Sep 2002 Table of Contents

IMPROVING PATIENT CARE

Are irrational office procedures contributing to your phone problem?

Fam Pract Manag. 2002 Sep;9(8):53-54.

The telephone has been in existence for over 125 years, yet in most medical practices its use has hardly been perfected with time. Complaints about the telephone are common not only among doctors, nurses and office staff but among patients as well. In an attempt to solve their telephone problems, many practices have added another operator, installed another phone line or purchased an automated attendant. But within a few days or a few months, the same old complaints resurface.

A practice’s telephone problems won’t go away until its physicians and staff examine their processes and identify how they may be contributing to the problems. Here are some ideas for improvement.

Appointment scheduling

I was recently checking out after an appointment for my son, and I asked the staff member whether I could schedule his next well-baby visit, only nine weeks away. “I’m sorry,” she said, “but we can only schedule appointments through the end of the month.” Her next words were – you guessed it – “Just give us a call.”

In addition to causing patient satisfaction problems, irrational scheduling processes such as this can quickly create a telephone nightmare for your practice. The good news is that it only takes one small change (i.e., developing appointment templates that extend a minimum of three months) to begin reducing unnecessary phone calls. What small changes in your scheduling process could decrease your telephone load?

Prescription refills

One of the best ways to decrease calls for prescription refills is to steer your patients to their pharmacies. Ask the pharmacists to fax in patients’ refill requests, or establish an electronic interface with them. Not only will this eliminate phone calls, but it will give you adequate documentation for the record after you sign off on the refill request.

You should also evaluate your prescription-writing protocols. If telephone volume for prescription refills seems high in your practice, consider whether you write prescriptions for too short of a cycle. Of course, high-quality pharmacology management trumps telephone operations, but it’s a good idea to evaluate these protocols each year.

To fend off calls for prescription refills, ask your patients whether the have any refill requests during each visit. Consider placing a tablet in your reception area labeled “Refills I Need to Discuss With My Family Doctor Today” so patients can plan ahead for the visit. Alternatively, you could post a reminder in each exam room, or integrate refill requests into the rooming process by having nursing staff ask about refills just as they ask about current medications.

Test results

When a patient asks when his or her test results will arrive, being realistic will save you from a deluge of phone calls. Establish your patient’s expectations when he or she leaves the exam room, and give yourself some wiggle room. If it’s usually a three-day turnaround for a CT, indicate four days to the patient. If the test is abnormal, you – and the patient – will likely hear of it long before the fourth day. If you call early, the patient will be delighted.

Patient education

During every clinical encounter, ask your patients whether they have any questions about the care they receive. Too often patients are ushered out hastily, causing them to call later with questions. Even if you’ve done a good job of educating your patients during their visits, you can bet they will only retain a fraction of what you tell them. Take-home patient education materials can help. To start building your armamentarium, purchase or develop brochures relevant to the top 10 treatment plans in your practice.

Billing and referrals

Confusing billing statements not only can increase phone calls to your practice but also can keep you from getting paid on time. Take the time to review the statements you send to your patients. Can you understand them? If you can’t, rest assured that your patients can’t either and will call your office with questions.

For those times when patients must call your office, set up your phone system so that patients can reach your billing and referral staff directly. Or establish an e-mail account to improve patients’ access to those staff members.

Miscellaneous calls

Evaluate the nature of the calls your practice receives, and consider alternative forms of communication. For example, let’s say you round on a nursing home and your practice receives dozens of calls each week to report minor injuries that don’t require your immediate attention but must be reported. Ask the nursing home staff to fax or e-mail those injury reports rather than calling.

Another idea is to create a comprehensive practice brochure or Web site that lists key information for patients: hours of operation, financial policies, directions and so forth. If patients have easy access to this information, they will be less likely to call you for it.

Transfers

Consider this real-life scenario: A patient calls her physician’s office and speaks to the receptionist, who determines that the call should be transferred to the scheduler. The scheduler can’t determine whether the patient is sick enough to deserve one of the day’s “precious” acute-care slots, so she transfers the patient to the nurse, who consults with the physician, and transfers the patient back to the scheduler. Total call time? 33 minutes. Value-added time? About 3 minutes.

To avoid this type of scenario in your practice, develop internal processes to limit or collapse telephone transfers. Route callers directly to the person who can get the job done. Every minute of transfer time is wasted time for the patient, and it ties up the line for the next patient.

Repeat calls

Perhaps the most important step you can take to improve your phone operations is to do the work correctly the first time. In the typical medical practice, a high percentage of telephone calls are repeat calls. Patients will continue to call back until their issues are resolved, so empower your staff to handle patients’ phone calls completely, not simply to take messages.

One way physicians can help prevent call-backs is to incorporate the idea of a “fourth” exam room every day. After every three patients, stop by your “fourth” exam room to take care of phone messages as well as documentation and paperwork. This will save you time at the end of the day and will put an end to the patient calling multiple times trying to reach you. Fewer repeat calls will also save your staff time, so they can better help your patients – and be available to help you.

ANALYZING YOUR PHONE PROBLEM

To get a grip on your phone calls, measure the frequency of your inbound calls by type of call for a period of at least five days using a tracking sheet such as the one that you can download below. Be sure to delineate the calls that are repeats. Then, study your findings. Are you receiving a high number of repeat calls in any one category? Do your practice’s processes force patients to call your office? Is your staff empowered to handle calls, or just take messages? How many “hand-offs” does each call take? Use the information you’ve gathered to guide your improvement efforts.

 Download in PDF format

Elizabeth Woodcock is director of knowledge management for Physicians Practice Inc., and is based in Atlanta.

Conflicts of interest: none reported.

Send comments to fpmedit@aafp.org.

Copyright © 2002 by the American Academy of Family Physicians.
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