Cool the Fire on Your Front Desk Lines

How to better manage phone traffic, and phone staff

The sound of ringing telephones is a mixed blessing. On the one hand, they mean that your practice is busy and that patients need your services. On the other hand, when the front desk can't keep up with the volume of calls, it means patient access is at risk and staff efficiency is less-than-ideal.

When telephones demand too much staff time or patients can't reach you, the traditional solution is to add new equipment or another receptionist to your practice. But there are some easier - and less expensive - solutions to consider.

Start with the first point of contact. When patients first call your office, who picks up? Many practices have installed phone systems with an automated operator, with one or two "real people" as backups. But one step forward technologically may mean two steps back for patient relations - often patients want to talk to that "real person" from the start.

Tim Bell, executive director of the Lumberton Clinic, a pediatric practice serving rural areas of southeastern North Carolina, says that there were "satisfaction issues" with their auto attendant, and now the roles have reversed: two live operators staff the line, with the auto attendant as backup.

Irene Heinemeier, administrator for Reno, Nev.-based Urological Surgeons Ltd., says that it was the physicians in her practice who didn't want a machine answering calls. "The doctors felt strongly that a patient should get to a real person when they call. It's a value to our organization," she says.

Straight to the source

Once the phone call has been answered, where does it go from there? Consider that for most practices, the majority of calls will be from patients who want to schedule an appointment. In some cases, calls are routed to a triage nurse, who may not be trained to schedule appointments. No wonder patients are upset when they are routed through a telephone tree, wait on hold for the triage nurse, and then hang on again for an appointment.

Let your schedulers do their job - it's simple advice that many practices don't take to heart. For example, staff members at some practices have to leave their workstations to hunt down physicians for permission to schedule an appointment. Physicians who insist on approving all appointments in advance are, in effect, biting into productivity, keeping incoming lines tied up, or leaving schedulers to play telephone tag with patients.

For appointments in her office, Heinemeier says, "the calls are camped on to the schedulers' lines and the calls are then answered in the order received. Our patient satisfaction has gone up dramatically since we are now able to do this," she says.

Barbara Gunder, chief administrative officer at the Salem Clinic in Oregon, says her practice adopts a similar method: there's no delay between calls, so when the first caller hangs up, the next call comes right through. "We've had to make a little adjustment with the staff, but now they like it," she reports.

To expedite the scheduling process, the practice has a comprehensive list of questions to determine if the patient needs emergent or routine care. To decrease patients' time on hold, the clinic has made a conscious effort to get to patients who are waiting on the line in less than 45 seconds. "The average last month was about 47 seconds," Gunder reports. "Still very good."

Constant reminder

A hefty portion of practice phone time is spent reminding patients of their scheduled appointments. Mailing reminder cards to patients four to five days before their scheduled appointment can save staff time by decreasing incoming calls from patients who can't remember their appointment dates. It may also produce cost-savings by reducing no-shows or late arrivals.

But for instances when a patient has not made an appointment and it's time to schedule a follow up, a phone call can be a better option. "We try to call the patients from a recall list generated by our computer system for most follow-up and yearly appointments," Heinemeier says. "This allows us to call the patient on our terms - when we have time to make the appointments - rather than sending out cards and then having the phone ring off the hook at times that may not be as good for us."

Many practices are finding that automated calls work well for appointment reminders. Make sure that the calls sound pleasant and do not breach patient confidentiality; for example, the automated message should not state the reason for the appointment. For his practice, "the automated system sounds promising," Bell notes. "But we want to go on using live personnel [to make reminders] as long as it's possible."

Take the direct route

To further reduce phone backlog, consider different routes for patient and staff calls. "A number of our key staff have direct lines that bypass the main incoming lines, which we like to reserve for patient calls," Heinemeier says.

Bell's practice, too, has a "back door" number for staff and family physicians to bypass the operator; it has reduced the number of calls per day she must handle. Some practices also have a direct line to the local pharmacy. In that case, be sure to set up protocols for how to handle prescription requests, including follow up, so that patients don't wonder if their request has gone into a black hole.

Instead of tying up a line when patients call back for test results, why not be proactive and think of test results as part of the education function? Many medical practices still tell patients: If you don't hear anything from us, everything is OK. That may make it easy on the staff, but it is hardly considerate of the patient. Gunder says her practice has informational brochures for physicians to give to patients that include information about when patients can expect callbacks regarding test results.

Be certain not to leave test results on a voice mailbox unless you have written permission to do so - and the results are normal. If you don't reach the patient or don't have permission to leave a message, mail the results immediately, rather than calling back a day or two later. This allows you to report information as you are processing the work, prevents the vicious cycle of callbacks, and lets you immediately re-file the chart.

Finally, head off patient calls for general information about practice hours and directions by sending out a "welcome to our office" packet to all new patients before their first appointment. Practices with Web sites can include a map of driving and parking directions online for easy access to information. Don't forget to include information about public transportation if it's available.

You can't eliminate all inbound calls - nor would you want to. But you can reduce them with a little effort and little cost. Review your current processes to determine how you can alleviate telephone demand before considering more expensive options.

Elizabeth Woodcock, director of knowledge management for Physicians Practice, can be reached at

This article originally appeared in the November/December 2001 issue of Physicians Practice.