Telephone triage: Can your staff answer the call? (Medical Economics Special Section)

Just as the front desk is the public face of your practice, the people answering your phones are its public voice.

Given that key role, these employees should not only be intelligent, flexible, and cool under pressure; they should also have a clear and thorough sense of their mission. But that understanding is lacking in too many practices, say experts, often through no fault of the staff members themselves.

"There's a lack of clarity as to what's expected of nonclinical people when they answer the phones," says Houston gastroenterologist Gary A. Glober, who consults with practices on developing leadership and communication skills. "Office managers, nurses, and the doctors themselves aren't making it clear what they want these individuals to say."

The solution, say experts, is to provide nonclinical staff with written guidelines on how to handle both urgent and routine calls. This can take any number of forms, ranging from posted phone and appointment grids, to decision trees, to triage manuals. But however you manage the task, the point is to communicate as efficiently as possible how you want incoming calls handled.

Here's a step-by-step process for getting that job done.

Three steps to creating a phone protocol

What doctors shouldn't do, says Glober, is to hand down phone procedures from "on high" without first collaborating with their staff. Here's how to carry out a collaborative effort:

Step 1: Gather information. The key here is to define the nature and scope of the problem you face. Holding an office-wide brainstorming session is one way to conduct this research. Another way, says Glober, is to have staff track calls as they come in, noting the type of call, the time of day, and how they were handled. "Do this until patterns emerge," he says.

He also advises polling new and established patients (in person or by mail) to find out if urgent calls are being handled satisfactorily. If not, discuss with staff members how they can be handled more efficiently. What about the handling of more routine calls, such as appointment requests, billing or insurance questions, or requests for lab results? Can these calls be answered more efficiently? If so, how?

As part of the information gathering step, each physician in a group practice needs to spell out how she wants different types of calls handled. For example, some doctors want all calls from referring doctors to be transferred to them immediately and the patient's chart brought in. Others don't. Similarly, how does each doctor want her personal calls handled? Should the operator ask the caller whether the physician should be interrupted, even if she's with a patient? Or should the caller be told that all nonemergency personal calls will be returned at the end of the day?

Doctors also need to spell out how they want different types of appointments scheduled. In a four-member primary-care group, for instance, each member may want same-day appointments for any patient who calls in complaining of mild chest pain, but only two of the four doctors may want to see that patient for a long appointment. "If doctors don't tell people handling the phones what they want, the only feedback these staffers get is when things go wrong-and things will go wrong a lot," says Bee.

Step 2: Draft written guidance. This can take any number of forms, ranging from the simple to the elaborately complex. If you're detail-oriented, you can draft your own telephone protocol manual, with guidance from one of several resources like Telephone Triage Protocols for Nurses, 3rd ed., by Julie K. Briggs (Lippincott Williams & Wilkins, 2006).