channel that works best for each patient.
Build patient self-service scheduling for routine appointments
+
Allow established patients to book standard appointments online or via AI-assisted phone and SMS, freeing staff for complex calls and clinical questions.
C
Operations
Begin tracking misroutes and repeat callers
+
Even a simple log creates the baseline data needed to redesign the phone tree and justify routing changes before Mitel CX goes live.
Share findings with all clinic managers
+
Managers need to understand what was found, what is changing, and what their teams will be asked to do differently.
Scoping in progress
Deploy standardized front-desk training through Relias
+
Digitize phone and scheduling training. Replace ad hoc peer training with a consistent onboarding and annual refresher curriculum available to all clinics. Scope and timeline being defined in partnership with IT and Relias.
Establish monthly performance reporting cadence with managers
+
Monthly review of KPIs by clinic covering Live Answer Rate, Abandonment Rate, Same-Day Callback, and First Call Resolution. Managers accountable to targets, not just awareness.
D
Technology
Audit and clean up the current Mitel phone tree
+
Remove outdated options, consolidate confusion points, and ensure every path leads to the right destination, before the new system is implemented.
Preserve voicemail transcription through the Mitel CX transition
+
Confirm with the implementation team that voicemail visibility and missed-number capture will not be lost during the Mitel CX cutover.
Establish baseline KPI reporting from existing data
+
Pull call volume, voicemail counts, and callback patterns from current systems. Establish starting benchmarks before Mitel CX is live.
Implement Mitel CX with purpose-built routing and queue configuration
+
Go live with a phone tree designed around patient intent, not department structure. Configure shared voicemail queues, supervisor dashboards, and caller context through transfers.
Deploy shared voicemail queues with status tracking
+
Replace individual voicemail boxes with team-visible queues showing ownership, status, and aging. Escalation rules trigger when callbacks exceed the defined threshold.
Scoping in progress
Integrate telephony with EMR for caller context at time of answer
+
When a patient calls, their record appears automatically, eliminating re-identification, reducing call time, and enabling smarter routing based on appointment history. Scope and integration path being defined in partnership with IT.
Build a hospital-wide access performance dashboard
+
Real-time visibility across all clinics into the core KPIs. Leadership can see access health across the organization without waiting for reports or relying on complaints.
Scoping in progress
Evaluate AI-assisted scheduling and virtual front-door capability
+
Assess AI receptionist and virtual callback tools that allow patients to book, confirm, or reschedule without waiting on hold. Scope and vendor evaluation being defined in partnership with IT.
Section 7
12-Month Roadmap
A visual overview of when each phase of work begins, peaks, and transitions. The six-month milestone marks the point where foundational changes should be visible in performance data.
Zero Missed Call, Initiative Roadmap
Jun 2026 to Jun 2027
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
Apr
May/Jun
QUICK WINS
Assign phone and voicemail owners
Same-day callback standard
Standardize voicemail greetings
Mitel phone tree audit
Baseline KPI reporting
MEDIUM TERM
Mitel CX go-live
Shared voicemail queues deployed
SMS patient communication
Relias training rollout (scoping)
Scheduling Call Center evaluation
6-Month Milestone Review
LONG-TERM
AI-assisted scheduling (scoping)
Telephony and EMR integration (scoping)
Hospital-wide access dashboard
Omnichannel access model
12-Month Program Review
Quick Wins (0-90 days)
Medium Term (3-9 months)
Long-Term (9-12+ months)
Milestone Reviews
Pending IT scope
Section 8
What Success Looks Like
These six metrics define what a fixed access model looks like at RRH. They are grounded in healthcare call center benchmarks and tied directly to what patients and staff told us they need. Click a card to read the definition.
>95%
Live Answer Rate
CLICK FOR DEFINITION
Live Answer Rate
Percentage of inbound calls answered by a live staff member during defined service hours.
<5%
Call Abandonment Rate
CLICK FOR DEFINITION
Call Abandonment Rate
Percentage of callers who hang up before being answered. High abandonment means patients are giving up.
<3 min
Average Speed to Answer
CLICK FOR DEFINITION
Average Speed to Answer
Average time from call entry to live answer during posted business hours.
100%
Same-Day Callback
CLICK FOR DEFINITION
Same-Day Callback
All voicemails returned by end of the same business day. No message carries over to the next morning.
>95%
First Call Resolution
CLICK FOR DEFINITION
First Call Resolution
Calls resolved in one interaction, no repeat call, transfer loop, or voicemail follow-up needed.
>90%
Patient Satisfaction
CLICK FOR DEFINITION
Patient Satisfaction
Patient-reported satisfaction with their phone access experience, gathered through survey feedback.
Section 9
What We Are Asking For
For the Whole Group
This initiative requires organizational commitment, not just project permission. The problems identified are systemic and have persisted for years precisely because they were never addressed at scale.
- ✓Formally endorse the Zero Missed Call Initiative as a strategic priority, with visible executive sponsorship
- ✓Support resource allocation for the next phase, including Mitel CX configuration, training development, and SMS capability
- ✓Hold teams accountable to the KPIs as part of operational performance reviews, not just patient satisfaction scores
- ✓Recognize that this is a 12-month transformation, not a one-time fix. Sustained progress requires sustained attention.
For Clinic Managers
The first wins depend on you. Technology will help, but the first 90 days are about people, ownership, and standards.
- ✓Name a daily phone and voicemail owner for every shift, and a named backup, starting now, before anything else changes
- ✓Stop taking voicemails after hours. While voicemail transcription will be rolled out with Mitel CX, we can help you implement it temporarily in the meantime.
- ✓Enforce the same-day callback standard. Track it. Report it. Make it a team expectation, not a suggestion.
- ✓Participate in the Mitel CX configuration process, your input on routing, queues, and workflows will determine how well it works for your team
- ✓Engage your teams in training rollout through Relias. Consistent standards only happen if managers prioritize them.
- ✓Share what is not working. This project depends on honest feedback from the people closest to the problem.
"Strong people are compensating for weak systems."
The path forward is to build the system that matches the people we already have: standardized workflows, better technology, and the visibility for managers to lead instead of just recover.
CONFIDENTIAL, Ridgecrest Regional Hospital, Zero Missed Call Initiative, June 2026, Prepared by Ziad Jureidini and Victoria Martinez