Match staff to volume to fix your phone hang-ups

Monitor call volume, type to cool this hot spot

Patients and physicians often prefer to handle minor medical problems over the phone. It’s fast, efficient, and saves the time and expense of an office visit.

But those advantages quickly evaporate if the patient calls, waits on hold, but can’t get through to a "live" voice. Telephone access is one hot spot of patient dissatisfaction that emerges in surveys.

"Health care is becoming more telephonically driven," says Lori Hauschild, RN, MA, director of primary care services for Physicians Plus Medical Group, a multispecialty practice in Madison, WI. "If that’s our encounter with our patients, we need to do a better job. We want to make our access for our patients hassle-free."

That’s why Hauschild and her colleagues have invested considerable time and money into solving the dilemma of phone access.

For example, one Physician Plus internal medicine clinic has eight physicians and receives 800 calls a day. The phone abandonment rate — people who hang up while on hold — has reached close to 20%.

High expectations for completed calls

Hauschild established a committee that is considering tough standards in which 90% of all calls would be answered within 40 seconds and no more than 3% of callers would hang up or abandon their calls while on hold.

"I have pretty high expectations for our staff," admits Hauschild, who adds that current abandonment rates surpass 10% in obstetrics/gynecology and internal medicine.

Resolving phone problems requires an evaluation of both technology and processes, says Connie Cone, telecommunications manager of Meriter/Physicians Plus.

Cone, who handles telecommunications issues for Meriter Hospital, — also in Madison — as well as the medical group, has installed automatic call distribution in the busier offices. The technology costs from $10,000 to $60,000, depending on its scope and is available from telecommunications companies such as Rolm, Lucent Technologies, and Northern Telecom.

With automatic call distribution, callers can hear a menu of choices, such as "press two if you need a prescription refill." That allows the practice to redirect calls so that schedulers can handle their high volume more efficiently, says Cone.

While most people have gotten used to automated call distribution and voice mail from other businesses, some patients may be turned off by it, acknowledges Cone. Some physicians don’t like the technology, either. "It’s really important to understand your patient population and what they will tolerate," she says.

Cone and Hauschild offer the following advice for practices who want to improve their telephone access:

- Monitor both the number and type of phone calls.

Automated call distribution allows practices to collect detailed data about the volume of calls, wait times on hold, and call abandonment.

"Once you get enough data, you can set your staffing levels according to what you predict your volumes are going to be and what you believe are acceptable answer times," says Cone.

Determining the type of calls may be as important as gauging the variation in volume. And you don’t need a sophisticated phone system to provide the report.

For a week, Hauschild asked the phone staff in internal medicine to keep a record of the purpose of the calls. She gave them a tally sheet with 10 possible reasons, such as prescription refills, need to schedule a routine appointment for specialty referrals, and physicians calling another physician.

Hauschild discovered that 25% of the calls were from pharmacies checking on prescription refills. She set up a direct line for them, sent notices to about 20 area pharmacies, and included an option on the menu for pharmacies to "press three." That removed them from the queue waiting for a receptionist.

r Match staffing to phone volume.

Staffing needs may vary by time of day or day of the week.

For example, Hauschild discovered that due to break times and lunch hours, the phones weren’t fully staffed 60% of each day. "Your staffing model needs to take into account break times," she says. "Why would we go down [in staffing] 50% at the noon hour when our calls go up then? Our abandonment rates clearly go up during the noon hour."

Hauschild revamped the staffing so she has six people answering the phones in internal medicine at noon, despite lunch breaks.

Hauschild also recommends spreading out the phone calls by opening the phone lines even before the first patients arrive. "We may not see patients until 8:30 a.m., but our phones go on at 8," she says.

Please don’t leave that caller on hold!

Standards for how long callers wait on hold before talking to a receptionist can vary. "My personal opinion is that people should not wait longer than one to two minutes," says Cone. "You either staff it differently or revamp [the system] so the calls go somewhere else."

- Create new phone numbers for special groups of callers.

Hauschild set up direct lines for physicians who want to talk to another physician so they will not have to wait on hold for a receptionist.

"Nothing angers a specialist more than when they get into a queue," says Hauschild. "Doctors are busy people. They don’t want to be in a queue."

Physicians Plus also recently set up a 24-hour nursing call center to triage patient calls. That hotline replaces a medical answering service and has its own phone number. Physicians Plus will eventually publish a toll-free number for patients to call 24 hours a day.

It may sound basic, but Cone also cautions practice administrators to make sure they publish the correct phone numbers and clearly list any distinctions between numbers. Patients who didn’t know what a TDD line was often called the second number listed, assuming it was for emergencies. Now the practice lists the number for hearing impaired.

- Anticipate variations in volume.

On the Tuesday after Labor Day, the phones went crazy in the Physicians Plus internal medicine department. Six phone receptionists tried to answer the calls quickly, but at one time, 27 patients were on hold in the waiting queue.

"Physicians Plus Medical Group sent flu announcements to thousands of patients, and the patients got them on Saturday," says Hauschild. "We probably got several hundred calls [from patients] just to schedule their flu shots."

Hauschild was unaware of the timing of the mailing. But as much as possible, she tries to anticipate events that may trigger a surge in phone calls.

When the medical group announced that it was integrating with the University of Wisconsin, Hauschild was ready. She added staff on the phones, distributed question and answer sheets to other staff so they could respond to patient questions, and set up a hotline in the patient relations department.