Don't Turn Down the Volume: Why the Telephone Still Matters in Healthcare

Technology may be changing how patients access healthcare, but sometimes they still just want someone to answer the phone.

Leslie Edmondson | Founder & Principal Consultant

While working with a healthcare care organization, we had one clinic where patients—and even employees at our other locations—had a hard time reaching anyone by phone.

We investigated. We checked the phone lines. We contacted the telephone provider. We looked for technical problems. We exhausted every possible explanation.

Finally, we discovered the problem.

Someone at the front desk had turned down the volume on the telephone ringer.

The calls were coming in. The telephone simply wasn't being heard.

At first, it's easy to look at a situation like this and think: Seriously?

But I learned that there was more to the story. And, years later, I heard an almost identical story from a friend.

The Pharmacy Phone That Didn't Ring

A friend had a family member with a question about a prescription her husband was taking.

She tried calling the pharmacy located inside a local grocery store. No answer. She tried again. Still no answer.

Eventually, she contacted the grocery store manager, only to learn that the grocery store and pharmacy operated independently. He couldn't answer her pharmacy question.

So she did what patients sometimes have to do when technology and processes fail them.

She got in her car and drove to the pharmacy.

When she arrived, she explained that she had tried to call repeatedly. Someone investigated.

The volume on the telephone had been turned down.

Again. No one volunteered to explain how that happened.

Two completely different healthcare settings. Two very similar experiences.

How often does something this simple create an access problem that leadership never sees?

Believe It or Not, Patients Still Call

Healthcare has made tremendous progress in digital access. Patients can schedule appointments online. They can use patient portals, send electronic messages, receive text reminders and find information through websites and search engines.

And yet patients still pick up the telephone.

They call to ask: Are you open? What time do you close? Where are you located? Do you accept my insurance? Can I walk in? Do I need an appointment? Can someone help me with a bill? Where do I go for my test? I have a question—can someone help me?

Sometimes patients don't want another link. They want a person.

The human element of healthcare access still matters.

Before You Blame the Employee, Understand the Problem

When we discovered what was happening at the clinic, it would have been easy to stop with: Don't turn down the telephone again. Problem solved.

Except it wasn't.

One management lesson I've carried throughout my career is the importance of having the right people in the right seats.

So we needed to understand why someone would turn down a telephone that patients depended on to reach us.

When the employee had an opportunity to explain, she acknowledged that the constant ringing had become frustrating. She turned the volume down—and then forgot to turn it back up.

That didn't make the decision appropriate. But it did give us information we could use.

The problem wasn't simply the ringer. We needed to look at the system surrounding the ringer.

What Is Happening at the Front Desk?

Front-desk employees in healthcare and/or urgent care environments may be expected to greet arriving patients, answer telephones, check patients in, verify information, collect payments, respond to questions, communicate with clinical staff, and manage competing priorities.

Another challenge in urgent care is that it doesn't necessarily operate on a comfortable Monday-through-Friday, 8-to-5 schedule. Evenings. Weekends. Holidays. Peak flu season. A waiting room that suddenly fills.

Then the telephone starts ringing. And ringing. And ringing.

Healthcare leaders face real workforce challenges. MGMA has reported that front-office employees and medical assistants remain among the positions practices most frequently identify as experiencing increased staff turnover.

That doesn't excuse poor service. It means leaders need to look at people and process together.

Follow the Calls

Our management team reviewed the incoming call patterns. And we found something useful.

Calls appeared to cluster around certain times—particularly around 8 a.m. and 4 p.m.

Now we had a different question.

What is happening at 8 a.m. and 4 p.m. that makes these calls difficult to manage?

What are patients calling about during those periods? Are they confirming hours? Asking about wait times? Are they trying to determine whether they can still be seen before closing? Are they calling about something that could be answered another way? Are arriving patients and telephone callers competing for the same employee's attention?

Data can help leaders distinguish between an employee performance problem and a process design problem.

Sometimes it's one. Sometimes it's the other. Sometimes it's both.

What Does Your Telephone Strategy Say About Access?

Our physician-owner had a very clear expectation: he wanted a live person to answer the telephone whenever it rang.

That was important to him and to the type of patient experience he wanted the organization to provide.

There's nothing wrong with that strategy. But if that's the standard, the organization also has to create the staffing, workflow, technology and expectations that make the standard realistic.

If one employee is simultaneously responsible for a line of patients at the desk and a succession of incoming calls, something eventually has to give.

So evaluate the entire process.

How many calls are coming in?

When are the peaks?

Why are patients calling?

How long are callers waiting?

How many abandon the call before someone answers?

How many calls could be appropriately routed elsewhere?

Which calls truly benefit from human interaction?

Could Technology Help Without Removing the Human?

This is where technology—including newer AI-enabled tools—can be useful.

The question shouldn't necessarily be: Can AI replace the person at the front desk?

Can technology remove repetitive work so our people have more time for the interactions that need a person?

Perhaps the telephone system can route billing questions directly to billing. Maybe callers can hear current operating hours without waiting for an employee. Maybe patients can receive directions by text. Perhaps scheduling can be handled online for appropriate visit types. Maybe an AI-enabled voice solution can handle certain routine administrative questions or route calls intelligently.

But evaluate those solutions from the patient's perspective, too.

Does the voice sound natural?

Is it easy to interrupt?

Can the caller reach a human being when needed?

Does it understand the questions patients actually ask?

Does it protect privacy appropriately?

What happens when it doesn't understand?

Does the technology make access easier—or simply make staffing easier?

Those aren't always the same thing.

AHRQ has documented healthcare organizations using interactive voice response and self-service options to improve telephone access and reduce unnecessary call volume while preserving access to customer-service representatives.

The objective shouldn't be technology for technology's sake. The objective is access.

Your Front-Desk Employee May Not Understand How Important the Role Is

This story offers another lesson. Sometimes employees don't realize how important their position is.

To the employee, it may feel like: "I'm just answering the phone."

To the patient, that employee may represent the entire organization.

She may be the first person the patient speaks with. She may determine whether the patient understands where to go. She may calm someone who is anxious. She may help someone decide whether your organization can meet their needs. She may be the first impression. And sometimes the last.

Healthcare organizations need to communicate that significance to employees.

Don't simply teach someone how to answer the telephone. Help them understand why answering it matters.

Recognize the People Who Get It Right

If we expect front-desk employees to create exceptional patient experiences, we should recognize them when they do.

Does your organization have an employee recognition program? If you operate multiple locations, how are great patient interactions shared across the organization? Could an internal newsletter or employee communication include a regular recognition feature? Are patient compliments passed along to employees and their managers? Are positive online reviews that mention employees celebrated?

If an employee receives a compliment such as, "She was so kind when I called and helped me figure out what I needed to do," that's more than a nice comment. It's an example of the culture you're trying to build.

Recognize it. Share it. Reinforce it.

And When the Phone Isn't Answered?

Patients don't necessarily know that you're short-staffed. They don't know that three people called out. They don't know the front desk is checking in six patients. They don't know the ringer was accidentally turned down.

They only know: No one answered.

And today, they have somewhere to talk about that experience: online.

Healthcare consumers increasingly use digital search, ratings and reviews when deciding where to seek care. Recent consumer research has found that online search is a major pathway for finding providers, while accurate information, ease of access, and online reputation can influence consumer trust and choice.

That means an unanswered telephone can become more than one frustrated patient. It can become: "Nobody ever answers the phone." Posted publicly.

Now prospective patients who have never interacted with your organization form an impression based on someone else's difficulty reaching you.

The telephone may be sitting on the front desk. But its impact can reach far beyond the front desk.

Call Yourself

Here's a simple exercise for healthcare leaders. Call your organization. Not from your office. Call from a number employees won't recognize.

Try it at 8 a.m. Try it at lunchtime. Try it near closing. Listen.

How many times does it ring?

How are you greeted?

How long are you placed on hold?

What do you hear while waiting?

Can you accomplish what you called to do?

Does the employee sound rushed?

Can you easily reach the department you need?

If no one answers, what happens next?

Then look at the data: call volume, peak times, hold times, abandonment rates, reasons for calls, staffing patterns, patient complaints, and online reviews.

Don't examine those things separately. Look at the story they're telling you together.

LMR Insight

Healthcare access isn't only about whether you have an appointment available. It's also about whether patients can reach you.

Technology has given healthcare organizations extraordinary opportunities to make access faster and easier. Use it.

But don't underestimate the value of the human voice on the other end of the telephone.

Evaluate the process. Support the employee. Use data to identify the pressure points. Use technology where it genuinely improves access. Recognize people who create great experiences.

And every once in a while: call yourself.

Because when you make it difficult for patients to reach you, they may eventually stop trying.

Turning the volume down on the phone can turn the patient volume down, too.

Further Reading & Resources

Agency for Healthcare Research and Quality — Standards for Customer Service
AHRQ's CAHPS Improvement Guide includes a healthcare case study examining telephone access, speed to answer, call abandonment and interactive voice response/self-service options.
View resource

Medical Group Management Association — Staff Turnover in Medical Practices
MGMA reporting on staffing and turnover challenges, including front-office employees and medical assistants.
View resource

Press Ganey — Patients as Consumers: A New Era of Expectations in Healthcare
Consumer research addressing access, convenience, online information and the factors shaping healthcare choice.
View resource

American Medical Association — Augmented Intelligence in Health Care
Resources on AI applications, opportunities, implementation considerations and the role of human oversight in healthcare.
View resource