David in His Fight Against Goliath
This week I feel a bit like David in his fight against Goliath as we tackle the topic of phone etiquette and phone triage within healthcare and how it directly impacts the patient’s experience.
There is a lot of, shall I say, passionate opinions out there on the matter, and it is quite the hot button topic.
It seems to be a common point of conflict for both the patients and the healthcare provider; however, there are effective tools and systems that can help decrease the growing frustration and improve practice efficiency and patient satisfaction.
A Patient’s Perspective
A couple weeks ago, I landed myself in the Emergency Room with an asthma attack. I was diagnosed with asthma as a small child, and for most of my adult life it has been well controlled with the occasional use of my rescue inhaler. However, on this particular Sunday evening, that was not the case. My husband and I decided to light our new fall-scented candle and to make a long story short, it triggered my allergies, which triggered my wheezing, which escalated quickly into a full-blown asthma attack.
Attempting to avoid the bill of an ambulance ride, my husband and I jumped in his truck and headed towards the closest hospital. We made it about fifteen minutes down the road when we decided to pull over and call an ambulance. The ambulance met us at a fire station just a block or two from where we had pulled over. In hindsight, we were playing with fire and should have called an ambulance right away, but I digress.
Once in the ambulance, the kind EMT administered an albuterol breathing treatment via a nebulizer and I felt immediate improvement.
Why Call Backs Matter
The next morning, I decided to call my asthma and allergy specialist to follow up with him. Upon doing so, the phone rang a couple times and a woman answered by saying the name of the practice, her name, and then asked how she could help me. For the sake of anonymity, we’ll call her Sally.
Our conversation is as follows.
“Hi Sally, my name is Amanda Gilchrist. I’m a patient of Doctor X and I wanted to follow up with him regarding an asthma attack I had last night that resulted in a trip to the Emergency Room.”
I then briefly recounted the events of the prior evening and followed it up with, “I’m not exactly sure if I should make an appointment, or just leave a message for him to call me back. I would like to speak with him about possibly acquiring a nebulizer to have at home in case this were to happen again.”
Almost cutting me off, she impatiently responded with, “I’ll redirect you to leave a message for his nurse.”
Judging by the tone of her voice and her overall abruptness, I was under the impression my inquiry was an inconvenience to her already very busy morning. She transferred me and I left a message on a recording machine with my name, birth-date, reason for calling, and my call back number.
Two days passed. Three days passed. A week passed. No call from my doctor’s office.
How to Lose a Patient
Can you guess what I did next?
I went onto my Facebook account and created a social media post asking for recommendations of other doctors.
You may recall from a previous blog “What Patients Really Want: Patient Engagement” this is not the first time I’ve had accessibility issues with my asthma and allergy specialist. While I’m not usually one to jump ship, I do often live by the three-strikes-you’re-out method and this was the straw that broke the camel’s back.
Honestly, I can handle knowing my doctor is busy and may not be able to return my call right away, but I would have at least liked to hear from someone, anyone, who was willing to help and didn’t view me as an inconvenience.
The topic of phone etiquette or telephone triage encompasses several components of what patients really want. It involves provider accessibility: the patient’s ability to either directly speak to their provider or receive a message from their provider in response to their questions and/or concerns. Furthermore, in a prompt manner.
Secondly, it also involves customer service: encountering a kind person to help them navigate their healthcare needs. Lastly (in reference to ordering, not priority), it also encompasses the patients’ desire for quality healthcare.
Many physicians feel the cons outweigh the pros in regard to spending time on the phone with their patients. However, research shows that establishing an effective system for phone triage is not only beneficial in the long run, it is proving to be essential in today’s technologically-savvy, consumerism-driven world.
According to an article published by Market Watch, potentially losing patients is not the only consequence of poor phone etiquette. Author Jen Wieczner writes, “The stakes are high: telephone triage errors are a leading cause of medical malpractice settlements, doctors say. And the current state-of-the-art system? A Post-it.”
She goes on to quote ophthalmologist and surgeon, Dr. Peter Polack, by writing, “That’s where patients slip through the cracks – people don’t get called back because the typical system physicians use is sticky notes.” (1)
There must be a better process in place. If not, patient satisfaction, patient retention, and possible litigation are just some of the potential risks at hand.
In an article published by Spruce Health, author David Craig, MD writes, “Physician phone availability also appears to provide objective benefit to patients. In one study, a full third of patients utilizing a physician call-in service reported that they otherwise would have gone to an emergency department.
Eighty-seven percent of the call-in patients also rated their satisfaction with the experience as ‘good’ or better, and 90% of them experienced improvement in symptoms afterward. Other work indicates that patient perception of the therapeutic relationship is strengthened simply through knowing that a physician is available if needed, leading to improvements in health and well-being even when no interaction occurs.” (2)
Dr. Craig holds the opinion that physicians should go so far as to give their cell phone number to their patients. Check out his article, it is very intriguing.
Relias Media published an article titled, “Callbacks Can Improve Patient Satisfaction,” and quotes Jay Kaplan, MD by writing, “Some people think that core clinical quality, such as making the right diagnosis and giving the right medicines, is the real stuff, and that customer service or service excellence is the fluff stuff. But quality and service are intricately interdependent, and by making that phone call to someone for follow-up, you are confirming the diagnosis, and from a quality-outcome perspective, we know that people who rate the satisfaction of their experience higher are more likely to adhere to instructions and medication regimen that you give to them.” (3)
This article is specifically regarding follow-up calls after a patient is seen in the Emergency Department, however I believe its truths can be applied to all areas of healthcare specializations.
Just a side note on the topic of returning calls in a “prompt” manner – in this same article authors write, “Kaplan recommends that follow-up calls be made to patients between twenty-four and forty-eight hours post-discharge from the ED.” (3)
From my professional patient perspective, considering the ‘less-than-urgent’ nature of my call, I would have been thrilled if my asthma and allergy specialist had called me back in that time frame.
A great way of knowing whether you have a good phone system in place or not is to ask your patients.
One of the questions on MedicalGPS’s patient survey is, “In the last 6 months, when you contacted this provider’s office during regular office hours, how often do you get an answer to your medical question that same day?” The answer options are, “Always,” “Usually,” “Sometimes,” or “Never.”
A perfect score of one hundred percent “Always” feedback is what every physician office strives for; however, in the real world there are way too many variables at play, which prevent even the very best practices from consistently hitting the 100% mark.
The MedicalGPS national average for the percentage of patients that give an “Always” answer is seventy-one percent, year to date for 2020. However, being “average” is not where high-performing practices want to be. Practices that strive to be high-performing shoot for the 80th percentile (eighty-one percent) and really aggressive practices that want to be outstanding might even set a goal at the 90th percentile (eighty-six percent).
How to Improve
In her article titled, “Phone Call Procedures in a Medical Office” author Nancy Kertsetter writes, “Efficient and effective phone call procedures will serve the needs of the patients and staff in a professional manner.” (4) It offers great advice on how to make improvements.
In her article published by Physicians Practice, author Carol Stryker takes her readers through “seven easy ways to expedite the incoming phone call process at your medical practice:” (5)
1. Simplify, shorten, and reorder the greeting.
2. Reduce the number of rings before rolling to voicemail.
3. Tell patients when to expect action or a call back.
4. Equip staff to handle calls effectively.
5. Secure a portal for patient communication.
6. Provide patients with educational material they can reference at their leisure.
7. Provide patients with a summary of the visit.
I’ll leave you with a quote from Associate Chief Nursing Office of Emergency Services at Cleveland Clinic, James Bryant, DNP, RN, CEN.
Dr. Bryant states, “We all strive to put our patients first and deliver high quality care. What it comes down to is going the extra mile to express genuine concern and empathy. Restaurants might give you a free appetizer. Mechanics might give you a discount on an oil change. Callbacks are our way of creating that unexpected ‘wow’ experience for ED patients.” (6)
You can check out his writings in this article. His words are true for all patient-provider relationships.
Patients truly experience the “wow factor” when they know their healthcare facility has an efficient system in place to answer and return their phone calls promptly and professionally.
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Jerry L. Stone