Improving Telephone Management

Print

One dermatology practice is trying to put its best foot forward by improving telephone service to patients, referring physicians, pharmacies, and others.

At North Atlanta Dermatology in Duluth, Ga., the group’s three dermatologists see 50 to 55 patients daily at their main office and three satellite offices in suburban Atlanta. A physician assistant also sees between 30 and 40 patients daily. Not only does the practice have the typical number of daily patient visits for a dermatology practice of its size, it also has the typically high volume of incoming telephone calls — more than 100 a day, according to the practice’s estimates. With numbers that high, it can be a challenge to provide patients with the best care via telephone.

Practice administrator Elaine Dimaggio says a philosophy of rapid response and staff training helps promote her practice’s reputation of friendly and accessible patient care. “I tell [staff] that the most important thing here is patient care, and that has to include how we handle our incoming phone calls,” says Dimaggio.

One way that Dimaggio eased the pressures on the staff and on the group’s telephone system was to work with clinicians to revise internal message-handling processes, retrain office staff, and take other steps aimed at reducing the number of times the practice attempts to return patients’ calls. Dimaggio says one way that the practice does that is by coaching staff to respond to patient questions promptly.

“I’m not going to say that nothing has ever slipped through the cracks here and a patient didn’t get called back for two hours, but I’m very adamant about returning the patient’s call quickly so they’re not sitting there for an hour wondering when the doctors’ office is going to call them back,” Dimaggio says.

Build a team

North Atlanta Dermatology’s telephone strategy hinges partly on having enough people to handle the daily call volume. Dimaggio and four other staff members help answer telephones during the practice’s regular hours, which are 8:30 a.m. to 5 p.m., Monday through Friday.

Although the practice closes its doors and telephones between noon and 1 p.m. each day, an automated message prompts patients to page Dimaggio’s phone for urgent matters — and she answers. Even when the practice is closed, a message at Dimaggio’s extension instructs callers to call her cell phone.

“There’s just no reason why somebody can’t get in touch with me or the office,” says Dimaggio. “I also have my contact information on our Web site so people can e-mail, too.”

Tracking improves response

Rapid response not only can improve patient care, it also can help ease the workload on staff by reducing the chronic game of “phone tag” between patients and staff. “I require the staff to retrieve calls from voicemail as quickly as possible,” says Dimaggio. “The minute they’re free from whatever else they were doing, they hook up to their phone and see there’s a message and call back.”

Staff members keep a log of incoming voicemails and live messages and track the practice’s response to each call. Dimaggio says recording call activity into a paper log helps keep staff focused on the practice’s commitment to respond promptly and not lose track of patient requests.

The practice recently boosted its total incoming telephone lines to 14 and, in what may seem at first like a step back from the personal touch, replaced its live-answer strategy with a recorded list of options. Now callers hear a brief welcoming message that mentions the group’s new address, followed by a brief list of single digit telephone extensions to select for appointments, test results, prescription renewals, billing questions, medical information, and other options. Referring physicians are directed to a special extension.

“If the patient says, ‘I’ve called five times and nobody’s returned my call,’ we try to find out when they called and what happened,” Dimaggio says.

Written guidelines instruct clinical and front-office staff on answering the telephones and how soon to respond to messages.

“No one leaves at the end of the day until they have answered every single message,” Dimaggio says. “Before the staff close out at the end of the day, they have to make sure all the phone calls were retrieved and returned.”

Phones manage results

When patients register with the practice, the patient information form they fill out asks for their home, cell, and work telephone numbers, as well as their e-mail address.
“I do this for a number of reasons,” Dimaggio says. “One, if we have to give them a biopsy result and can’t get a hold of them, we have other resources to try. Second, if a doctor has to change the appointment, we have a way to get to the patient.”
Options for the practice to leave news about a negative test result are also listed on the patient registration form. The practice might leave a message on the patient’s telephone answering machine or voicemail, or send an e-mail or post a letter. The patient can request to always be notified personally or may ask the practice to leave results with certain household members. Only a small minority insists on receiving notification of negative tests results by letter only or insists on calling in for results, says Dimaggio.

In most cases, nurses telephone negative results to patients from the nursing station during the day. If the nurse is not able to leave a message, a postcard is sent — assuming the patient has approved doing so in advance. Normally, nurses make three calls before sending a postcard regarding a normal lab or biopsy result. Alternately, the notification postcards could say, “We’ve been trying to call you. Please call us at the following extension,” Dimaggio says.

Patients whose tests indicate a melanoma or serious cancer receive calls from their dermatologist. Positive results of a less dire nature are often delivered by a nurse’s telephone call.

Confirm all appointments

Though many dermatology practices do, North Atlanta Dermatology doesn’t use an automated system to confirm office appointments. Instead, Dimaggio has hired four students from medical assistant programs at local colleges to work part-time in the late afternoons and early evenings to make the calls. The part-timers are given a list of upcoming appointments for each physician and make confirmation calls two to three days before the appointment. The callers follow a script that prompts them to deliver basic information about the appointment, such as the name of the presiding physician, the time, the date, and office location.

Extra efforts are made to speak personally to any patients who are scheduled for surgeries or other procedures that require more of a dermatologist’s time.

If leaving a message or voicemail, the appointment confirmation staff notes such on the record with “C” for confirmed or “LM” for left message. In the small number of cases where appointment staff cannot get in touch with a patient and are not able to leave a message, they try a second time later in the evening. Finally, if attempts to contact the patient are still unsuccessful, they make a note in the practice’s computerized scheduling system. This multistep process records enough information for Dimaggio to know the circumstances should a patient complain about not having received an appointment-reminder call.

“You always get no-shows even though the appointment was confirmed, and I do have the front office call them at the end of the day to remind them that they missed their appointment and ask if they want to reschedule,” she says, adding that the reminder process does not seem to have significantly reduced the group’s no-show rate of two or more per day. But at least it helps Dimaggio to track the sequence of events.

“The key to what we’re doing is to not let it be impersonal or at least try our hardest,” Dimaggio says. “I know I can’t make everybody happy but I’m always open to any ideas to make improvements.”

CONTENT PROVIDED BY:

Disclaimer: The material above has been prepared by Physicians Practice. It has not been reviewed by the DermQuest Editorial Board for its accuracy or reliability. Reference to any products, service, or other information does not constitute or imply endorsement, sponsorship, or recommendation by members of the Editorial Board.