Improve your practice with effective telephone management JANE WHITNEY

John Fineman has a painful rash in a place he'd rather not talk about; he dials his doctor's office, but he gets a busy signal. He tries again; still busy. He tries a third time; good, he hears it ringing and ringing . On the 10th ring someone answers, "Hello, will you hold the line please?" "Ye .," he begins but doesn't finish because he's already on hold. Minutes pass; he becomes agitated. "Was it the right number?" More minutes pass. "What if she's forgotten me?" Eventually, "Yes, go ahead please." He gives his name and asks to speak to Dr. Bloggs. She says, "Give me your name again?" "Oh Lord, my name's not that odd, is it?" he thinks. But he complies. "Sorry," she says. "Dr. Bloggs is busy right now. What did you want to see him about?" "Too busy for me?" he wonders. She's hurt his feelings, and he tells her he'll try again later. "OK," she says, "Bye now." He feels diminished, a mere worm, and then there's that damn rash . . . He wonders whether he can get anything at the local pharmacy. Later he wonders whether he should change his doctor. Devil may care?

A 1977 US survey revealed that disrespect by office staff and physicians was the second most frequent complaint among patients. The survey also showed that 30% of patients thought their doctors acted like God - it's too bad when a receptionist acts like the devil on top of that! The receptionist isn't wholly to blame for snarling. There are many demands made on her - for example, she helps the office to run smoothly, as an office administrator, and while she is doing this she is, in 90% of cases, the first contact your patients have with your office; she gives a good, bad or ex-

cellent impression of you and your practice. She has to combine the qualities of a public relations officer, secretary, billing clerk, filing clerk, clinical aide and, though you may not have realized it, hostess. While performing her job your aide is constantly plagued by interruptions from the telephone, your patients and you. Customer wants courtesy

From a business point of view a medical practice is a service industry. As a service industry its success depends on successful public relations, and these, in turn, depend on successful personal interaction. Since your receptionist is so frequently the first contact with patients, her role as a hostess may be more important than you realize. A bad, or even average, impression on the telephone could lose the office a patient - and that's bad business. The patient directly or indirectly pays you and your aides, and that makes the patient the customer. And there's a saying about customers: they're always right, and they shop around, too. A patient calling for an appointment or to talk to a doctor wants courtesy at the very least. A polite receptionist will satisfy most patients, but that shouldn't satisfy you. A hostess has to be more than polite; she has to show a personal interest and use positive words and gestures. Politeness is satisfactory, it's expected, but there isn't anything unusual about it. Satisfied patients will not rush to provide referrals, and in a competitive service industry you have to offer more - the extras, the unusual things that patients can tell their friends about. Your receptionist has to be able to offer the extras. As the perfect hostess she has to see that the waiting room is comfortable and attractive and the reading material is up-to-date. She should remember patients' names and personal things about them, so she can say, "Good morning, Mrs.

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Jones, how is your hang-gliding coming along?" instead of, "Good morning, Mrs. Jones, please take a seat." To provide the extras your receptionist should offer help, allay the fears of patients and, above all, keep smiling. The efficient receptionist is not necessarily the most effective receptionist. She becomes effective when she can deal with people not only quickly, but with interest and tact. A study by industrialist Edward A. Pickering, commissioned by the Ontario Medical Association, concluded that professional competency had been oversold by the medical profession. In the same way secretarial efficiency may have been oversold to you. There appear to be three approaches to improving an aide's effectiveness: * You can provide training or retraining. * You can rationalize office routines. * You can install time-saving telephone equipment. Before you can provide training, however, you have to analyse your aide's shortcomings. If an aide is not doing a good job on the telephone, doubtless a disgruntled patient will complain. (They complain anyway, you say? True, but you can reduce the number of complaints.) Effective detective

If you don't want to take a patient's word you can do your own detective work: Call yourself at the office from time to time, or have a friend do it. You could use a checklist to pinpoint problems. For example: * Did you get a busy signal? * How long did you wait before the telephone was answered? * How long did you have to wait on hold? * Was the aide courteous? * Was the aide understanding? * Did the aide make you feel important?

If you want to go further than improving telephone management and investigate total patient satisfaction you could ask patients to complete the questionnaire prepared by M.G. Landry (Can Med Assoc I 120: 1450, 1979). This questionnaire was designed specifically to help you find out whether your patients like the job you are doing. If you find that your aide's attitude is not satisfactory it could be due to four things: her personality (which you can't do much about); deficient training (which is your responsibility); overwork (also your responsibility) or poor organization (a joint responsibility). One practice in British Columbia did try to do something about a receptionist's personality; the physicians installed a mirror in front of her telephone. Three months later they had the sweetest receptionist in the province. By changing the way she looked this receptionist was able to change the impression conveyed by her voice. The simplest way to provide training for your assistant is to send her to a course designed specifically for medical office assistants. MD Management Ltd., the Canadian Medical Association's wholly owned subsidiary, offers practice management seminars for medical office assistants in most provincial centres. The seminars are held in the evening and take about 4 hours. Those that attend are given a 30-page colour-coded booklet whose topics include: the importance of public relations to a medical office; the medical office assistant's role as hostess; creating the right impression on the telephone; the latest telephone equipment and services; and how time can be saved through patient education. A comprehensive bibliography is also presented. Self image M.G. Landry, vice president of MD Management, explains and illustrates the points made in the booklet; the process is entertaining as well as being informative. Landry stresses the importance of the office assistant to the success of a medical practice - he builds up the aide's self image. Later, aides are invited to act out the parts of patients and assistants, and a discussion follows

tary and the telephone" - but these are not designed specifically for the medical office assistant. Bell also lends out a 30-minute film, "How to lose your best customer without even trying". Improving office routines should lead to more-effective use of time. To reduce telephone interruptions to the doctor's work, an aide has to be able to screen calls. The success of your screening policies depends on how good your guidelines are and how well you train your aide. A call-check list (see box, page 1611) will help your aide to screen calls. Your aide has to know the difference between an emergency call and one that can be called back. And the callbacks have to be properly scheduled. An effective way to manage callbacks is to cluster them at intervals through the day. This avoids the 5 pm rush, increases the quality of patient care and reduces the number of patients calling to see why they haven't Don Price conducts seminars in 1980 been called back. It also gives you a break between seeing patients. on how the assistant could have handled the situation better or difAlso you can introduce a teleferently. No one is bored, and as phone hour to reduce the number one medical office assistant at a of calls made during peak visit recent MD seminar said, "Well, times. Telephone messages are not we've been sitting here for 3 hours so easily lost when they are written but you wouldn't think it." on brightly coloured paper, which Aides are provided with plenty saves time looking for them. You of coffee to keep them awake after could have a preprinted map showa hard day's work and with Diet ing where your office is located. This can be mailed to new patients Pepsi® to keep them slim. CMA members are notified well and save your receptionist from in advance of forthcoming seminars tying up the phone with long explanations of how to get to the in their localities. Follow-up courses are also pro- office. An answering service can vided; in future, Landry says. the help ease the telephone load, but number of aides that attend will be you have to place test calls from reduced to give each one more at- time to time to see that it is protehtion. More emphasis will also be viding an effective service. given to role-playing, since this arouses the most interest and stimu- Switch an assistant lates discussion. Don Price, assistIf you have to use an automatic ant program director of MD Management Ltd., will be conducting answering device rather than an answering service make sure that the seminars in the New Year. At one time Bell Canada of- you can call the office from any fered courses for telephone recep- telephone and have the message tionists; however, a spokesman for played back. At peak telephone Bell told CMAJ that these have not times you might switch an assistant been available for more than a year. from filing duties, for example, to Bell still gives out telephone man- telephone work to ease the load on agement pamphlets on request - the regular receptionist. Finally, a "Words and ways", and "The secre- rather obvious point, keep incoming CMA JOURNAL/DECEMBER 22, 1979/VOL. 121 1609

CALL CHECK Patient Symptoms

I

Ii i. ii I

Unconscious. in shook Fever- Vomiting Severe pain Heavy Bleeding Reaction to medication - injection

tionist to any incoming call, and by flicking a switch she can put the first caller on hold and talk to the new caller. She can then alternate between the two callers as if she had two lines, thus having the advantages of a two-line system for less than the cost of installing two lines. If your practice is in a locality where the call-waiting feature is available (not everywhere) you can also have a call-forward feature. With this, calls to your office and home can be automatically transferred to any other telephone. The featherweights

Routine New patient - iii, wants to talk to doctor Patient under treatment - wants to talk to doctor Patient request for information Family request for patient information insurance Co. or attorney request for patient information Business calls for physician's attention CPA, Attorney, Broker, Medical soc. Physicians personal calls: Family: _________

Friends:

_________

if doctor not available: Hospital Send patient to emergency room Phone Address___________________________________________ Non-emergency refer to Dr._____________________________________________________ Ambulance:__________________________________________ Poison control: _________________________________________

Other-. ________________________________________________

and outgoing personal calls to a minimum. Busy signal survey

If your receptionist is properly trained and the office routines are worked out you may still be able to improve service with more telephone equipment - usually extra telephone lines. To find out whether you need extra lines the telephone company can do a busy signal survey for you. This counts the number of calls that fail to get through to your office. If more than 20% of callers get a busy signal you probably need more lines. More incoming lines may make it necessary to have more telephone personnel to answer them. However,

lines are often busy because office staff are using incoming lines to make necessary business calls, for example, scheduling surgery. If this is the case you may add an unlisted line for outgoing calls only. The telephone company can also carry out a survey of the days and times of day in which telephone calls are heaviest. From these times you can reschedule some jobs that can be done at nonpeak times. Some offices hire part-time staff to help the receptionist during these very busy times. Some practices that have light telephone traffic can manage with one line and a call-waiting feature Incoming callers get a regular ringing tone if the telephone is already busy. A beeptone alerts the recep-

A featherweight headset can be a great help and timesaver for the medical office assistant. There are several kinds on the market including the StarSet® (available from AEL Microtel LtcL, cost $118.20). Landry recommends this over the Ventura® ($5.05 per month) distributed by Bell because it is lighter and provides greater flexibility. The advantage of a featherweight headset is that it leaves the aide with both hands free to look through a file or make notes. It is particularly valuable where you schedule appointments directly onto a computer. The StarSet® comes with a coiled extension cord that enables the aide to get up and retrieve a file while still talking to the caller. If the assistant must go further she can disconnect the headset from the extension cord; the caller remains on hold until the assistant reconnects the headset. The StarSet® plugs into a standard desk telephone that has been equipped with a special jack. One other item that you may want to install is a reception area telephone. This telephone has no number marked on it so incoming calls are avoided, and the telephone company can arrange that no calls can be made outside the local area. The reception area telephone is for the convenience of patients - it's one of the extras. It also prevents patients from using the office assistant's telephone, which save her time, ensures confidentiality of any information on her desk and prevents theft - something to consider, especially if you are an optedout physician, and have cash around the office.E

CMA JOURNAL/DECEMBER 22, 1979/VOL. 121 4-For Rx summary see page 1604

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Improve your practice with effective telephone management.

Improve your practice with effective telephone management JANE WHITNEY John Fineman has a painful rash in a place he'd rather not talk about; he dial...
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