October 2000 Bulletin

Phone tree ‘efficiency’ can be annoying

Some practices need it because of limited staff; others prefer a warm voice

By Sandra Lee Breisch

Are your patients dialing into a phone tree maze? Do they listen to option after option only to get prompted to another option? Or encounter lengthy messages and more wait time–and never speak to a warm voice? And does your phone tree say, "goodbye" if the patient couldn’t or didn’t press an option fast enough–forcing the person to redial again?

If so, your phone tree might be discouraging or even preventing the public from communicating with your practice.

"Patients want personalized care," stresses Judith G. Lazar, an administrator at the CNS Medical Group, PC, a hospital-based group that rehabilitates spinal chord and traumatic brain injury patients in Englewood, Colo. "We do not use a phone tree," she says. "The only recorded message we have is a prescription line. We believe that patient care should be personal care. We all hate this voice mail thing."

So, how many options are optimal?

"Zero choices are optimal," says Lazar, who points out that many patients, particularly the older generation and non-Touch-Tone(TM) phone users "are not happy" with the phone tree system.

Yet, some practices really need a phone tree because they don’t have enough staff to handle the volume of incoming calls.

One such group is the Orthopedic Physician Associates and Seattle Spine Group where 13 orthopaedists utilize a seven-option phone tree that asks the caller to then punch in another option.

The group’s administrator, David G. Fitzgerald, says, "We get patient complaints on the phone tree all the time saying, ‘the main menu greeting is too long,’" he says. "We just explain it to them."

To help the group streamline telephone access and determine any kinks in the phone tree system, Fitzgerald said the group uses an automated call distribution (ACD) software system. It is designed to track everything from on-hold times, calls that bounce back to the operator, the person answering the calls–and more.

However, a recent consultant’s report on their ACD system found that calls bounced back to the operator, so people are "on hold" and frequently calls holding on the receptionist’s telephone lines exceed the "on-hold" timer and returned to the operator.

"We know that telephones are really the door into your practice," says Fitzgerald, who admits their phone system "needs improvement."

Besides annoying patients and risking the loss of their business, phone trees could also pose a potential liability for those practices that direct patients to "dial 911 if you think it’s an emergency."

"That’s because you are delegating the responsibility to a patient as to what is an emergency?" Lazar explains. "While some patients minimize their problems, others will see something as a medical emergency–when it is not a medical emergency.

"Another issue is if your recording says, ‘If this is an emergency, call 911 or go to the emergency room,’ and the patient’s insurance plan doesn’t cover the services or deem it [their visit] as an emergency, there might be financial implications that can adversely affect the patient."

At the Yale School of Medicine, the use of phone trees, voice mail and
appointment scheduling is not only "discouraged" but "prohibited" between the hours of 8:30 a.m. and 5 p.m. from Mondays through Fridays.

The Yale Physicians’ Practice Standards state, "If [phone tree] used, the caller must be given the option to speak to an attendant within the first 30 seconds of the recorded message. Phone trees referring the caller to another phone number must use a system that automatically transfers the caller. Callers should not have to hang up and dial another number."

"It’s critical that the person answering be a very warm welcoming person at the other end of the phone and a professional, helpful person," says Marianne Dess-Santoro, executive director, Patient Financial Services and a member of the school’s practice standards committee. "We tell our staff who are answering the telephones to identify their name, their critical practice area and ask the patient how they may help that person."

The standards address some 15 items that include telephone response time, phone greetings, voice mail utilization, phone tree utilization, appointment scheduling, patient registration, reception/waiting areas (staff greeting of patients and visitors in all clinical areas), the patient experience and more.

"The patient’s experience should be optimal going in, during and going out of a physician’s practice," Dess-Santoro stresses.

So, what’s OK to use phone tree options for?

"It’s helpful to have a phone tree with options to refill routine prescriptions and hours of business," says Dess-Santoro. "But for everything else, you really need to speak to a person to make an appointment or if you have a medical concern or question."

As Lazar puts it, "In a nutshell, go back to personal contact and personal caring. And if that means physicians need to have a human being answering their phones, then they should do that."

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