Be 'comfortable, creative' when hiring front-line staff

Access veteran gives interview tips

While the classic patient access mantra has become "garbage in, garbage out," managers themselves often fail to heed it, says Michael Friedberg, FACHE, CHAM, director, patient access services at Armanti Financial Services in Bloomfield, NJ.

"We are often non-discriminating in who we hire" to do that crucial front-line job, he notes. "We don't provide them adequate training; there is a lack of periodic retraining, many don't get feedback on their work, and we don't always give them the tools necessary to do the job."

Adding to the stress, Friedberg says, are pressures from clinical staff to register quickly and patients who aren't always cooperative.

"As a general rule, human resources departments in hospitals do not do the best job of screening applicants for jobs in patient access," he continues. "They're not always aware of the skill set required." That makes it even more important, he says, that patient access leaders "become very comfortable and creative" with the task of selecting their employees.

"If you ask patient access managers around the country what their greatest challenge is, the No. 1 answer is 'the ability to recruit, train, and retain qualified and motivated staff,'" he adds. Complicating the issue is the fact that health care decision makers "entrust the financial stability of our hospitals to people we pay just slightly more than housekeepers."

That said, there are ways to identify the right candidate, Friedberg says. "Access directors are very creative at figuring out how to get the job done, so if they're good at that, they should be able to come up with creative ways to find staff."

He offers these tips:

• Local colleges and universities are great sources for employees.

"I've found [college student employees] to be very conscientious and smart, and I know a number of health care professionals who started in registration," he says. "The downside is that if you find somebody good, you get them for four years and they're gone. But if you get four good years, sometimes that is worth it. Just constantly be on the lookout for good staff."

• Just because a person has no experience in health care, that's no reason not to hire them.

"You have to screen carefully, but remember that everybody's got to start somewhere," Friedberg notes. If the applicant is "friendly, computer-literate, and comfortable working in less-than- optimal conditions," he advises consider hiring him or her. "Just because the person hasn't been a registrar in another facility doesn't mean he won't make a good one."

Insisting upon direct prior experience is a mistake that is widely made by employers, Friedberg says, pointing out that the difference between outpatients and inpatients and between HMOs, PPOs, and fee-for-service plans is something that can be taught. Sometimes there are advantages to hiring an individual without experience, he adds. "They have no bad habits."

• Your department is the best advertisement you have.

"If you walk in the admitting office and it is loud and disorganized, with papers everywhere, why would anybody want to work there? A desirable candidate who sees this environment may say, 'I'm not interested.'"

More appealing would be "bright, neat cubicles and none of those cartoons on the wall that are critical of the boss or little urns labeled 'Ashes of Problem Employees,'" he advises. "I have a strange sense of humor, but the average Joe might say, 'Do I really want to work for this person?' Be careful and conservative so as not to offend anybody and to present a professional, non-judgmental kind of place."

Use 'template' for interview

The interview process should follow a prescribed format, with everyone who conducts interviews working off the same sheet, Friedberg says. (See interview template.) "My belief is the candidate should be interviewed by at least three people — the director, the manager, and perhaps a front-line employee. Sometimes people will say things to someone they perceive to be a colleague that they won't say to the boss."

He lists these further suggestions for a productive interview:

• The interview should happen on two different days.

"Then you get to see that the candidate comes on time at least twice, and that he or she can dress appropriately," he notes. "As a sidebar, I am astounded by the way people will come dressed for an interview these days."

• The receptionist is a great source for further information.

"I used to be a secretary for a very famous physician," Friedberg recalls. "When he would interview, meet, or talk with people, sometimes he would ask me about [their behavior] when they had to sit and wait, how they treated me. I might tell him, 'That person was extremely arrogant with me.'

"You want to make sure that everybody who encounters the candidate has the opportunity to somehow give feedback on this person's behavior."

• Go with your gut.

If the person looks great on paper and gives all the right answers, but something doesn't seem right, trust your instincts, Friedberg advises. Similarly, don't eliminate a candidate just because he doesn't look good on paper, he adds.

"I hired somebody for registrar who had committed a crime," he says. "He checked 'yes' on the form, and I asked if he would be comfortable telling me about it."

The candidate explained that he had made a mistake seven years before, when he was young and impressionable, had served his time, and now wanted to be a productive member of society, Friedberg notes.

"I hired him and he was fantastic," he adds. "You have to see people for who they are."

• It's important to ask the right questions, and just as important to read into the answers what the person isn't saying.

Ask candidates to describe themselves, and listen carefully for what you can find out about them, Friedberg recommends. "If they say they are adaptive and can handle anything someone throws at them," he adds, that's a good thing. "If they say, 'I get bored easily, and tire of doing the same things day after day,'" Friedberg notes, that's not such a good thing.

"If they say, 'My supervisor hated me and made my life miserable,' that would be something I would be concerned about," he adds. "That does happen, but you need to get a feeling as to where you think the truth lies."

Friedberg suggests asking about short- and long-term goals. "If they say, 'I need cash, or a J-O-B,' I'm not comfortable. If they say, 'My long-term goal is to find a job where I feel I make a meaningful contribution to my employer and to society,' that's a good answer."

• Ask about salary requirements early in the interview.

In the access field, where it takes between six to nine months for a person to become proficient at the job, it's particularly important to determine if a new hire is likely to jump ship, he points out. "If somebody says the minimum they can accept is $15 an hour, and you know the maximum you can pay is $10, you know not to go further. Even if the person is willing to take a pay cut, it probably won't work out, because he's not going to stop looking for a better-paying job."

On the other hand, Friedberg says, the salary figure a person gives may not really be his or her bottom line. "You need to probe, and the response to a question will garner two or three follow-up questions to get to the root of what a person is really saying."

• If candidates say they have a skill and the skill is important to the job, you need to test them on it.

"We had somebody who said they were familiar with personal computers and Windows," Friedberg says. "On the first day of training, the instructor said, 'Take your mouse,' and the person says, 'What's a mouse?'"

Friedberg picked up on the importance of testing for skills many years ago when he worked at a temporary employment agency, he notes. "If people said they were expert in WordPerfect, we gave them a 10-question test. If they couldn't score eight or better, they were probably exaggerating their experience.

"There's always a learning curve," he adds, "but you don't want to hire somebody who is going to be a burden to the rest of the staff."

(Editor's note: Michael Friedberg is the author of the new book "Staff Competency in Patient Access: Tools, Tests, and Tips for Building a Successful Team." He can be reached at