4 Hidden Bottlenecks in Your Practice: How to Banish Them

Leigh Page


July 17, 2018

In This Article

The Phone Calls Never Stop!

4. Overwhelming Volume of Incoming Phone Calls

The bottleneck: Staff answering the phone are overwhelmed by calls asking to talk to a physician or waiting for medication refills.


Remove phones from the receptionist's responsibility. As already stated, having one person greet patients and answer the phones is an invitation for bottlenecks to happen. It's more efficient to have one person answering the phones and another person greeting patients.

When one person does both jobs, callers are put on hold for many minutes while arriving patients are greeted. Then the receptionist has to deal with the caller backup, and makes incoming patients wait for check-in.

Determine why people are calling. Patients' calls to the practice often involve some aspect of their care process that they are confused about, Brown says. In many cases, patients wouldn't have needed to call if someone had explained the matter and made sure that the patient heard, understood, and remembered what was said.

"In our practice, we view each call as opportunity to improve efficiency," she says. "Was there something we could have done differently so that person didn't have to make the call?"

This approach involves a little bit of research, which can be time-consuming, but it can save time in the long run, Brown maintains. Other callers may have had the same problem. Keep a record of the types of calls and requests you're getting, and figure out ways to forestall that problem. Some practices have found that printing out a visit review and instruction guide at the end of each visit helps patients to remember what they're supposed to do, and how the therapeutic regimen works.

Find a better way to handle refills. In many practices, requests for refills are a major reason for patients to call, and this can significantly tie up the phones.

"Patients who use medications for chronic diseases, such as high blood pressure or diabetes, are usually on them for life," Brown says. So it makes sense to put these patients on year-long prescriptions. "In my practice, we give the patient a prescription for 3 months with four refills for the rest of the year," she says.

She points to a STEPS Forward module that shows practices how to arrange for refills to be renewed just once a year, when patients come in for their annual comprehensive care visit. In most states, the maximum duration of a prescription is 12-15 months, according to the module.[6]

"You write one prescription for the whole year and build in the refills," Brown says. "If you do 12 months' worth of refills, within 6 months the practice is saving 1-2 hours each day per doctor."

Provide a patient portal. Brown says having a portal has reduced the number of calls her practice receives. A portal can handle many issues, such as requesting appointments, paying bills, and reporting lab results.

However, there is evidence that portals can actually increase the number of calls in some practices. That was the conclusion of a 2016 study in the Journal of the American Board of Family Medicine.[7] The authors did not speculate as to why this was happening.

Use phone trees. Some callers may resent directives to press various numbers for different services, but speaking to live person is not necessarily a good alternative, Morgan maintains. "It's a myth that people prefer to talk to a person," she says. "The live person is often still going to have to transfer them around."

Morgan advises customizing your phone tree so that it meets the needs of your patients. "Ask yourself, what are your patients most commonly calling for?" she says. "If they want school physical forms, that would go on the phone tree."

Girgis, on the other hand, does not believe in phone trees. "We don't have a place for voice mail messages," she says. "Patients who call in always reach a live person. Even if we can't help them, we still want to guide them."


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