As a former Kaiser Permanente call-center employee, I found "Kaiser Clerks Paid More for Helping Less" (May 17) quite interesting. I worked in the Vallejo call center for nearly two years, primarily in the obstetrics/gynecology specialty queue. Although the scripts we were required to follow made transfers to nurses mandatory for most symptomatic patients with ob/gyn concerns, I was constantly pressured to keep my transfer rate below 35%, not 50%. The 35% rate was consistently enforced for all employees, including evening and weekend staff members, who could not book appointments because the Kaiser facilities were closed. Management wanted us to send messages to medical providers whenever possible, even when we knew that the messages would not be answered for several days.
Because I do not have a medical background, I worried a lot about symptomatic patients and transferred them to a nurse if I had any doubts about the best course of action. Although I managed to earn a bonus every quarter, I finally decided that the job was causing more stress than I wanted in part-time employment (I am a retired state auditor). By the way, even though the bonus program has been stopped, appointment clerks were still receiving management feedback on call-handling time and transfer rates on May 10, my last day at Kaiser.
American Canyon, Calif.
Regarding Kaiser's "incentive" program for its message center employees, I find myself stunned. Certainly Kaiser's policy of paying a bonus to switchboard operators for keeping their interactions with patients short cannot be faulted. After all, this is simply a way to reward them for increasing their productivity by handling more calls per shift. As long as this criterion is tempered by evaluating patient satisfaction as well, I do not see a problem.
However, paying bonuses for limiting patients' access to telephone "triage" nurses or their ability to even schedule an appointment with a doctor is as perverse an incentive as any I can think of. These employees are not health-care professionals. There appears to be only two ways to achieve these ends: dispense advice in lieu of transferring the call to a trained nurse and convince callers they do not need a doctor's appointment. Both of these approaches are, to put it mildly, problematic.
John S. Ford MD
I find it absolutely astounding that telephone clerks, in the name of efficiency and subsequent bonuses, were making decisions on who got to see a doctor or talk to a nurse! As a Kaiser Permanente customer, this information is especially appalling since we have been informed that, effective Jan. 1, our premiums will be increased by 25%. Lest the focus of the decision be foisted off on clerks, let's not forget that evidently Kaiser executives failed to consider the other overriding part of the service delivery formula, i.e., will this action "improve quality of service"?