Get 'knock your socks off' participation with ladders

Many patient access departments have implemented career ladders, and many others are planning to do so, in the hopes of improving staff retention. However, participation is often disappointing.

One common pitfall is a lack of organizational planning. "The patient access management team should take the lead in establishing the foundation for the job ladder program," says Ron Camejo, director of revenue cycle practice at Chadds Ford, PA-based IMA Consulting. "A solid foundation must be established or the job ladder program will fail, either before or after implementation." He recommends doing the following:

• Take a close look at the organizational chart. Determine how to differentiate between an entry-level position and a more advanced position for each function in the department.  

"Work with human resources to develop salary ranges and titles for each position, and to identify where current staff members fit into the new hierarchy," says Camejo. "Since there will be some budgetary considerations, the chief financial officer's blessing will be required for the job ladders to become reality."

• Make sure there are well-defined criteria for advancement.

Include the career ladder program in job descriptions and tie it to the employee evaluation process. Well-defined criteria should indicate details such as productivity and quality requirements, training prerequisites, necessary certifications, and the fact that managerial and supervisory promotions are contingent upon vacancies as well as qualifications.

"Staff members at all levels quickly grow disenchanted if they don't understand the criteria for growth within the organization," says Camejo.

• Communicate effectively with existing and prospective employees.

Introduce the job ladder program as part of the recruiting process, and review it in detail during the orientation process. It should also be a part of routine employee evaluations.

"You should be able to clearly articulate a strategy for advancement with employees," says Camejo. Advancement should be contingent upon meeting quality and productivity standards, cross-training in other areas of the department, certification by national organizations, and other organization and departmental requirements. 

• Develop a comprehensive training program.

This is necessary to ensure that staff members are able to function optimally at the various positions, and are, therefore, able to advance within the organization. The training program should promote the department's goals for cross-functionality, and competency testing should be included to lend credibility. 

"A comprehensive training program allows the organization to develop expertise, as opposed to always having to hire that expertise," says Camejo. "As a result, the pool of potential applicants can be expanded, with a focus on aptitude and attitude for entry-level positions."

Develop future PA leaders

At Carolinas Medical Center in Charlotte, NC, 12% of the corporate patient access staff participates in the department's career ladder program. The career ladder program is open to all registrars who have been employed for one full year and have a successful performance appraisal. Every new hire starts as a Registrar I and then has the opportunity to move up to a Level II and Level III. Each level comes with a change in the amount of incentive that the employee earns. 

To sit for the Level II exam, staff cross-train to different areas and take continuing education classes. Passing the exam gives them a higher level of monthly incentive. To become a Level III, an employee cross-trains to different facilities and sits for the Certified Healthcare Access Associate (CHAA) exam. Again, passing the exam and becoming a Level III equates to a higher level of monthly incentive.

To participate in the department's leadership and development (LEAD) program, an employee must be a Level II registrar and be nominated by a manager. "Our LEAD program has given us a pool of internal candidates for management positions. We do two candidates in each class and do two classes per year. We have filled two supervisory positions from the LEAD graduates," reports Katie M. Davis, director of patient financial services.

Two pitfalls that can result in poor participation are rules that are too stringent, or mandating certification, such as CHAA, that the individual must pay for in advance, according to Holly Hiryak, RN, CHAM, director of hospital admissions and access services at University Hospital of Arkansas in Little Rock. "We typically pay for staff to certify at this time. But with these economic times, we are looking at requiring our access associates to pay for testing, then reimbursing them once they pass," she says.

Salary increases are always a motivator, says Hiryak, but recognition is important to staff as well. "Staff can have their designation added to their name badge as well as their signature on any correspondence," says Hiryak. "They also have the opportunity to take on more responsibility with the opportunity of moving into a supervisory or leadership role. If they choose not to participate, then they are left behind in terms of salary, responsibility, and opportunity."

[For more information, contact:

• Ron Camejo, Director, Revenue Cycle Practice, IMA Consulting, 2 Christy Drive, Suite 219, Chadds Ford, PA 19317.

• Katie M. Davis, Director, Patient Financial Services, Carolinas Medical Center, Charlotte, NC. Phone: (704) 512-7181. E-mail:]