Patient Experience: What happens when the phone rings?

As long as the Harvard Business Review continues to not ask me to write an article for them then I will continue to refuse to do so.

True story.  Flying yesterday at thirty-six thousand feet I was able to exchange a look of terror with the passengers on the other plane.  A near-miss is defined as being within a thousand vertical feet of the other plane and within three nautical miles.  We were so close to the other plane that we felt our plane move from the plane’s slipstream.

Enough of my problems.

I was in the hospital’s cafeteria watching people before my meeting about reinventing patient experience with one of the hospital’s executives.  Two people stopped by my table to tell me how much they liked my socks.  It occurred to me that if my socks were noteworthy enough to warrant comments from two strangers that they may be the wrong socks to wear to meet with the executive.  I was wearing sensible shoes, so at least I had that going for me.

So, I did some work for an organization that felt it needed a call center.  And for that call center they wanted to talk about ACD’s, IVR’s, CRM, and a suitcase full of other technical things.  I thought the best way to be of service would be to stop at Costco and buy them the call-center-in-a-box startup kit.  Maybe I’d also get them the all-in-one-EHR.

This is what happens when someone reads something they shouldn’t, something which they believe gives them instant credibility on a subject of which they previously knew nothing.  I watch one of those shows about goofy problems in the ER, but even so I remain hesitant about thinking I am the right guy to insert a chest tube.  I did buy some scrubs and a white jacket just in case someone feels the need to pull me in on a procedure.

When I asked why they felt they needed to design a call center their reasons were legion.  Too many numbers, too much wait time, too many dropped calls, too many call backs.  They want job descriptions, training manuals, a system for scheduling the people who were taking the calls, and they want scripts written for every conceivable type of call.  Call-center-in-a-box.

I asked what business problem they were trying to solve, a question which branded my immediately as a heretic.  Burn him at the stake the pink-faced call center director shouted.  All I could think of was that I was glad I had not worn my fancy socks.

If they proceed along this course they will have a very efficient call center—phone rings, it is answered, both parties disconnect.  Rinse and repeat.

I am not a fan of efficiency.  Efficiency is about speed, and speed kills.

I once did some work for one of the largest telecommunications firms in the US.  They wanted a call center strategy.  I told them that they should close all of their call centers, and then I closed my laptop.  (I sensed that they wanted a little more detail so I went to the white board.)

They told me it cost about thirty dollars to answer each call, and they received millions of calls.  I then had them create an exhaustive list of the reasons people called.  I was the scribe—in consulting lingo we refer to the in the work plan as facilitation because you can charge more for facilitating than you can for writing.

We created a pretty substantial list.  We then worked through each of the reasons on the list.  For an item to remain on the list, the people in the room were asked to defend why a customer should have to call about that item.

They learned that phone calls fell into one of three areas; people needed something, people had a question about something, or people had a complaint.  They learned that whatever it was people needed should have been handled at some point upstream in the process.  They learned that the information that was needed could have been provided at some point upstream in the process.  And they learned that complaints arose from something that did not happen correctly at some point upstream in the process.

Of the few items that remained—I gave in on some to make them feel better—I asked which of those could be handled through a customer portal.

Each item that is addressed at some point upstream in the process takes the cost of the call from thirty dollars to zero dollars.  The same is true with handling an item in the customer portal.  Eliminating a call ensures there are no call-backs, no waiting time, and no abandoned calls.  It also ensures that everyone gets the same answer, the same right answer to the same question.

It also ensures and insures the brand.

Your hospital gets hundreds if not thousands of calls each day.  Your hospital has dozens of phone numbers.  Each phone number is answered differently by people with different skills and experience and having different objectives.  People are placed on hold, transferred, given other numbers to call, and given the wrong information.

The other thing this hospital wants to do is to have one phone number people can call; a noble idea and a very bad idea.  They want it to handle two-dozen different call origination types, everything from getting information about how to donate to what hours the cafeteria is open to how to schedule an appointment.

In effect, they want their call center to be the same as their web site.  Their web site has more than fifty clickable links, everything from getting information about how to donate to what hours the cafeteria is open to how to schedule an appointment.

There should be a number for patient stuff and a website for patient and prospective patient stuff—a customer portal which is not even close to what EPIC and Cerner mean by patient portal.  There should also be a number or numbers for other stuff and maybe, just maybe a single link on the customer portal for all of the other stuff.

Designing patient experience so that the experiences on the web and on the phone are similar is only beneficial if those experiences are remarkable. Designing a call center experience that mimics the lack of functionality of your website is a waste of money.

6 thoughts on “Patient Experience: What happens when the phone rings?

  1. While many will agree with the importance of improving the patient experience, when asked to act, folks seem to forget this focus. Instead, they try to improve something like a Call Center that has accurately been described as receiving most of its calls because something when wrong. If more attention were truly given to improving the patient experience, the need to “rely” on a call center would decrease (along with the dollars spent on running the center that could be better spent on improving our healthcare systems upstream!).

    We must continually remind all those involved with healthcare to lift their heads, remember the purpose behind that roles they are there to perform and work harder at connecting the dots needed to provide better outcomes for our patients.


  2. I believe that for some patients, speaking to a person is preferable than using a website. But there are a lot of practical applications for a website: making appointments, getting test results, getting information on symptoms management (i.e., nutrition, hypertension, etc.).

    There are situations that require two way communication beyond a web chat, where demonstrating empathy, assessing symptoms and responding to feedback/complaints is important to the patient.


    • Indeed. Was going to say similar. Also, some (e.g. elderly) may not have access to or be skilled at navigating complex websites. and a human voice/ear would seem essential for these types of people / complaints in both senses – ailments or complaints about lack of treatment for them. There should then be a phone line to handle these types of calls – or else a VOIP/ Skype type online phone/video link. Call centers may be fine, as long as the responders are human and empathetic- it’s not the medium but the messengers and the tendency to need robotic checklists and cue sheets and standard (fob off) replies that seems to me the core issue here.


  3. Well said, Paul. Since we’re on the subject of call centers, how about answering the phone before 8:00AM and after 6:00PM? How about giving the patient a call-back time frame? It seems that call center policies are designed by people who have both flexibility and privacy during their work day. Yet, there are many people who can’t make or receive personal calls during the work day, or who don’t have sufficient privacy to discuss medical matters. For them, access to many hospitals is foreclosed. The implications of these exclusionary policies are obvious and painful to consider.


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