Improving Telephone Management in Your Practice

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AAFP=20 Home Page > News & = Publications > Jo= urnals=20 > FPM=20 > May = 2005

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May=20 2005 Table of Contents

With a few simple changes, you can give your patients = better=20 service and your staff a break.

George Conomikes

Covered in FPM Quiz

Tool inside

Although telephones are intended to = provide=20 physicians and patients with a convenient means of communication, both = callers=20 and staff often get lost in the morass of calls. For example, callers = get busy=20 signals, calls go unanswered during normal business hours, callers sit = on hold=20 for long periods of time, receptionists sound hurried and patients don't = get=20 their questions properly resolved. The result? Frustration for everyone=20 involved.

Telephone mismanagement problems are = just as acute=20 today as they were 10 or 20 years ago, as evidenced by the high turnover = rate=20 for receptionists in physicians' offices. However, implementing the=20 recommendations below will result in better phone service to your = callers and=20 lessen the pressures on your receptionist.

KEY = POINTS

=E2=80=A2 Practices that lack proper phone = management systems=20 often experience unnecessary stress when handling incoming calls.=20

=E2=80=A2 By conducting a phone traffic = study, practices can=20 see which times of the day and which days of the week experience = the=20 heaviest phone traffic and can plan accordingly.

=E2=80=A2 To maximize telephone efficiency, = consider adding=20 extra phone lines and designating special call-back times in your=20 appointment schedules.

Perform a telephone traffic study

To help you address the problems related to = phone=20 management, consider performing a telephone traffic study. Design a = worksheet=20 with spaces for one-hour periods throughout the workday. (See an = example=20 below.) Ask your phone receptionist to record each incoming call = with a mark=20 in the appropriate time slot. This will show you the number of incoming = calls=20 each hour. Use a separate sheet every day, and record all calls for four = to six=20 weeks. If your practice experiences seasonal peaks, study phone traffic = during=20 those periods, too.

A phone traffic study will help you = determine=20 whether you have enough staff and phone lines and whether you have the = right=20 phone-related processes in place to manage your incoming calls = effectively. Once=20 you have identified your times of heaviest traffic, you will be ready to = take=20 appropriate action.

Increase your phone availability

A number of practices answer their phones from 9 = a.m. to 5=20 p.m. and are "closed" for an hour at lunch. This means that the office = is=20 available to take phone calls for just seven hours per day. However, = this does=20 not match the calling pattern of your patients.

In primary care, most of the early morning phone traffic = is=20 forwarded to answering services and answering machines. These callers = are often=20 working men and women who do not want, or are unable, to call you from = work.=20 They may prefer not to have their co-workers overhear their medical = problems, or=20 they may not have access to a phone at work. For the same reasons, a = number of=20 your patients may prefer to call you during their lunchtime or at the = end of=20 their workday, after 5 p.m. If you are not available during these times, = your=20 patients will be leaving many messages. (Be aware that new-patient = callers are=20 not likely to leave messages or call you back.)

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To increase your phone = availability,=20 have an employee available to answer the phones approximately one hour = before=20 the office opens, one hour after it closes and during the hour your = office might=20 be closed for lunch. For most practices, this means having one person = answering=20 the phone a bit earlier and someone else answering the phone a bit = later. Many=20 offices also find it helpful to stagger the staff lunch hours to create = phone=20 access during lunchtime. This will increase your phone availability from = seven=20 hours a day to nine or 10 hours a day. That's an increase in = availability of 30=20 percent to 40 percent at no additional cost to the practice.

Another way to increase your phone availability to = patients is to=20 train referral specialists to call you during non-peak hours. For = example, you=20 may be difficult to reach by phone on busy Mondays and Fridays. The best = times=20 for them to call your office might be at the end of your morning = appointments or=20 the end of your afternoon appointments.

Channel your calls appropriately

You can reduce the phone traffic for your = receptionist by=20 adding phone lines that patients can call directly. Extra phone lines = usually=20 cost about $15 to $30 per month. These lines will divert calls to the=20 appropriate person and lessen the volume of phone traffic that needs to = be=20 managed by the front desk receptionist. It is important to stress to = your staff=20 that these special lines should not be used to make outgoing calls. They = should=20 be kept available to allow callers to get in. Here are some lines that = have=20 worked for many practices:

TELEPHONE=20 TRAFFIC STUDY WORKSHEET

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Instructions:=20 Record each incoming call by marking in the appropriate time slot. = Use a=20 separate sheet for each day of the week, recording all calls for = four to=20 six weeks.

Today's date: _____/_____/_____
Day of = the week:=20 ___________________________________

7:00 AM

8:00

9:00

10:00

11:00

12:00 PM

1:00

2:00

3:00

4:00

5:00

6:00

Carve out = small periods of=20 time in the appointment schedule for the physicians to = return=20 = calls.

Billing office = line.=20 This line goes directly to your billing staff and should be = listed on=20 your patients' statements and any communications with health plans. If = the=20 billing receptionist is busy, a voice message can be activated, = announcing:=20 "This is the billing office of Dr. Hart. I'm sorry we are either away = from the=20 desk or on another call. Please leave your name and number, and we will = call you=20 back soon."

Pharmacy line. Pharmacists = appreciate=20 being able to call a special line to leave their messages. This line has = a voice=20 message that says: "This is Dr. Hart's pharmacy line. Please leave a = message. We=20 will be reviewing these messages at 10 a.m., noon, 2 p.m., and 5 p.m." = This=20 tells the pharmacies that someone at your practice will review their = messages=20 every few hours.

Nurse line. This line is = especially=20 helpful to practices that have a nurse doing most of the callbacks. If = the nurse=20 is busy, a voice message could request that patients leave their name, = number=20 and reason for the call. This allows the nurse to pull charts before = returning=20 calls and, if needed, check with the patient's doctor regarding the = problem.

Practice manager line. = Managers=20 receive a significant number of calls that only they can handle, like = those from=20 sales representatives and health plan executives. Having a direct line = to the=20 practice manager will make your other phone lines more accessible for=20 patients.

Appointment line. Some = practices have=20 staff other than the front desk receptionist handling appointments. If = this is=20 the case in your practice, consider adding this special line with a = voice=20 message if the appointment person is busy or away from the desk.

Minimize on-hold calls

A significant number of callers want to speak = directly to=20 their physician. This is frequently impossible considering physicians' = hectic=20 schedules, so many practices put the patient on hold while attempting to = find a=20 nurse who can speak with the patient. This process is problematic for = several=20 reasons. Back office nurses are usually busy, which means the patient = will be on=20 hold for a long period and the phone line will be tied up. Even if = located, the=20 nurse may not be able to respond effectively without the patient's = chart.

Here's a better process: When a caller asks to speak = with the=20 physician (or nurse), the receptionist should tell the patient that the = doctor=20 is busy. Then the receptionist should ask for the patient's name, number = and=20 problem so that the appropriate person can pull the chart and return the = call.

This tactic avoids lengthy on-hold times and lets the = patient know=20 that someone will actually look at his or her chart to make the return = call more=20 effective. It allows time for the chart to be pulled and passed along to = whoever=20 returns the call. It also cuts down on interruptions to the physicians = and=20 nurses. This method could be even more effective in combination with = designated=20 call-back times.

Schedule call-back times

Assigning specific call-back times will help you = efficiently cluster your return phone calls and reduce the length of = time=20 patients must wait for their calls to be returned. To do this, carve out = small=20 periods of time in the appointment schedule for the physicians to return = calls.=20 A call-back schedule can be set up to allow physicians 10 or 15 minutes = to=20 return calls about every two hours.

Prior to call-backs, if time permits, the physician and = nurse can=20 review the calls together and determine who should return them. In some=20 practices the nurse does the dialing while the physician is talking with = another=20 patient on the phone. When the physician finishes that call, he or she = can take=20 the next call without delay. In other practices the nurse will do some = or most=20 of the call-backs.

Setting up a call-back schedule is much more efficient = and=20 effective than waiting for the physician or nurse to have a free moment = during=20 the day. It is also a significant patient-pleaser, because patients are = given a=20 reasonable timeframe to expect a return call.

Relocate your phone receptionist

Many practices have found, especially with the = advent of=20 managed care, that appointment scheduling over the telephone requires = asking=20 patients many questions, especially about their insurance plans. This = takes=20 considerable time, particularly if that same employee is checking in = patients,=20 collecting co-pays, requesting new-patient data, updating = established-patient=20 data, etc.

Because many practices find this is too much for the = front desk to=20 handle, some have decided to take phone management or appointment = scheduling=20 away from the front desk. This might lead to significant job redesigns = for=20 several staff members. It might also lead to the relocation of desks, = computer=20 terminals and filing systems, but the trade-off is worth it. Shifting = phone=20 duties away from the front desk results in better phone management, = better=20 appointment scheduling and better check-in and checkout management.

The secret to success

If your practice suffers from poor telephone = management,=20 try implementing the suggestions above. Once you perform your phone = traffic=20 study, you will have a better understanding of the areas in which your = office=20 can improve. Practices that apply these strategies will notice a = difference; it=20 will make your patients happier, your staff more efficient and everyone = less=20 frustrated. 3D"end

Send comments to fpmedit@aafp.org.

George Conomikes is president of = Conomikes=20 Associates Inc., medical practice management consultants. The firm's=20 headquarters are in Los Angeles. Conflicts of interest: none reported. = =C2=A9 2005=20 George Conomikes.

Copyright =C2=A9 2005 by the = American Academy of=20 Family Physicians.
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