The importance of good patient interaction within the medical sector

This report endeavours to provide tips and recommendations to ensure that your medical contact centre is working as effectively as it can. Improvements will increase your patient’s satisfaction levels and call experience, provide a more user-friendly, productive resource, improve your service delivery and employees morale and set you apart from other medical organisations. These improvements lead to an increase in prospective patients choosing to use your service.

This report is based upon the conclusions of a medical contact centre study, which used a management theory and interaction research framework. The study included listening to live and recorded interactions across a range of services and producing detailed transcripts. Training documentation and procedures were also taken into consideration as well as discussions with operators and supervisors.

Why should a medical contact centre be given attention?

• If a medical contact centre is the first point of communication between a patient and a medical organisation then the agent becomes the ‘mouthpiece of the organisation’, holding responsibility for the impression given and the quality of service for the patient. A medical organisation’s reputation and value is under examination with every agent patient talks to so any interaction should be as effective as possible.
  
  
• Medical contact centres are often used for initial enquiry lines, clinics and after-care services. They also provide a service that improves accessibility to doctors; greatly improving the customer service a medical organisation can give. Recently, there has been increasing focus on communication in the medical sector from professional medical bodies (Kurtz et al., 2005). This is because it has been recognised that attention in this area greatly improves patient/client experience. Therefore, it is in the medical organisation’s interest to ensure that they place focus on their contact centre interaction, which is an essential part of the patient’s experience, as any agent will be associated with the product/service provided.

The Call Centre Industry

There has been an increase in academic literature concerning call centres during the last decade, due to the massive growth in the industry as a whole, which looks set to continue. One research report estimates that between 2010 and 2013 the number of call centres in the UK is expected to increase from 6254 to 7038- an 11% increase (Market Review 2004-2008, accessed 21st June 2009). However, surprisingly, there has been little research with a focus on language despite call centre work being reliant on verbal interaction between agent and caller. It is important to ensure that customer-agent interaction is of the highest quality in order to retain a competitive edge.

There is an increasing backlash towards contact centres in alternative geographical locations to the actual organisations they represent, particularly against contact centres located overseas, this commonly taking place for the purpose of reducing costs. This is directly related to:

• The lack of research into the level of English required. Actual call centre interactions are rarely analysed, leading to training programs for accents and grammar leaving agents poorly equipped to deal with the range of calls that they will be receiving.

Many companies now make use of the fact that they have British-based call centres as a marketing tool.

For British-based bureau contact centres it is important that impression management is carefully handled. Agents can then act as representatives of an organisation as effectively as possible. It is a common general public belief that contact centre interaction is a frustrating and confusing activity so it is important to develop any solutions that can help to change this.

Key findings

1. ‘Discourse Technologisation’

We live in an age of ‘discourse technologisation’ (Fairclough 2003), meaning the increased awareness of language and the effects it can produce. Consideration and emphasis is increasingly placed on ‘customer-employee’ interaction. The shaping of customer- employee interaction is called ‘styling the worker’ (Cameron 2000).

‘Styling the worker’ in the medical contact centre industry is most commonly achieved through

• Training procedures
• Frequent monitoring
• Scripting to standardise and manage the agents delivery of language

The language used by agents in medical contact centres is used to gather patient information relevant to the topic of the call and ultimately complete the interaction. If a script is provided for the agents it is one of the most, if not the most, important way of projecting a medical organisation’s values.

Script Construction

Issue: Scripted parts of calls are delivered in a different way to unscripted language. For example, when going through an extended piece of script agents tend to rush this and deliver it in a monotonous tone. This can be registered by the patient and leads to an ‘unnatural’ conversation.

Recommendation: Unless strictly necessary, scripted interaction should be limited and, where required, agents should be monitored to ensure they are interacting in the most natural way possible. During the closing moves of a script- also indicated by agents’ tone, pace of voice and lexical choice (i.e. alright then, well), it is not of benefit to put any important or extended amount of information relevant to the customer. This is because they are also in the process of closing down the conversation. Closing moves are often heard as general practice and not registered as containing anything of real significance.

Issue:The agents are crucial for whether they believe scripts sound natural, because they are using them most. The research also reflected that patients are less likely to respond to artificial formality leading to a decrease in rapport throughout the exchange- a factor crucial to an enjoyable patient experience.

Recommendation: When creating scripts it is of benefit to not only consider the goal of the exchange but also the patient profile and the medical organisation’s users. In everyday, spontaneous interaction, we are constantly adapting our speech due to whom we are interacting with. Although it is impossible to tailor a script for each individual patient it would be possible to use features that would be relevant to certain types of groups. In particular, during medical interaction it has been found that rapport-building limits the chances of the patient coming away from the interaction feeling as though their intended reason for the contact was not addressed (Levinson et al. 1997).

Issue: As scripts are written, a formal version of English is often used, when in reality, speakers probably wouldn’t choose to speak in this way. When conversations are broken down and examined it is often the most mundane features that move an interaction forward successfully.

Recommendation: To carefully consider the language used in the construction of scripts. It would also be beneficial to spend a significant amount of time listening to the scripts being used ‘live’ with a focus on how the interaction seems to flow after certain stages of the script and particular ‘hot spots’ of information delivery. It is important to do this, whether you use an in-house medical contact centre or whether you choose to out-source. Out-sourcing holds an advantage here, as they are more likely to be able to invest the time and hold expertise in this area.

Issue:Agents being asked questions that they are not equipped to deal with leads to stress on their behalf and inconvenience for the patient. It also provides the most obvious indications that the agent is not a direct employee of the medical organisation.

Recommendation:If a medical organisation chooses to outsource, it is very important that they supply their selected call centre provider with the most comprehensive background information about their organisation’s services as possible. Any information that is not included in the script will be accessible in an FAQ section. Equally, if this information changes at any point, it is important that the medical organisation informs their contact centre to allow for the update of the FAQ section.

2. ’Constructed personalisation’

‘Constructed personalisation’ refers to the artificial relationship that is constructed between agent and caller during an exchange. Call centre work also involves ‘emotional labour’2 (Hochschild 1983) from the agents. Sometimes emotional labour can be an expression of performed emotions as opposed to genuine emotions. If not managed carefully, this can lead to an increase in stress on the worker and after longer periods of time, it can lead to emotional dissonance³. Emotional labour is a term that is highly relevant to the medical contact centre industry because of the nature of some calls.

Issue: Agents often prefer calls where they are required to perform a higher level of emotional engagement, as this is more likely to allow for self-expression. If a patient has a problem, the agents genuinely empathise and wish to help and prefer this to the straightforward data capturing. This aspect greatly contributes to their job satisfaction, which in turn improves the quality of the rest of the calls they will take during the day.

Recommendation: It is clear that agents feel the empathy that would be desired by management, although it does not seem to be the case that this has to be specifically engendered in the agents. Instead it appears that the agents draw on interpersonal skills already possessed before it was required in a professional capacity. This highlights that recruitment and selection processes are vital in selecting employees that already hold these soft skills.

Issue: Sometimes agents draw on emotional labour to protect their inner identities and maintain impartiality. Through mentally registering the fact that they hold an institutional identity this leads to an increased ability to be able to deal with emotionally intense calls. Medical contact centre interaction, in particular, regularly results in emotional pressure being placed on agents due to the subject of many of the calls and their potentially sensitive nature.

Recommendation: Supervisory staff should be aware of the level of emotional demands placed on agents and these need to be effectively managed. If not, then it will have a direct impact on the agent’s attitude, which will inevitably have an impact on the calls they take. If agents deal with these types of calls on a regular basis extra training should be considered regarding coping strategies etc.

3. ’Striking the Balance’

Agents are not solely responsible for the emotional labour that they perform through the display and management of emotion. It is a common misconception that it can be decided what degree of rapport an agent displays. Because interaction is a joint activity it is the responsibility of both the agent and patient to determine the level of emotional reciprocity⁴.

It is important that agents are effective at ‘reading’ people

• Rapport-building is often seen as an important aspect of an agent’s skills. This is difficult to achieve without adapting stricter scripts that only focus on data capturing. Agents being given more independence through unscripted interaction, supported by monitoring and training, will allow rapport to be created more effectively. This would also limit the affect of ‘cargo syndrome’ (Jefferson and Lee 1992)5, which can make the patient feel as though they are not being treated with care. Furthermore, previous interaction research has shown that picking up and responding to patient clues (direct or indirect comments about personal aspects of their lives or their emotions) means an agent can demonstrate understanding and empathy, and this actually shortens an interaction (Levinson, 2000). Therefore, this provides a benefit for the medical organization as well as improving patient experience. It is important to consider that language is a system of choices, not a system of rules: language and soft skills are inextricably linked.
• In the medical contact centre industry an agent also needs to be an effective, reflexive communicator in order to identify the correct level of emotional reciprocity that they need to display. For example, if an agent is enthusiastic and upbeat at a time when a patient is discussing a sensitive, personal experience it can be as damaging as a lack of interest.
• Where agents are restricted by scripts and the data capturing process, patients repeatedly attempt to give information before it is required. To combat this, agents have to draw upon their institutional identity, which allows them greater rights to influence the order of the call. At this point, phrases such as ‘We will be getting to that stage of the call shortly/ If I could just take your name first’ prove most effective, in extreme cases a slight increase in volume on the part of the agent increases the likelihood of speakership.
• Over familiarity can be as damaging as indifference. Patients do not expect to be treated as though they are a personal friend of an agent they have had no previous social interaction with, yet at the same time, do not wish to speak to an agent who sounds like an automated machine. It is important to ensure that scripts and agents ensure an effective achievement of striking the balance.

Conclusion

In sum, this report was produced with the aim of improving medical contact centre interaction - the recommendations provided and the issues discussed are all directly associated with this. At Direct Response we are constantly monitoring and improving the services we provide in order to ensure that we remain a market leader in this field. For more information about the services we can provide you with…

At Direct Response we are constantly monitoring and improving the services we provide in order to ensure that we remain a market leader in this field. For more information about the services we can provide and how we could help your organisation, please contact our business development team on: