It’s quality, not quantity of training, AM discovers
Soft skills get a hard look
Extensive auditing of outpatient registrations at the University Hospital of Arkansas in Little Rock revealed myriad errors and throwing more training time at the problem just hadn’t done the trick, says Holly Hiryak, director of hospital admissions. Because of a decentralized system of outpatient registration, Hiryak adds, "once people go through training, they’re sent out there to register without good backup. The original solution was to add time to the training, instead of looking at quality [of training]. We got to the point where we said, This is not working.’"
Inspired by a presentation by Geisinger Health System of Hershey, PA, Hiryak and her colleagues have launched a new approach to the education of access personnel, one that places major emphasis on soft skills training, she says. Rather than "sticking employees in front of a computer on day one," which had been the hospital’s traditional approach, Hiryak notes, trainers will focus for two days on a soft-skill presentation that covers these topics:
- teamwork;
- professional behavior;
- confidentiality;
- adapting to change;
- hospital systems orientation;
- effective communication;
- customer service/how to deal with difficult patients.
Near the end of that two-day session, she says, there is an introduction to the revenue cycle. At present, Hiryak explains, "we immediately introduce them to the registration system, without taking into consideration that some of these people had never worked in a hospital, never dealt with patients or clinicians?"
Now employees will not sit down in front of the computer until the third day, when they are introduced to the process of getting the patient registered and into the system, she says. After three days of that training, each employee is paired with a "preceptor," who acts as a resource for that person for two months, Hiryak adds. "The first week or two, the new employee will not register without the preceptor present," she says. "With time, the employee will not have to spend every moment with the preceptor, but that person will always be available." During the first two months, the preceptor will provide one-on-one training to the new employee.
The hospital’s revenue integrity specialist (RIS) team will be an integral part of the new training program, she notes. (See Hospital Access Management, January 2001, p. 6.) Their role will be to audit, train, give feedback, retrain, and evaluate outcomes, Hiryak says. After conducting registration audits, the revenue integrity specialists will give feedback on the employee’s progress to the employee, preceptor, and managers, she explains. "Training will be modified based on audit results."
Only at the two-month mark will the new employee get to the nitty-gritty of insurance training and the details of managed care, Hiryak says. "By then, the registrars will know what questions they need to ask," she points out. "When you bring them in new, they don’t know what they need to be asking." At the end of this two-day training, the employee will take a competency test, Hiryak notes.
At some point after the two-month milestone — but before six months have elapsed — the trainer will conduct a site assessment with the employee, she adds. The trainer will look for things like a professional appearance, a neat and organized workstation, how the employee interacts with the patient and others working in the area, and if the employee is following correct procedure, Hiryak says. Once the site visit is complete, the trainer will discuss the findings with the employee and the manager, she notes.
Although the outpatient registrars report to clinic managers — who may be nurses or people with business backgrounds — the auditing and update training are Hiryak’s responsibility, she explains. "The employees are expected to meet a performance standard, and we give feedback to the manager on how the employee is performing."
Existing employees also involved
The hospital’s initiative also includes ongoing training, Hiryak notes. "We will have all of our existing employees go back through access registration training, and we will present updates on any new insurance information at least monthly. If the information is deemed critical, multiple mediums will be used to announce changes."
The revenue integrity specialists already have begun conducting monthly inservices, she says, because so many discrepancies have been found among the outpatient registration staff in terms of procedures and knowledge base. Employees are so eager for information, Hiryak adds, that about 150 people attend those inservices, where attendance has been voluntary. Under the new training plan, however, attendance at the continuing education sessions probably will be mandatory, she says.
"With all the frontline staff, we will go out at least twice a year, conduct audits and give feedback, and retrain as necessary," Hiryak says. "Our goal is to audit 20% of all outpatient registrations. It will be a continuous cycle of quality improvement." The idea is not for the employee to be threatened by the auditing and retraining process, she says, but to see it as a tool. Pager numbers for the RIS team have been published, she adds, so employees can use them as a continuous resource.
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