Human Resources: ISO: The World’s Best Front-Desk Person

Experts say they are pivotal, critical, of the utmost importance. They are the voice and face of your practice, the front line. They make that indelible first impression on patients walking through your office door.

Your front-desk employee can make or break your practice. That’s right, this crucial role is held by your receptionist, an employee you’re most likely not paying very well and perhaps don’t even talk to much.

So you may want to change your ways.

“The front-desk person has the single greatest influence on customer satisfaction,” says Greg Mertz, president and CEO of Horizon Group, the Virginia Beach, Va.-based practice management consulting firm.

Mertz, who specializes in front-office operations, has conducted surveys proving that the influence front-desk workers have on patient satisfaction is larger than that of any other office employee - even those who actually provide patient care.

Cecil Wilson, chairman of the board of the American Medical Association and a solo general internal medicine practitioner based in Winter Park, Fla., agrees.

“If the patient has been received well at the front desk and made to feel that we’re glad they’re here, by the time they get to the examining room, half my work is done,” says Wilson. He adds that patients who have been treated poorly before seeing their physician often don’t rate their clinical experience very highly, no matter how well their physician treated them. And unsatisfied patients are less likely to comply with treatment plans.

The bad and the ugly

But the front-desk position continues to be a low-paying one with high turnover. Employees are often hired in this capacity in a hurry when yet another one leaves for greener pastures. It’s a small wonder, then, that sometimes things can and do go terribly awry at the front desk.

It was the police officer’s uniform that set off the peculiar behavior of the front-desk receptionist at Anchorage Fracture & Orthopedic Clinic one day three years ago. Seeing the cop/patient walk through the door, she jumped up and ran deep into the bowels of the office, hiding in a back exam room. Practice administrator Beth Balen recalls that when other employees went to comfort the trembling receptionist, she admitted that that specific officer had arrested her recently, and she was frightened because she hadn’t told her probation officer where she was working.

According to Balen, no one had any idea that this employee had a criminal record - much less a probation officer. The cowering receptionist was soon let go.

There was also an incident at a New York City practice when healthcare consultant Dorothea Taylor was filling in as practice manager. One day, in the midst of a heated argument, one receptionist hauled off and slapped another one hard on the back of the head - right in front of a room full of gasping patients. Needless to say, he too was fired with little ceremony.

And then there was the case of the employee who’d been hired quickly by an ophthalmology practice in a jam to find someone. This receptionist grew surlier and surlier over the course of her employment - not at all reflective of the demeanor she had projected during her interview process. Within weeks, she was ducking out in the middle of shifts to a nearby hotel room to rendezvous with one of the office’s tech workers. When the practice finally bothered to call several of the worker’s previous employers, they revealed that she had embezzled funds from one of them and was still embroiled in a lawsuit. She was let go that day.

Less sensational but still significant stories range from front-desk staffers who, through inaccurate data-gathering, catalyze costly billing errors, to those who, through their ill-tempered demeanors, make incoming patients feel like inconvenient burdens.

The good

These horror stories are of course matched by those of exemplary front-desk staff. Paige Langit, the current front-desk employee at Anchorage Fracture & Orthopedic, is so warm and welcoming that patients often ask for her when they arrive - even if they’ve only met her once or twice.

It could be her always-upbeat and caring demeanor, says Balen, or maybe it’s that Langit periodically gets on the loudspeaker and, rather than simply saying what she has to say to another staff member, sings it in whatever top-40 tune is on her mind that day. This invariably elicits chuckles from patients lingering in the practice’s waiting room.

And then there’s Sandra, who works for Peter Lavine in his Washington, D.C., orthopedic surgery practice. Lavine says that Sandra has expanded her job far beyond front-desk duties to become a jack-of-all-trades in his office. She’s taken so much ownership of her self-initiated patient duties that she has come to view the practice’s patients as her own. And she watches out for their interests.

“She’ll come back and say to the X-ray tech and me, ‘You guys better pick up the pace here - my patients are getting cranky,’” laughs Lavine.

Sandra - who’s been on the job for almost seven years - has also built up so much goodwill among local attorneys and workmen’s compensation adjusters that she can easily pull a few strings for patients who are having a hard time getting an appointment, adds Lavine.

Hard to get, harder to hold

If you’re lucky, you’ve had more Sandras and Paiges at your practice than criminals, assailants, and embezzlers. But odds are you’ve had a difficult time attracting and retaining good employees at your front desk. Healthcare consultants and practice administrators say that finding and keeping a great front-desk person is becoming exceedingly difficult.

Why? Money, mostly.

“They tend to be the lowest-paid people in the office,” says Kenneth Hertz, senior consultant with the Medical Group Management Association. “It can be hard to get someone to work for, say, just above minimum wage, and come in with all the interpersonal skills necessary and do a good job.”

Such wage levels are not commensurate with the position’s stress level. In medium and small practices, front-desk workers are frequently under pressure to do much more than simply greet incoming patients. They typically schedule appointments, photocopy insurance cards, handle HIPAA papers, gather demographic data, collect referrals, serve as a gopher among doctors and nurses, work in concert with billing staff, receive copays, and attempt to calm angry patients - all while continuing to answer the phones.

“You have to have 27 tentacles to handle all that,” says Hertz. He adds that the front-desk worker is also a convenient scapegoat: “If the schedule goes bad, patients blame them, though they usually don’t have anything to do with it.”

If you truly want to attract stellar front-desk employees to your practice, offer a good salary and benefits package and follow tried-and-true hiring practices. Take the time to search for just the right person, and use temps to fill the void in the meantime.

Experts advise looking for someone who doesn’t have a history of frequent job-hopping and who at least has a high school education and perhaps a few years of college or technical training. You also want someone who is articulate, says Taylor, a senior consultant with La Penna Group in Grand Rapids, Mich. She adds that the ability to multitask in this position is paramount.

Consultants differ on whether new front-desk employees should be required to have experience in medical settings. Some, like Taylor, say it’s essential; others, like Cynthia Childs, practice administrator at Haywood Medical in Gardener, Mass., says she puts more stock in a candidate’s demeanor, regardless of background.

“You can teach them how to be a front-desk person, but you can’t teach them to be cheery and fun and to have an upbeat personality or to care about patients, to empathize,” says Childs.

But Lavine has discovered it’s possible to hire a receptionist who is too empathetic. A few years ago, he had on staff a very sweet, very caring receptionist who often went overboard. Lavine recalls that she would stay on the phone with patients for long periods, discussing all manner of details in their lives, not excluding their car troubles and the herbal remedies they were considering. Meanwhile, the office surrounding her was edging toward chaos.

“After a while, I’d have to say, ‘Can you please just make the appointment?’” says Lavine.

Mertz agrees that demeanor is key, and healthcare experience is good - but he also prefers front-desk employees who have intense customer-services experiences from other arenas under their belt, such as the food service industry. Such backgrounds usually make employees warm toward patients, but not too warm, and they are more likely to have robust trouble-shooting skills.

“Waiters and waitresses spend their entire lives making excuses for the kitchen, and front-desk people have to do that for the doctor,” says Mertz.

Hertz suggests that employers interviewing potential front-desk employees ask them about past scenarios in which they had to deal with an upset patient or customer, or a miffed boss. What did they do?

If you’re satisfied with an interviewee’s answers, the next step is a test, says Taylor. She has interviewees take a spelling test (because they will need to write notes to the doctor) and a math test (because they will need to collect copays), and then she scrutinizes them while they perform several filing tasks.

If you get that far and are still satisfied, perform reference checks. Taylor recommends starting by calling all references - supervisors only, no former coworkers - and asking for the straight scoop. She suggests asking very specific questions and requesting that references rate the potential employee on a scale of 1 to 10 in important performance areas. That way, she says, if you are considering many candidates and are not sure which to choose, you can let the numbers make the final decision.

Good questions to ask include: How is his attitude? Is she a team player? Does he take initiative around the office? Is she punctual?

“If the front-desk person isn’t there on time, I’m screwed,” Taylor says. “They have to be ready to rock and roll first thing - not getting their coffee and putting on their makeup.”

If all references check out and Taylor really likes the candidate, she’ll offer the job. If the position is accepted, she’ll ask an outside company to perform a background check. This step costs about $40, she says, and reveals whether candidates have bad credit, verifies their credentials, and indicates whether or not they have a criminal record.

If the background check reveals no potential problems, you very well may have found yourself a winning front-desk person. Or not. Taylor explains that even with very carefully conducted interviews, there’s still a 25 percent chance that your employee will disappoint, and you’ll find yourself at square one. Such is the reality of identifying stellar front-desk employees, she says.

Train, train, train

Even if you do manage to hire a front-desk employee with excellent potential, don’t expect much if you aren’t committed to training that person.

During a recent trip to his physician, Hertz was presented with HIPAA forms - declaring he had read the practice’s privacy policy - to sign. Since he hadn’t been given a copy of the practice’s privacy practices and was not required by law to sign the form, Hertz chose not to. The front-desk person, not knowing the law, insisted he sign. She didn’t realize that she needed only to file the form away, noting his refusal to sign. When Hertz asked see a copy of the policy, the woman replied, “We don’t have any more.”

Rather than blame the employee, Hertz attributes her lack of training and direction to her supervisors. “We don’t encourage them to think, and so by and large they don’t,” he says.

“Disney invests 80 hours of training in each of its street sweepers, realizing they are the people on the ground answering customers’ questions, like: ‘Where is Space Mountain? Where is food? Where is my kid?’” notes Mertz. “The front-desk person is truly the practice’s street sweeper - dealing with missed appointments, questions about why the doctor is late - and yet, in my 30 years in the business, I’ve never seen one get any formal training.”

Hertz says the more common scenario goes something like this: “Mary is working at the front desk for $7 an hour and quits, and it gets crazy and the phones are ringing off the hook. The practice goes through old resumes, maybe does a few quick interviews, and hires whoever can start right away. The training is: ‘Here’s your desk, here are the phones, we’ll do some training for you later - bye.’”

That scenario probably occurs 75 percent of the time, approximates Hertz, leaving new front-desk people feeling lost and ineffectual, with no sense of the expectations others have of them and no choice but to rely on their coworkers for insight into how the practice and its computer systems operate.

Just allowing new workers to spend a few hours getting to know what happens in each department would work wonders toward expanding their understanding of the practice’s processes and work flow, says Hertz. A few days’ training on the practice’s computer also makes sense. In fact, it’s a smart move to retrain everyone on your computer system’s basic operations every few months, given the high rate of staff turnover. And of course, telling the new employee the practice’s expectations would eliminate a lot of ambiguity.

And pats on the back of any kind are always welcome, as many front-desk employees don’t interact very much with the doctors and thus are often unsure whether they are performing well or are having any effect on the practice’s work flow - unless that effect is negative, says Taylor. Then the employee gets plenty feedback. “Hopefully,” says Mertz, “someday the whole healthcare profession will wake up and realize that the folks at the bottom of the pyramid are critical to the health of their practice.”

Suz Redfearn is an award-winning healthcare writer based in Falls Church, Va., who has written for a variety of publications including The Washington Post and Men’s Health. She can be reached via editor@physicianspractice.com.

This article originally appeared in the October 2006 issue of Physicians Practice.