Automated Phone Trees

We have all experienced the dreaded pause that’s the giveaway that you’ve entered telephone purgatory. You dial your local electric company or your credit card company, the phone rings twice, then the pause of dead air. Your stomach sinks, and that silence on the other end is broken by the sound of an automated phone system, telling you how happy is it that you’ve called and how it (an inanimate machine, remember) cares about your service.

Telephone purgatory has become so ubiquitous, that it’s one of the cultural experiences to which we can all relate. Who among us hasn’t felt like a fox chasing a rabbit, as we push beeping buttons in hopes of getting to the end of a telephone maze, and thus the voice of a human? In fact, entire Web sites have sprouted up, dedicated to posting cheat sheets outlining which buttons to push to quickly reach a human.

Careful considerations

Like so many technologies in use today, automated telephone systems are a tug of war between saving money and increasing convenience for our patients. When considering automated telephone solutions (commonly known as automated attendants) for your practice, it’s important to keep your patients’ perspective in mind, and remember those painful times you have experienced on the other end of someone else’s telephone attendant handiwork.

You must also seriously consider your goals if you are considering any type of phone automation for your office. Is your office so large you want to be able to route callers to specific staff such as billers, or does your small office want to simply send prescription refill requests to a voicemail box that you intend to check hourly? Or do you dream big and want your patients to be able to call in and cancel an appointment or pay a bill via telephone without ever talking to a human?

It is also important to consider your audience. Is your patient base going to adapt well to an automated phone system? Are your patients among the generation who assume automated systems are all there ever was, or will they revolt the first time they are not greeted by a human over the phone?

Phone system automation comes in many technology flavors. Platforms range from modules that add on to your existing phone system (aka PBX) for larger offices, to new waves of “phone system in a box” technologies, where the automated attendant runs on what looks to be a normal PC with a number of special connectors hooked to your phone system. Additionally, more advanced, large enterprise solutions can even include what are called Interactive Voice Response (IVR) systems, which can actually recognize the words you are saying, such as “connect me with billing.” While IVR is a nice feature, its practicality is questionable in many cases, particularly for anything less than large enterprise deployments.

Smart set-up

The meat of telephone automation comes not from the specific technologies you choose, but in how you choose to set it up, operationally. I’ve had clinic managers insist I build a special prescription refill line, which dumped script refill calls to a voicemail box, to be picked up every 30 minutes by the nurse. Setting up such a line that intercepted calls to our clinic was technically an easy task. Unfortunately, when someone was out sick, or the clinic got too hectic, there could be more than 40 refill voicemails waiting (in some cases, the same patient calling multiple times). This then can take huge amounts of time to keep up with, leading to frustrated patients and nurses wanting to poke that little voicemail notification light out of their phone with a sharp instrument.

So, while it was technically possible, it wasn’t necessarily a good idea in that clinic’s operation. This case illustrates why it makes sense to have small pilot projects in a single clinic before rolling out major phone changes to the entire organization. Solutions that looked good on paper may be a little bumpier in practice.

Another common myth is that by setting up a queue (sometimes called ACD/UCD groups) for patients to be on hold, patient access will improve. We all have heard the phrase “please wait for the next available agent.” The problem with that logic is if your single front desk telephone operator is already overwhelmed, the only thing happening to patients who call in to an automated queue is they are going to be on hold, and likely for extended periods of time, especially if that front desk person is also making photocopies and checking in patients. You must first consider whether the workload is simply too much for one operator, or whether the automated system can help route calls by bypassing steps, rather than just replicating the current call flow in an electronic, “on hold” world.

When building a system, avoid getting hung up on a single setup you had in mind. Just because you’ve seen other people use call queues at the front desk, doesn’t mean it’s the best solution for your practice.

Practices should discuss and document their goals before undertaking a telephone automation project. Gather input from all sides, including patients, as well as your front desk and clinic staff. Hire a technical partner who has experience in setting up what are called call centers, or similar environments, and discuss your goals and concerns.

If your patients are complaining about being unable to get through to schedule an appointment, perhaps your office phone coverage hours need to be reviewed, in combination with considering setup of call queues and the ability for patients to directly dial nurses’ extensions after calling your main telephone number. Explore your options (and your budget) with your technical partner, and discuss your long term and short term goals. Perhaps you initially want to improve patient telephone access, but eventually you would like to allow patients to cancel their appointments by just pushing a few buttons. If you build a roadmap and work with your technical resource, your route on the technology road should lead you somewhere other than telephone purgatory.

Jonathan McCallister is a client-site IT manager for a major healthcare consulting firm, and he is currently assigned to a 140-physician practice. He has worked in healthcare IT management for more than eight years and in general IT management for more than a decade. He can be reached via physicianspractice@cmpmedica.com.

This article originally appeared in the June 2010 issue of Physicians Practice.