The phones, the phones, the phones.
Every time we look, everywhere we look, getting the phone answered seems to be a problem we just can’t lick, a continual thorn in the side of our practice, something that’s hindering all the other efforts we try to make things better, to get ourselves to the best care environment for our patients, our staff, and our providers.
Without fail, our scores on every patient satisfaction survey, no matter how we ask them, no matter how we slice and dice it, show our lowest ratings are for our patients’ ability to get through to us on the phone.
Since long before I started working here, the administration has tried to figure out how to do this better. How do I get someone to answer the phone? How to get our patients to the right place with their phone calls, to get them what they need, when they need it?
Nursing line. Appointment line. Refill line. “Leave a message” line. “Speak to a provider” line.
We’ve tried phone pools, dedicated people on dedicated tasks, rolling queues, trackers that monitor who is free and how many calls each operator has answered.
We’ve had consultants who come to our practice, whom we pay huge sums of money, who follow us around with clipboards and stopwatches, and without fail their conclusions are almost always, “You really need more people answering the phones.”
Our HCAHPS (the Hospital Consumer Assessment of Healthcare Providers and Systems) scores are wonderful on professionalism and quality of care and communication in the office, but plunge well below our desired goals for getting through on the phone, and almost nothing we do seems to make that budge.
Yesterday, my administrator was on the phone with someone from the Office of Patient Services, after we had received a complaint about a phone call going to the wrong place, someone unable to reach their doctor.
Turns out one of our provider’s phone number was listed incorrectly in an online directory, and then once that patient finally got through they were put on hold, had to run through a different phone tree, got sent to voicemail, and finally ended up getting somewhere else with instructions in a language they couldn’t understand.
As I sat there listening to them discuss this issue, it seemed that we’ve made this too complicated.
This morning, I called a colleague in private practice at her office, and even though it was very early before office hours, her phone rang, and on the second ring someone picked up the phone and asked if they could help me.
And once I got to her (about 30 seconds later) she apologized that she herself had not picked up my call; she said very few staff were there that early.
That was all it took. No long waits on hold, and no phone tree. No advertisements about the wonderful services they offer.
Just a live human being answering the phone.
On the phone with Patient Services, my administrator asked if we were required — was it really necessary? — for us to start every phone option with, “If this is a medical emergency, please hang up and dial 911”.
The representative from Patient Services thought about it for a while, and even though she wasn’t sure, she said it was probably the “standard of care” so we should continue doing this.
This takes us back to the concept of responsibility, and how much in our society we are required to CYA, medicolegally; we don’t want someone leaving on a voicemail — one that might not be picked up for several hours — saying that they’re having crushing substernal chest pain radiating to their jaw and down their left arm with associated nausea, vomiting, and diaphoresis, and then it will all be our fault that they had a heart attack and died at home.
If only we’d told them to hang up. If only we told him that if this was a medical emergency they should hang up and call 911, everything would’ve been all right.
Just last night, when we were cleaning up a mess we discovered in an exam room in the practice, I looked at the product warning label (in English and French!) on the bottle of “odor eliminator” (air freshener) that is provided to our practice to use.
It says, “In case of eye or skin contact, flush immediately with water for 15 minutes. Seek medical attention if necessary.”
Note that it doesn’t say put down the bottle and called 911. It gives the person using this noxious chemical a little bit of leeway into whether they will need to call a doctor or not. It leaves a little judgment to the person who splashed something on their skin. Sure, the lawyers went through it and probably decided that they needed to say something, but not every spill requires a call to the doctor.
I think if we can figure out a way to get the phones simplified, get rid of all the phone trees, get everyone an answer to the question they’re calling with, we’re all going to be better off — the staff, the patients, and the providers.
If every time a patient calls and requests a refill, the person answering the phone says, “Hey, why don’t you sign up for our online portal, so you can request a refill of this medicine with a simple click of a button, and your provider can respond with a click of a button that sends your prescription electronically to your pharmacy in a flash? Think of it; you will never again need to call for a refill.”
That simple act during that phone call will save multiple phone calls during the year when that patient would otherwise be calling for refills.
The number of calls saved becomes staggering when you do the math.
And if our patients can have access to open schedules, and simply put themselves in for appointments, without having to go through a long phone tree to prove they are sick enough to deserve an appointment, wouldn’t that be better — wouldn’t that save a few phone calls and endless frustration?
As I said before, I’ve spent a great deal of my professional (and personal) life on hold, listening to really annoying Muzak, and can probably think of a lot of things that would put my time to better use. And I’m sure all of our patients feel the same way.
In the 21st century, everyone wants to be able to do things with their phones, but not in the way we think of using our phone as something tethered to the wall of our kitchen with a long twisty cord.
The phone should be an expediter of care, making things simpler.
One of the long-standing works-in-progress at our institution is a universal phone center for the entire ambulatory care network, a magical off-site place where banks of operators will instantly pick up the phone call, take detailed messages, and route them to the appropriate staff.
This has potential, and may help in some ways, but if all this does is send a new message to somebody else who then needs to call somebody back, then it’s just adding a layer of time, work, and wasted energy.
We have to create systems that get the work done when it needs to happen, without a lot of excess flailing of our arms.
Sitting in my office this morning with the door closed, finishing off this column, the multiuser telecom device sitting on my consult table began to ring.
Knowing that I had no conference calls scheduled, no meetings with people off-site that I needed to put on speaker phone, I got up and walked over to the device, and hit the answer button.
“Hello, this is Mrs. Jones down in Ambulatory Surgery. Can someone come down and pick up this patient who is ready to be taken to the preoperative staging area?”
“I’m sorry; I think you have the wrong number,” I said.
Actually, she had dialed the correct number, and it turns out that the number that is currently listed in the online directory for one of the preoperative surgical areas in the hospital is in fact the number they’ve given to me for my new meeting speakerphone.
I thought about telling her that I’d send someone right over to pick up the patient, but I figured it would probably not help much.
The telephone is ringing, but nobody’s home.
Won’t somebody answer it?
Fred N. Pelzman is an associate professor of medicine, New York Presbyterian Hospital and associate director, Weill Cornell Internal Medicine Associates, New York City, NY. He blogs at MedPage Today’s Building the Patient-Centered Medical Home.
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