Communication Management

Figuring out how best to resolve phone calls, email messages from patients, refill requests, etc. needs to involve staff members who are likely to be involved. A first step is the establishment of goals for each communication type, which usually address time to resolution, and the number and types of handoffs (e.g., 95 percent of phone requests are resolved on the first call). The standard work processes will be heavily influenced by the goals. Some LEAP practices share those goals with their patients (e.g., we will answer your email within 12 hours). For larger practices, a recurring question is whether to centralize the handling of various communications or send them directly to the patient’s core practice team. The advantage of the latter, if feasible, is the team’s knowledge of their patients.

As with all elements of primary care work, a major goal is to have communications handled by staff working at the top of their license. To have an RN triage all incoming patient calls or to have a provider fill out paperwork for routine refills is not working at the top of their license. Several LEAP practices developed work flows that first maximize what can be done by administrative/front desk staff (e.g., initially triage incoming messages,  make appointments, put available information into forms). Where permitted by nursing licensure, they sometimes used LPNs rather than RNs to triage patient phone calls or emails, and only referred on to RNs or providers those contacts requiring clinical assessment and decision making. Medical records staff can be trained in data extraction and data entry in the Electronic Health Record. This significantly decreases the amount of time nurses and providers spend reviewing the inflow of paper information about patients. 

Many communications of necessity require more than one person to resolve. Examples would be patients calling with potentially serious complaints. Resolving issues or answering questions before hanging up the initial call has many advantages, but can put patients on seemingly endless hold. Effective handoffs are facilitated by work flows that try to route calls directly to the individual who can resolve it. Because that individual is often the provider, practices need to design space in the day to do this work, set time expectations for provider involvement, and clarify how provider calls will be managed. For example, providers vary in their willingness to be disturbed when with a patient. Several LEAP practices use electronic inboxes to get communication work done. An increasingly important role for MA/LPN dyad partners is to help their provider partners monitor and manage their inbox.

Many things—such as staff vacations, new personnel, flu epidemics, emergencies—can alter demand and disrupt communication workflows. For this reason, it is very useful to periodically measure the volume and nature of incoming phone calls, paper communication, and emails. Monitor efficiency measures, such as percent of first calls resolved, average hold time, and patient satisfaction or complaints about phone or email access. It’s also important to measure the backlog of clinical information on paper that is waiting for review by the provider. First, identify and measure the areas that need attention, then use performance improvement tools and test cycles to make adjustments.