THE TELEPHONE IS THE FIRST POINT OF CONTACT FOR NEARLY EVERY patient of your practice and the only contact for most referral sources. You know the problems: too many calls coming in, too many messages going to doctors and technicians, long waits on hold or, worse, getting a busy signal. It could be because you have won rave reviews with referring physicians and patients. But if that isn't the primary reason for bottlenecks on your phone system, there may be other explanations: your people, your communication in the practice, or just the time of the calls.

Get the Right Person
Answering the phone and making appointments is usually assigned to the youngest, lowest-paid, least-trained and most junior employee on the staff. But it's a sophisticated job requiring a high level of knowledge and poise. An assertive, intelligent, well-trained and friendly employee can handle many more calls, leaving patients with a much higher level of satisfaction than a trainee.

There are specific skills you will want the staff members handling your phones to have including:
• Ability to multi task; your receptionist should be able to manage the computer while handling incoming and outbound calls, and checking in patients for their scheduled appointments.
• Ability to diffuse tense situations through appropriate conflict resolution skills.
• Appropriate interpersonal communication and people skills for dealing with the multitude of patient personalities and their individual needs.

Good phone workers should also have plenty of experience with the specialty of the practice and with the physicians there. They'll need to know the answers that physicians would give in many situations. Putting patients on hold to go find out the answer is a major cause of the phone lines being tied up when other patients are trying to call in, creating frustrated and irritated patients.

Trained and experienced phone receptionists will more efficiently hear what's bothering the patient, determine the urgency of the call and provide the appropriate solution: an appointment, some advice or call routing to another desk. Savvy phone receptionists will "hear" what the patient doesn't say, too. Vague and manipulative patients leave out important details that are essential to giving a smart appointment.

Enhance Working Conditions
Good workers need good working conditions. That means a minimum of other interruptions and distractions while they're on the phone. It's difficult to greet patients and carry on private, sensitive and high quality telephone conversations at the same time.

Quiet and private work areas without a lot of background noise are part of the solution. A comfortable chair and an uncluttered desk with plenty of reference material handy with the answers to the most common questions complete the picture. Finally, people in telephone-intensive jobs need good phone equipment. That may mean a comfortable headset.

Too Many Calls the Problem? Distribute the Load.
Employees frequently come up with the same solution when the problem is busy signals or long 'hold' times. They usually want to get more help. Adding personnel is a high cost solution to the problem, but may be necessary when everything else fails. But try some other solutions first. Distributing the calls within the office to other workers may take some of the heat off of the receptionist. Providing specialized lines that ring at other desks, for example, is a common solution. A specialized phone number for the billing department, for example, would be the only number printed on your statements and collection letters.

When patients are calling about their accounts, they frequently have one of those documents in front of them. Having that call answered by a patient account representative rather than the receptionist takes pressure off that busy desk.

When routing calls to the billing department, it may be possible to get them to the right desk by separating the accounts among the employees. For example, in the office with two insurance billers, one could handle patients with last names beginning with A-L, and the other with names M-Z. In this way, the operator or receptionist would know immediately who to route the call to. Other practices make the distinction based on insurance class or account type.

Another example of the specialized telephone line is the pharmacy line. This is a number dedicated to patient and pharmacy calls regarding prescriptions. It's answered by an answering machine or voice mail with a clear set of instructions to leave the patient's name, refill desired, and the name and phone number of the pharmacy. An office clerk can clear these messages hourly and, once charts are pulled, a medical assistant can handle getting the authorizations and making the callbacks. It's a service to pharmacists who would rather speak to your machine than wait on hold. Patients may also find the number convenient for this purpose but, if you publish the number to patients, be sure to include in the answering message your regular incoming phone number for urgent calls.

Communicate to your patients the best time to call by putting the message in your patient information brochure, and be sure every new patient and established patient recieves one.

Another way to divide and conquer is to provide a private line for VIPs to call, answered by the office manager or other designated (non-receptionist) employee. Service to these individuals will get better, they'll be made to feel special, and service to patients calling in on the main number will also improve.

Level the Peaks
You can handle excessive call volume by attempting to level the incoming call load throughout the day. This means educating patients as to the best time to call. For example, many practices send recall notices to patients each month. Try adding this message: "For fastest service, the best time to call is between 2:00 and 4:00 p.m. Tuesday, Wednesday or Thursday." Shifting callers away from Mondays and Fridays, when you're busiest, may work some of the time.

Answer All Day
Spreading the phone calls out over a longer day may help, too. Consider the practice where the nine employees work between 8:00 a.m. and 6:00 p.m., but only answer the phone between 9:00 a.m. and 5:00 p.m., also signing out to the answering service for an hour at lunchtime. The office is staffed for 10 hours but the phones are only answered 70 percent of that time. The practice could give better service and handle calls more smoothly by answering the phone as long as employees are on the premises.

Get Rid of Some Calls
It may be possible to eliminate some incoming calls, too. Try compiling a list of the most frequently asked questions each day. You'll find that the same things keep coming up over and over again. The practice that does a better job of educating the patients about those issues while they're in the office will eliminate lots of phone activity.

Giving patients more take-home literature and face-to-face education sessions in the office may be the answer. It doesn't have to be the doctor doing all of this; technicians, office managers and receptionists can each have a role in contributiing to better, more informed patients.

Some physicians, in an effort to try to put a patient more at ease about a medical concern will instruct the patient to "call me in a few days and let me know how you're doing." It's more efficient to instruct pa-tients to call only if they're not getting better.

You can also stay in control of lab results calls by not asking patients to call in to get them. Instead, let patients know that you will notify them by postcard or phone call of the result. In this way, the nurses or medical assistants can make the calls when time permits, rather than having a bunch of interruptions or messages to return.

Shorten the Calls
Patients can be pretty uninspired communicators sometimes. They can ramble on and ask irrelevant questions, dragging out the call and reducing your ability to handle high volume. These people need your intelligent, trained, experienced and assertive receptionist to help them get to the point quickly. A smart receptionist will know when to interject, "Do you need an appointment?" or "This sounds like a call for the nurse."

It's also helpful to answer with an identifiable practice name that helps the patient confirm that he or she has reached the right party. Simply answering "doctor's office" frequently causes the patient to ask, "Is this Doctor Smith's office?" It's much more efficient to answer with the name of the doctor or, in a larger group, with the name of the practice, eliminating this little dance.

It's also helpful to take command of the conversation as part of the answering process: "Are you calling for an appointment?" If it sounds like the caller needs medical advice, "The medical assistant can help you with that—where may she call you?"

Delegate the Calls?
Deciding who should handle the call is often a difficult process for many physicians. Physicians shouldn't delegate medical management of patients to employees until they're confident in the training and judgment those employees bring to the job. But once that's confirmed, it's smart to let the employees handle routine items.

Create a grid with job positions across the top (physician, medical assistant, office manager, receptionist, etc.) and the types of calls you get (vision-related issues, insurance accepted, etc.) written down the left-hand column. Then, identify who can handle which types of calls on a routine basis without having to check with others. It may be that the medical assistant could handle many of the prescription refills in the office after checking the chart for instructions, for example.

You'll want to classify the types of drugs receptionists and technicians are authorized to refill and the protocol for bringing those refills to your attention at the end of the day. You may decide that your receptionist is unlikely to do much damage with a one-month authorization for an eyedrop medication, but your office protocol might require all non-maintenance medications to come to your attention before any authorization of renewals, such as an antibiotic prescribed for treating an infection.

Give the Reason First
Another time saver that tends to shorten calls and reduces patient resistance is offering the reason when stating a policy or procedure on the phone. A patient faced with a blunt statement of practice policy like, "You'll have to be prepared to pay when you come" may tend to resist or get the wrong impression of your office. Instead, try words like, "To keep the cost of paperwork down, we prefer to be paid at the time of the visit." Here are some others:
"To save you time in our office, please complete this form before your visit."
"So I allow enough time, would you please tell me the nature of your problem?"
"So I can access your file, would you please read me the number above your name on the statement?"

These are all ways that your employees can shorten the calls, redirect calls and keep people off hold or from receiving busy signals. Increasing patient satisfaction is getting harder as managed care pressures continue to put more barriers between the doctor and patient. Don't let your phone be one of them. 

 Mr. Denning is a principal consultant with Practice Performance Group, La Jolla, Calif., and can be reached at 1-800-452-1768 or