Do patients say good, or not so good, things about your access staff?
Put them in patients' shoes
A physician is impatiently standing over your shoulder. You look up and see a long line of patients waiting to register and all the while, the phone is ringing off the hook. Right then, a patient starts yelling that he has been waiting too long and has to go to work.
This may be a day in the life of a front-end employee, but it's also a recipe for a long list of angry complaints.
There is no doubt that the patient access role isn't for everyone. "The front-end person definitely can't be someone who gets frazzled if they are multitasking," says Mary-Ann Minsley, RN, MBA, administrative director for the office of revenue cycle management at University of North Carolina (UNC) Health Care System in Chapel Hill. "They just have to stay calm, keep smiling, prioritize, and get it done."
A growing trend is making things even more challenging. "Customer service is much more important now than in the past. We are the front door and can make or break a patient experience," says Jayne Wright, patient access director for the North Operating Group of SSM Health Care in St. Louis. "We want our patient experience to be exceptional. We want them to come back over and over for their health care needs."
In addition, Minsley notes that "most of the patients coming in, in today's economy, are sick. We are seeing more illness vs. preventive care, because more and more, people are considering preventive care to be discretionary. People are stressed not only because they are ill, but they're also wondering how they will pay for health care services."
Patient access staff often make the mistake of taking negative reactions personally. "We remind staff that the person in front of them is feeling sick and may be stressed about their financial situation. They may have lost their insurance and may not have their copay today," says Minsley.
Carrie L. Gallo, RN, MBA, director of patient access for Summa Health System in Akron, OH, says that patient access is "the first line for any hospital or offsite facility." Whether scheduling is done by talking with physicians' offices or the patient directly, the ease of being able to get a procedure scheduled promptly, getting a worried patient in to see someone quickly, or preregistering a patient can "smooth out the whole process," says Gallo.
As a result of actions by access, "when the patient arrives at the facility, they can go directly to their testing area. They may be anxious, but they don't have to wait and there are no surprises," says Gallo.
The reality is that today's patients expect service with a smile and want things to happen very quickly. "People don't have a lot of patience anymore, because they are very busy. That's one reason that satisfaction and customer service is at the forefront of any registration and scheduling department," says Gallo.
Evaluate your employees
During the patient access employee's annual evaluation at UNC Health Care, customer service is "rated very heavily," says Minsley. Here are two things that are taken into consideration:
Comments by internal and external customers. The department has switched to a "360 degree" evaluation process. The idea is to look at how the employee is perceived by multiple layers of people. This includes physicians, the employee's coworkers, whoever they report to, and employees from other departments with whom they work.
Patients are included in the evaluation process. "Patients are sent an evaluation form post-event. If they name an employee, that comment is considered for the employee's annual evaluation," says Minsley. "In addition to the mailing, there are evaluation forms in all the outpatient service areas. The patients can use these to give us immediate feedback on their experience."
The employee also is asked to do a self-evaluation and provide names of people they would like to have contacted for input. "And those people don't always say what the employee expects they will say," says Minsley. For instance, one front desk supervisor gave a list of physicians for input to her evaluation. "More than one physician responded that she was lazy and often 'dumped' work on her direct reports!" says Minsley. "Some employees act exceptionally well to the physicians and the administrators but may fall short when dealing with others. For this reason, we get as much input as we can." Based upon the input, specific areas for improvement are targeted. Employees are given further training, mentoring, and frequent feedback.
Direct observation. Supervisors, physicians, and directors routinely observe employees and report to each other across departments. 'When we walk up to them, we look for things like how many beats does it take before they smile and greet us," says Minsley. "We also make secret shopper phone calls listening for the 'smile' in their voice and whether they are using the script."
Patient access staff are well informed about this practice. "We want them to be aware we're doing this, because it keeps them on their toes," says Minsley. Minsley adds that although patient access staff are held accountable for how much money they collect, "they also have to know when to stop pushing."
Minsley says that when hiring a patient access staff member, she always asks them, "'Do you consider yourself to be a happy person?' When they say yes without even flinching, it seems to be a good indicator that they will more likely be able to smile and be courteous, and put the patient first even under duress," says Minsley. "For example, one of our front desk clinic staff is always smiling. The patients just love her. Recently, she spent her own money to buy a stuffed animal at the hospital gift shop for a sick child."
To recognize these star employees, directors and managers can identify an individual they think is a "Plus Person," with a ceremony that is held quarterly at the department heads' meeting. "The managers write a couple of paragraphs explaining why their employee is outstanding. Each service area is allocated a set number of nominations per year," says Minsley. "Patient access has been allocated four slots per year." In addition, each manager is expected to develop a local recognition program for his or her area.
Minsley says that she expects her staff to be "diplomats" even when they're not in the department, especially when they are wearing their hospital ID. "It doesn't matter where they are. They might be outside on the sidewalk or in the elevator," she says. "We expect them to look people in the eye, smile, say 'Good morning,' and provide assistance whenever and wherever possible."
Go above and beyond
Summa Health's patient access department recently centralized its scheduling function. Instead of having to call a facility directly, physicians and patients can call a single "one-stop" number to schedule an appointment. "Patients don't want to wait. Since our application allows us to view all of our sites, that has been a huge benefit from the patient's perspective," says Gallo. "Our physician customer satisfaction is also greatly improved, because we can gain efficiencies and economies of scale in our phone system." Every available call goes to the first caller, with all calls pushed through to the next available scheduler.
While this system change improved satisfaction in some ways, another problem was identified. Too often, patients thought patient access staff were unfriendly.
The hospital's Press Ganey surveys revealed a disconnect between the way patient access staff believed they acted and how patients actually perceived them. "Month after month, we saw a common theme. At the point of arrival, they didn't feel like staff were consistently friendly," says Gallo.
For the survey's four questions on waiting times and the friendliness of patient access staff, the department scored at the bottom of the barrel - in the 10th percentile. Staff tended to blame others for their low scores. "My staff didn't really accept responsibility. They would tell you that the delays were caused by another department, or because the patient got there late," says Gallo. She reminded staff that the scores took into account similar patient access departments with the same challenges, which they were being compared to.
Gallo started doing some role playing so staff could put themselves in the patient's shoes. "We went out there and showed them that even though the patient is rushed and anxious, a simple touch on the shoulder or stopping what you are doing can make the patient feel it's all about them," she says.
If a patient arrives frantic because he or she got stuck in traffic or couldn't find a parking spot, staff have the skills to turn things around. "They greet the patient and reassure them that they will call the department to get them registered right away," says Gallo. "The patient now sees that the department knows they've arrived, so they won't be bumped."
Next, the employee volunteers to escort the patient to his or her appointment, even if it's all the way on the other side of the building. Instead of being exasperated, that patient is more likely to end up smiling and thanking the patient access staff person. "They often start their experience out very rattled. But when they realize they didn't take off work for nothing, they start to feel that they are in good hands," says Gallo.
Previously, staff insisted that they already made eye contact with patients, used a friendly tone of voice, and gave the patient their full attention, when at times they actually did none of these things. "They didn't believe that they didn't do that," says Gallo. "We did videotaping and hidden shopping and pointed it out to them. They are much more aware now."
Another thing Gallo did was to put a "smile in the voice" of patient access staff. All registration staff have a mirror attached by Velcro to the side of their computer monitor so they can see their own reflection when talking on the phone. The statement, "What you see is what they hear" is posted. "If staff smile when they talk on the phone, they come across as more personable," says Gallo.
After working hard on these changes, staff were surprised to see that survey scores for their department rose to 65% overall, with some areas in the 90th percentile. "Staff now believe that the scores are indeed accurate," says Gallo. "Customer service scores are also tied to raises. Research will tell you it's not all about money to staff. But when you are at an entry-level position, I have found that money is important to the staff. They look for that 'reward,' as every little bit does help."
[For more information, contact:
- Carrie L. Gallo, RN, MBA, Director, Patient Access, Summa Health System, 525 East Market Street, Akron, OH 44304. Phone: (330) 375-3929. Fax: (330) 375-4760. E-mail: [email protected].
- Mary-Ann Minsley, RN, MBA, Office of Revenue Cycle Management, University of North Carolina Health Care System, 101 Manning Drive, Chapel Hill, NC 27514. E-mail: [email protected].
- Jayne Wright, Patient Access Director, North Operating Group, SSM Health Care, 12303 DePaul Drive, St. Louis, MO 63044. Phone: (636) 625-5479. Fax: (636) 755-3869. E-mail: [email protected].]
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