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Use data to deflect unfair complaints about access
Investigate fully before you act
When someone has a complaint about patient access either an individual staff person or the department overall how you respond can "make or break" what happens next.
"Good data can help deflect unfair or mistaken accusations made about patient access," says Peter Kraus, CHAM, CPAR, a business analyst with patient financial services at Emory University Hospital in Atlanta. For example, a patient may complain about a rude employee, but that individual doesn't work in patient access. A patient may say he or she waited an hour for service, but your data show that in fact, the patient waited an hour in radiology and only five minutes in access.
Data also can help you if an error is brought to your attention by someone in a department outside of patient access. "Responding that the registrar is 98% accurate overall comes across differently than just responding that an error was made and the staff member re-educated," says Michael S. Friedberg, FACHE, CHAM, associate vice president of patient access services at Apollo Health Street and author of Staff Competency in Patient Access. "If other departments understand that the overall accuracy is being monitored, it demonstrates good proactive management."
The most common complaints about patient access involve incorrect data collection that causes the department in question more work. For example, if the registrar incorrectly identifies the physician in the system laboratory, radiology results will be directed to the incorrect provider. This causes the provider who receives the information to have to research and send it back to the hospital, and causes the ordering physician to not have the results timely, as the lab and radiology departments will have a hard time determining who the doctor should be.
"This is a common problem, especially when there are physicians with the same name sometimes even same first and last name practicing at the same facility," says Friedberg. "This is particularly common with foreign-born doctors that tend to shorten their names."
When responding to these types of complaints by other departments, data can establish the magnitude and validity of a given issue. "Other departments may feel that ten errors in a given month place an undue burden on them. But to patient access, ten errors is a minor problem," says Friedberg. "This is the type of disconnect that requires a lot of time and energy from the patient access director."
Don't go on the defensive
Friedberg says that patient access directors often have a knee-jerk reaction of trying to defend their staff in all circumstances. "I am not saying not to defend your staff when they are attacked or in the right," says Friedberg. "However, a good way to defend them is to acknowledge a mistake, if in fact it was made, discuss the staff member's overall accuracy, and lay out the steps being taken to prevent the repetition of the mistake."
There often is a perception around a hospital that patient access is an easy job and that mistakes made are due to carelessness. This can put the access manager on the defensive from the onset. "If there are data to show that a particular staff member has a high accuracy rate, other managers are less likely to react in a negative manner," says Friedberg.
It is important to show that the number of errors of a particular type is small, such as duplicate medical record numbers, which are a burden on the health information management (HIM) department. Friedberg once was approached by his CFO about a high number of 75 duplicates in a given month, which the HIM director had complained about.
"My response was that we had started to notify HIM of errors so that records could be merged, and that 75 duplicates out of 15,000 registrations equated to a 0.5% error rate," he says.
Friedberg adds that in these difficult financial times, it's vital for patient access to create its own data, to identify potential problem areas internally before others bring them to the attention of higher-ups. "Providing discussion of efforts to reduce errors, based on proactive discovery of areas of deficit supported by data, is even more important," he says.
"I never assume the registrar was wrong," says Vicki Lyons, patient access manager at Baptist Hospital East in Louisville, KY. The hospital's patients relations department follows up on most complaints, but if it is unsure of the exact process that should have been followed, Lyons is asked whether the registrar did or said the wrong thing.
Lyons says that if in fact the registrar didn't do anything wrong, you can use that as an opportunity to inform the patient about how the hospital registration process works.
"If I need additional information to see exactly what the complaint is, I will call to ask more questions," says Lyons. "If the patient relations department and I talk, and they know exactly what the issue was, then they will make the phone call back to the patient." At times, though, patients do not want a phone call back they just want to know that someone will look into the process and follow up.
"The worst thing you can do is not follow up on a complaint. I think it sends the wrong message to the person making the complaint that someone does not care enough to make a phone call back," says Lyons.
Lyons always tells patients that she's sorry for any inconvenience that may have been caused by the incident, and that they can feel assured that the complaint will be taken seriously and followed up on.
In some cases, however, the patient's complaint may have been the result of another department's actions. In this case, Lyons tells the person complaining that she will notify that manager so that they can follow up with their employee or she gives the person the option to call the manager directly.
Lyons says that she doesn't use any scripting to address patient complaints. "Each situation and complaint is different. It sometimes sounds phony when a script is stated to the customer or patient."
Take these steps
Janice M. Grey, interim manager of patient registration services for California and Davies campuses at California Pacific Medical Center in San Francisco, says that the very first thing you should do is apologize for not meeting the patient's expectations. Next, thank the patient for bringing this issue to your attention.
Then, you should research the complaint fully and respond back to the patient with your findings, including any actions taken to prevent the occurrence from happening again.
"Don't minimize or dismiss a complaint, regardless of how minor it seems to you," says Grey. "We are dealing with the patient's perception of what occurred. If they are complaining, it is important to them."
For example, a patient may complain to you about having to wait to register for a diagnostic test, when the wait time was only about five minutes. Would you think that this complaint was baseless?
"In several of my high-volume areas, we see 350-400 patients a day," says Grey. "Our goal is to register 90% of all patients within ten minutes. So if the complaint came from that area, I might think it was not worth my time to investigate."
As it turned out, however, the patient did have reason to complain. "It was a rare slow time in that area and two staff members were chatting amongst themselves," says Grey. "That is the reason the patient had to wait."
On the other hand, don't make any promises to a patient before you research the complaint fully. "When someone is angry, they often stretch the truth just a bit in the heat of the moment when relaying what has taken place," says Grey. "Once in a while, you get someone that is so out of control and wants action taken against someone immediately for the wrong they feel has been done to them."
This may be happening in a public area, with the patient loudly demanding that the person receive disciplinary action or get fired.
"It is not easy being on the receiving end of this, especially in a professional setting," says Grey. "Your first reaction is to promise anything just to quiet the patient down and get them away from other patients. But more often than not, after researching the situation, you may find that it was not as serious an incident as reported, and minor or no disciplinary action is called for."
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In some cases, your research may reveal that something important needs to be addressed, such as a process that needs to be changed. "Good data can also lend credibility to resolution proposals when the complaint is valid," says Kraus.
For example, a patient once told Grey that the registrar made a mistake because all her physicians did not receive results of the diagnostic test she had completed. This, the patient explained, caused a delay in the treatment she needed. Grey retrieved the documentation that the staff person had at the time of the registration, including the physician's orders, and compared it against the account that was set up for the patient to see if it was done correctly.
"In this case, the registrar did not make an error. The physician listed on the patient's complaint was not on the requisition," says Grey. "When I shared my findings with the patient, she thanked me for bringing this to her attention. Her understanding was her oncologist was including both of her other physicians in all test results."
To prevent this from happening again, patient access staff now inform patients that only the physician listed on the requisition will receive their results. "If they need any other physicians to receive the results, we tell them to please let the ordering physician's office know, so they can forward them," says Grey.
[For more information, contact:
Ed Erway, Chief Revenue Officer, University of Kentucky HealthCare, 800 Rose St., Lexington, KY 40536. Phone: (859) 323-5502. E-mail: firstname.lastname@example.org.
Fairon F. Fitzhugh, Senior Practice Operations Manager, Children's National Medical Center, 111 Michigan Avenue, NW Washington, DC 20010. Phone: (202) 476-5169. E-mail: email@example.com.
Michael S. Friedberg, FACHE, CHAM, Associate Vice President, Patient Access Services, Apollo Health Street, 2 Broad Street, 4th Floor, Bloomfield, NJ 07003. Phone: (973) 233-7644. Fax: (732) 876-0385. E-mail: Michael.firstname.lastname@example.org.
Janice M. Grey, Interim Manager, Patient Registration Services, California Pacific Medical Center/California and Davies Campus, P.O. Box 7999, San Francisco, CA 94120-7999. Phone: (415) 600-2790. Fax: (415) 600-2291. E-mail: GreyJM@sutterhealth.org.
Vicki Lyons, Patient Access Manager, Baptist Hospital East, 4000 Kresge Way, Louisville, KY 40207. Phone: (502) 897-8159. E-mail: Vlyons@BHSI.com.]