Bad telephone service can put practice on hold

A column answering your questions about the business side of your practice

By Karen S. Schechter amednews correspondent— Posted Aug. 15, 2005.

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Question: Recently I have been receiving complaints from my patients about our office's accessibility on the telephone and the way in which calls to the office are handled. I don't know if this is a staffing or an equipment issue. How can I identify the source of these complaints and rectify the situation?

Answer: The manner in which your telephones are managed has a major impact on the success of your practice. Effective telephone management addresses many patient complaints such as accessibility to doctors, ease in appointment scheduling and processing and returning calls.

The first task is to understand the demands on your system. How many published numbers and incoming and outgoing lines do you need to process your practice's volume of calls? First determine how many calls your office receives each day, the peak hours for incoming calls, and the number of calls lost because lines are busy.

If your telephone system is relatively new, you might be able to program it to generate usage reports. If not, you can obtain this information from your telephone company by asking it to conduct peak-load and busy-signal tests.

Once there is an understanding of the call volume and peak call times, develop and implement a plan to manage the incoming calls. Specific issues to address include the number of incoming and outgoing lines and how they are used.

For example, consider having different telephone numbers for calls from physicians and for certain services, such as billing, insurance processing and prescription refills. If there is a separate number for billing and insurance, include this information on patient statements and in the practice's brochure.

Another way of handling requests for prescription refills and reducing the related incoming call volume is to educate patients to call the pharmacy for refills instead of the physician's office. Establish a fax protocol with area pharmacies so all prescription requests are sent to a special fax located at the nurses' station.

Also, consider dedicating one or more lines for outgoing calls to reduce the likelihood that patients calling in will get busy signals.

You can also educate patients to call the office during non-peak times, particularly for nonurgent calls. Typically, non-peak times are from about 1 p.m. to 3 p.m. Your own practice's peak and non-peak times may vary; the telephone system/company reports will give guidance.

Adding new lines and telephone numbers will not necessarily lead to more efficient patient communications if the switchboard hours are too limited, or if there is not enough staff on hand to respond to certain patient calls in a timely manner.

The next task is to investigate what the patients experience when they call the office. Areas to look at include: the number of rings before someone answers the call, the friendliness and helpfulness of the person answering the call, how long the caller is put on hold, and what is accomplished during the call.

If the office has an automated attendant, try calling it and listening carefully to its instructions. Press the buttons for the various options to find out how quickly patients get the information they need. Are the options sufficient -- or overwhelming? How does the system handle emergencies?

Also be sure to evaluate the answering service. Are the telephone operators courteous, helpful and professional? How quickly and accurately does the service relay information to the physician on call?

The findings from this look at the patient's experience can then be used to develop performance standards and to implement policies and procedures that ensure calls are being handled in an efficient and effective manner.

Management should implement policies and procedures that support maintenance of the practice's telephone service performance standards.

In addition, there are tools that could be developed to help staff. Provide scripts for responding to the most frequently asked questions. Have a list of routine screening questions for certain types of callers, such as patients (new and established), drug representatives, and other vendors. Establish triage protocols for managing calls related to urgent, same-day or next-day appointments as well as providing phone advice.

You could even place a small mirror by the telephone so that the employee may monitor the tone of his or her voice by watching his or her facial features. Callers can sense an audible difference between a smile and a frown.

The key to an effective and efficient telephone service is having well-trained staff.

The skills and knowledge required to respond to a patient's medical needs are very different from those needed to answer a patient's billing or insurance questions.

However, one skill that is a must for everyone communicating with patients on the telephone (or in person) is the ability to demonstrate concern and an understanding of the callers' needs.

There are many ways to obtain telephone etiquette training for staff, including workbooks, audio and video presentations, Internet resources and workshops, either off-site or specifically designed for the practice.

Patients' telephone experiences, more often than not, set the tone for how they feel about the practice. Patients tend to judge the efficiency of a practice by how well its phones are managed.

Patients who have difficulty reaching your office to make appointments, contact a doctor or obtain care for an urgent problem are more likely to change practices.

Unfortunately, patients often make their decisions to continue with a practice based on the quality of customer service received, not necessarily the quality of care.

Karen S. Schechter amednews correspondent—

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