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Shattering the Phone Bottleneck

The Business of Medicine

How data & observations led to boosts in clinical capacity, patient satisfaction

In just seven days, one clinic slashed phone call volume by nearly 60 percent and hang-ups to less than 10 percent – without changes to job titles, pay ranges, staff size, or doctors’ point persons. Healthcare Process Improvement Leader Amy Lueb explains.


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What are the most common patient complaints? Well, if you’ve ever been on the receiving end, you probably know that most are about the administrative parts of a hospital or clinic.

For instance, how often have you heard complaints about difficulties in reaching a staff member on the phone? Or how an appointment never starts on time?

If you’re an administrator, you may have tried quick fixes such as:

  • Having more people on the phones
  • More staff training
  • Online pre-registration and new-patient paperwork
  • Asking patients to arrive for appointments 15 to 20 minutes early

But, in my experience, even after enacting these solutions, patient complaints usually don’t change. The reason: administrators didn’t address the right issue in the first place.

Without more information, patient complaints can actually lead us away from the real, underlying problem. And sometimes, without knowing it, we make up stories to understand the patient’s experience. For example, our knee-jerk reaction to phone complaints is to just put more people on the telephones. But, more isn’t always the solution. Instead, it’s important first to collect data about possible causes.

Analyzing a practice’s telephone troubles

Let’s walk through an example of why solutions based on data and observations are more effective.

We worked with a clinic receiving patient complaints the staff never answered phone calls or responded to voicemails. If someone did call patients back, it wasn’t until several days later. To give some context, this clinic had about 30 available appointment slots a day and 15 administrative, non-management staff. They ran at about 65 percent capacity and had a cancellation rate of less than 5 percent.

We took a look at the clinic’s internal data and here’s what we found:

  • 75 percent of incoming calls were transferred to other associates
  • The call abandonment rate was greater than 20 percent (in contrast to general standards less than 5 percent).
  • Call volume was about 800 calls per week, with a steady daily increase through the week.

We also observed the staff at work to see any behaviors or processes contributing to the problems. Our observations revealed that:

  • First, a majority of calls were for new or follow-up appointments, not clinical questions
  • Associates were giving out their direct numbers for patients to circumvent the phone system
  • People would call the clinic multiple times daily
  • There was no process for returning calls left in certain voice mail queue
  • Each provider had one administrative person responsible for scheduling all of that doctor’s appointments and surgeries
  • All administrative associates, no matter title, job description or tasking, were required to be logged on and answering phone calls while they were in the office
  • The differences in the type of appointments being scheduled were also minimal.

These observations and data revealed several issues:

First, when a patient called the clinic, the likelihood of reaching a medical assistant or nurse assigned to the patient’s doctor was small – hence the high transfer rate. If the patient did reach the right staff member, the likelihood was small that the staffer wasn’t on the phone with another patient, creating a high volume of voicemails and high abandonment rates.

Second, when the patients called a staffer on a direct line, more often than not the staff member logged off the phone system to answer, because they knew it was a patient under the staffer’s care. This habit was a breach of established standards and process.

And lastly, since most patients weren’t able to reach the right person on first try, patients subsequently called the clinic multiple times a day make appointments, increasing the phone call volume by 50 to 75 percent.

Now you can understand why merely adding more staff wouldn’t fix the problem. The real issue was not staff capacity, but getting the patient to the right person on the first call.

Creating an action plan

As soon as we identified this pain point, the clinic created an action plan.

They decided to create a mini phone center with only three associates to schedule all appointments. Doctors were still able to keep their point persons, but this person no longer managed appointment scheduling. All these changes required was a rearrangement of job tasks. The clinic made no changes to staff job titles or pay ranges, and the clinic did not hire more staff.

In the first week following the changes, call volume fell by almost 60 percent and call abandonment rate decreased to less than 10 percent. The clinic suddenly had more capacity for new physicians coming into the practice. Over the next few weeks, patients noted the ease of the improved scheduling process.

Customer feedback and comments are very important to the success of any business, but if you just try to Band-Aid each symptom, you will never truly solve anything and the disease will continue to grow. Look for data aligned with observations to drive how to put in place effective and productive solutions the first time.

Have a healthy, happy practice

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