Is your telephone hurting your practice? Phone do's and don'ts

Imagine an auditorium filled with your patients, prospective patients, every physician who sends you referrals and every pharmacist who handles your prescriptions. If you wanted to make a good impression, would you keep them waiting, then send your least-experienced staff member to address the crowd without a script?

That's effectively what many physicians do every day when it comes to manning their office telephones, experts say. They forget to train anyone in the office how to deal with the barrage of questions callers may have and leave the responsibility for making a good impression on staff members without telling them what to say -- or what not to say.

Patients' impressions about their phone interactions with office staff are a significant contributor to their overall satisfaction with physicians' offices. Health industry survey firm Press Ganey asks patients every year about their satisfaction with various elements of their doctors' offices and consistently hears complaints about poor service over the phone, according to its most recent "Medical Practice Patient Satisfaction Pulse Report," released in November 2010.

In the report, which was based on a survey of 2.7 million patients, the firm reported, "Patients continue to voice frustrations over the ease of scheduling appointments, the helpfulness of telephone staff and the promptness in return calls."

Karen Laccheo, a receptionist for her husband, Topeka, Kan., family physician Michael Laccheo, MD, said the practice is on a mission to make sure his patients are never frustrated.

The office uses many of the best practices recommended by customer service experts. Laccheo said her husband feels strongly that patients at his practice always should be able to reach a person, not a machine.

His Yellow Pages listing notes, "No phone menu. Speak to courteous staff." And true to the listing, Laccheo answers the phone, in a cheerful voice. "I just believe in good service -- I want it to be as if you were going to a Ritz-Carlton," she said.

Dr. Laccheo, who is in solo practice with a staff of three nurses, said he can hear phone conversations a few feet away when he's between patients.

"I think a lot of physicians don't know what happens at the front desk, or don't care, or choose not to care," she said. "But they should. They should realize it's the first point of contact for patients, and it should be the most pleasant and courteous contact."

Jeffrey Denning, a practice management consultant based in La Jolla, Calif., said patients' first judgments of a physician's office often are based on almost subconscious impressions. When patients have a hard time finding the office, can't find a parking spot or arrive to find a dirty office, they judge the quality of the practice, even if it has nothing to do with the physician's clinical skills. The same is true of phone interactions, he said.

"The big issue with telephone service is cementing the idea with the new patient that the doctor is a good doctor. New patients don't know what to expect. ... That person who answers the phone needs to sound competent."

The professional approach

More specifically, Denning and other experts said, the person answering your phone should sound relaxed, comforting and professional, no matter how busy the office is.

"People forget they're dealing with people who are sick, or their kid is sick, or their mother is sick," said Jim Grigsby, a practice management consultant in Sebastian, Fla.

The person calling should not sense stress or frustration from the person answering the phone -- something customer service consultant Nancy Friedman calls "emotional leakage."

Friedman, a self-described "telephone doctor" (not a medical one), advises business owners of all kinds, including physicians and medical office managers, on phone customer service.

"Empathy and sympathy are very crucial components of a phone call," she said. "Most physicians have a large constituency of seniors. They talk slowly; they don't have all their information ready. It can be nerve-wracking when you're taking information. But rushing a patient through questions, or rushing through their information, is rude."

She believes it's common for patients to switch practices because they're treated rudely by someone over the phone, sometimes even before they've seen the physician.

Friedman's "phone doctor" career began with a call to her insurance agent, telling him she was canceling her coverage because of persistent rude customer service when she called his office. He responded by inviting her to help train his staff, and she hasn't stopped giving telephone customer service advice since.

She and other experts say the first step to success is to realize that all office staff needs phone training to make it happen.

What's my line?

Consultant Denning advises doctors to script everything they possibly can. That means nothing is left to chance, staff members are empowered to help callers rather than just take messages, and patients get better service.

Scripted responses are good for more than the initial greeting, experts say. When everyone knows how to answer the phone correctly, staff can meet regularly to talk about the kinds of calls and how best to handle them. Perhaps another physician in town in your specialty retired -- what do you tell her patients when they call looking for a new doctor? Maybe you decided to drop out of a certain insurance carrier's network -- what do you tell that plan's members?

At a more basic level, Denning said the person answering the phone should know what type of patients you want to see more of, what type you don't see, which insurance coverage you do and don't accept. The goal is for the person answering to be able to handle virtually every call without consulting someone else. "When you hear a receptionist say, 'I'm going to check with the doctor and give you a call back' more than once a day, you've got a problem," he said.

Posting scripts by the phone is useful if you have an issue you know will prompt calls. For example, if you change office hours, make sure the staff has scripts to explain why.

For a smaller practice, the scripts may be unofficial. At Dr. Laccheo's solo practice in Kansas, the small staff could hear one another on the phone, so a common script emerged without writing it down.

Where and how the phone is answered

In many physicians' offices, one person is the receptionist, answering phone calls while also greeting patients who come in the door. That's not a good formula for good customer service, Grigsby said.

If you can afford it, have one staff member devoted to answering phone calls, Denning said. Even better, have that person sit far from the front desk, in the same room as patient files, or in front of a computer where they can access the office electronic medical record. That allows the person to grab a patient file quickly to consult it or make an entry in the file while on the phone.

If that person is a nurse, he or she can triage by listening to the caller describe symptoms and deciding whether the patient should come into the office and, if so, how soon. If the nurse can handle prescription refills, even better -- that will eliminate the stack of requests from piling up on the physician's desk.

At Dr. Laccheo's practice, that's precisely what happens. One nurse works the phones full time, and Laccheo handles scheduling and prescription refill requests, so there's no voice mail or message stack waiting for nurses or the doctor. This means the physician can see patients and stay on time.

It may sound like a waste to have a highly trained staff member answer phones, but Denning said that's a common mistake. "Traditionally, we break people in on the front desk, and we promote them away from it."

Of course, physicians should handle some calls themselves. Denning said he worked with a pediatric practice that had a "mother's hour" every day, when physicians were available to talk to parents over the phone. Doing that, he said, was a wise alternative to exchanging messages or having the parent schedule an unnecessary appointment.

That might not make sense for other specialties, but there are other times, particularly with angry patients, when a physician should handle calls, Denning said. Dr. Laccheo does talk to patients when it's called for, his wife said.

Denning said it's not hard to tell when physicians need to pick up the phone: "When a patient is not satisfied with somebody else, and you know it when they won't let it go, using your best technique, you ask the patient, 'What can I do to make this right?' "

In many cases, he said, complainers just want to be heard. Otherwise, they wouldn't bother speaking up. They would just stop calling.