More Little Cost Cutting Ideas: Lose the Front Desk

Innovation also means finding  ways to adapt

Editor’s Caveat:  This is the 3rd in a series that reveals cost cutting measures in tiny, independent practices under duress.  In my case,  our 1.5-person, part-time practice is in a locale hit hard by rapid changes in hearing healthcare.  We think about reducing marginal costs all the time and the more we think, the more our thoughts move out of the box.  The resulting ideas may give you a chuckle, but all are serious and either already implemented or in process.   

Eliminate Your Front Desk

 OK, maybe keep the desk to put stuff on, but eliminate or move the person that occupies that space.  Receptionists are at the bottom of the pay scale.  As a result, they come and go faster than professional staff in most offices.

 It takes a lot of time and effort to train a receptionist to handle the intricacies of a well-run dispensing Audiology practice.  They have to know what to say on the phone, know how to schedule, understand insurance coverages, office-specific software, hearing aid features…. the list is long and daunting.  They also have to be friendly, calm, and able to multitask most of the time, and maintain competency and goodwill in the midst of constant interruptions.  

Do such people exist?  Maybe, but they are Rare and Highly Desirable and work for George Soros, Mitt Romney, George Clooney… you get the drift.  Economics 101 says that such Scarce Resources  go to the highest bidder and that is not us!      

Now What?

The alternatives are strange. A few steps of logical thinking are required to work through the options:  

  1. Find someone with more skills OR  increase their skill set with on-the-job training (bookkeeping, hearing aid dispensing or both).
  2.  Either way, increase their wage AND move them to the back so they can be effective.  
  3. OR, skip the skills, identify the position as non-essential, and replace the front desk with automation and technology.  

In other words, redefine your human resources.  Bookkeeping is a back-office skill for good reason — receptionists who are entering invoices and reconciling accounts often get a little surly when they’re interrupted by a patient, not to mention making mistakes on transactions, which can be quite costly.  It’s an occupational hazard.  Receptionists who are licensed hearing aid dispensers are unlikely to stay content sitting out front handling phones and batteries.  They’ll become your competition if you don’t raise their wages and find another receptionist.  It’s a circular problem.

Low Cost Automation and Technology Solution

Push the Button to See The Audiologist Pop Up!

For under $50, you can  install a button for patients to push.  Systems are wireless, sending the signal to two receivers — one is a pleasant chime that is loud enough to hear in your office and in the hallway; the other is a flashing bright light to alert you if you’re in the audiometry booth area.    

The key is to respond immediately when they come in so they know that you know they’re there.  The other very important key is to train them to push the button.  We do this with every new patient — explaining the system at their initial intake and going through it again when we escort them out after that first appointment.  It’s like being initiated into an exclusive club with a secret handshake.  

A good button is critical to success.  People hate to sign in but–we were surprised to find– they LOVE to push buttons, especially if button pushing is instantaneously rewarded with a flashing red light and an Audiologist summoned as though from a magic lamp. Talk about feeling empowered.  

What if the Audiologist is on the phone or with another patient, which is usually the case?  No problem:

  1. Patient arrives, several minutes before her appointment.  She pushes the button and the red light flashes.
  2. Chime sounds in consult room where Audiologist is working with current patient or on the cell phone.  “Excuse me for a second.  I’m going to let that patient know that we know she’s here and we’ll be with her in 5 minutes. “
  3. Audiologist runs to waiting room, where she either speaks or signs:  “Hi!  Wow, thanks for coming early.  We’ll be with you in 5 minutes.”  or…  “Hi, I’m running 10 minutes behind, I’ll be with you at 9:40.  Is that OK?”  That’s usually OK, unless you’re ALWAYS 10 minutes late in which case patients become… impatient (see below).  You can’t do that with this system.  
  4. Audiologist runs back to consult room, finishes the appointment, escorts patient to the front door, picks up the waiting patient and repeats the process.  

What If Things Don’t Go According to Schedule?

What if the Audiologist is running late?  That shouldn’t happen regularly, but it’s bound to happen once in a while.  Waiting is a serious problem.  The key is to meet and greet immediately and NEVER let patients feel the pain of waiting, even if they have to.  Psychology studies are done on this and have the following observations and advice:

  •  On average, people overestimate their wait time by 38% .
  • For most patients, 25 minutes is the outside limit for waiting in a doctor’s office. 
  • Uncertainty magnifies the stress of waiting.
  • The waiting experience gets a higher rating when people are given feedback on expected wait times and explanations for delays. 
  • Occupied time feels shorter than unoccupied time.
  • Final moments count most:  positive effects near the end of the wait can discount negative feelings during most of the wait.  
We ask patients to complete a SADL (Satisfaction with Amplification in Daily Life) questionnaire if they are biding time in the waiting room.  Other suggestions, besides good magazines, are coffee, chocolate and… mirrors.  Studies report that mirrors by elevators reduce complaints about waiting.  That’s why there are mirrors on every floor.  They allow you to check your appearance and surreptitiously survey those around you.  Sounds like fun and should work well in an Audiology waiting room.  
 

Economic Advantages: Improved Satisfaction, Reduced Costs, Increased Efficiency

 
1.  Eliminate time and costs of a non-professional employee. 
2.  No more sign-in sheets. That makes patients happy, increasing their Marginal Utility.
3.  Eliminate HIPAA-required expenses of blacking-out names on the list, filing the lists, locking the files, and eventually shredding the lists. Reduces your Marginal Costs.
2.  Patients feel close rapport with Audiologists who respond to their summonses.   Nothing comes between the patients and their Audiologist. More happiness, more Marginal Utility.
3.  Audiologists learn to stay on schedule. Reduces Marginal Costs.
4.  Audiologists stay in shape, thanks to all the running.  Reduces absenteeism.
5.  Patients are “primed” by the chime that their appointed time is drawing to an end. They start gathering thoughts and belongings for an orderly exit.  Increases Marginal Utility, reduces Marginal Cost.
6.  Serial SADL results enable better hearing aid follow-up counseling and instrument adjustments.  Increases Marginal Utility.
7.  Patients learn the “on-time” principle of the system and begin to arrive a little early, in case we’re running early.  
7.  Patient frustration, stress, and negative feelings reduced with button-induced feedback on wait times.  Marginal Utility goes up.
8.  Better (silent) communication with weird UPS dude (check out the picture and decide for yourself).  Marginal Utility goes up.
 

What if the Audiologist Doesn’t Hear the Chime?

That is a serious problem when it happens.  No system, including a live receptionist, is fool-proof.  Check the equipment regularly and when in doubt, wear hearing aids and stick your head into the waiting room.

About Holly Hosford-Dunn

Holly Hosford-Dunn, PhD, graduated with a BA and MA in Communication Disorders from New Mexico State, completed a PhD in Hearing Sciences at Stanford, and did post-docs at Max Planck Institute (Germany) and Eaton-Peabody Auditory Physiology Lab (Boston). Post-education, she directed the Stanford University Audiology Clinic; developed multi-office private practices in Arizona; authored/edited numerous text books, chapters, journals, and articles; and taught Marketing, Practice Management, Hearing Science, Auditory Electrophysiology, and Amplification in a variety of academic settings.

6 Comments

  1. Holly,

    I have to admit to the economic benefit, but I worked in a office with a similar setup and when you get busy it can drive you completely nuts! Plus, the patient who has an appointment with you that keeps getting interrupted by walk-ins can get cranky. This works great in small, part-time and satellite clinics, but it drove me crazy at my previous employer and I felt a bit unprofessional as the audiologist doing double duty as a receptionist.

    Just my 2 cents

    1. Unprofessional isn’t the right word, but more like annoyed by the constant patient comments of “why don’t you have a receptionist”…

      1. Interesting — it is a comment we have not received. On the other hand, we’ve been studious about the patient training process, and careful to explain why we have switched and what benefits accrue to the patient by the switch. That may have allayed the questions?

        1. Yes, I think patient training is key. People need to understand what to expect. My last employer put me in that situation and clearly patients were not educated in this way and that led to a lot of frustration on all ends.

          So do you have someone handling calls through the back office or do patients leave messages?

          1. We do everything via a Smart Phone, answering calls between patients and at the end of the day. It is, again, a training thing: we let patients know that they can call us 24/7, including weekends and if we don’t answer, leave a message and we’ll get back to them. Since we shedule via the phone, we handle most calls on the fly by setting an appointment time for a full discussion. There have been some funny ones — like the phone call I picked up at 4am on a Sunday. It scared the patient to death, as they thought they wouldn’t bother me, and just leave a message!

    2. Thanks for that 2 cents and let me add mine to the pot. I totally agree with you. The caveat at the beginning is that this only works for very small, professional offices that work by appointment-only, with patients that have been oriented to the arrangement. Walk-ins are an entirely different topic that deserves discussion as a management issue.

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