Do access staff look unhappy? Nip plummeting morale in the bud

Don't pay the price of having unhappy workers

With upset, frustrated patients facing high co-pays and deductibles on the one hand, and increasingly complex payer requirements on the other, having happy access staff may seem like an impossible dream.

Morale in patient access is "always a challenge," according to Vicki Lyons, patient access manager at Baptist Hospital East in Louisville, KY. "Patient access is a department that is always receiving negative feedback. We always hear when something has gone wrong, since this area affects every department and every floor in the hospital." Access employees often feel they are constantly hearing negative comments, from information that they entered incorrectly to a patient complaining about something that occurred during the registration process. "A lot of times, it is not even patient access staff that made the error," says Lyons. "But the issues still have to be addressed and followed up on. And the employee still ends up being questioned about a process that they feel they do a good job at."

If staff are unhappy, there's a steep price to pay in the form of high turnover and other problems. "Unhappiness does increase turnover," says Diane Manuel, director of patient access for admissions and the emergency department at Wake Forest University Baptist Medical Center in Winston-Salem, NC. "I attribute turnover to the extended time between when positions are vacated and when they are filled. Employees work understaffed. This results in unhappiness and discontent, so they look for less stressful positions within the hospital." 

Nancy Garrett, patient registration supervisor at Sacred Heart Medical Center at RiverBend in Springfield, OR, says that unhappy access staff "look for other positions, and their interpersonal interactions with one another are negative. They do not represent our organization as positively as we need, especially since they are often the 'first impression' for our hospitals."

Garrett gives these "early warning signs" of unhappiness: "Sick calls increase, there are more complaints to me as a supervisor, there are more interpersonal issues, and their data integrity declines. And, it is clearly visible on their faces."

Negative impact on revenue cycle

"Access staff are the face of the organization," says Kevin McAndrews, system vice president of patient financial services for PeaceHealth in Bellevue, WA. "If they are unhappy, it reflects negatively in their contact with patients — our customers. Also, their job is really important in terms of data integrity. If access staff are unhappy, they get careless; they don't really care if they take the time to follow up to get that group number or driver's license copy."

McAndrews says, "We try to preach that our patients are the most important thing in our day and to be present in the moment. And if you are unhappy, you are not present in the moment. As a manager, it's part of your responsibility to ensure that our internal organization is healthy. You do that by taking the temperature of the water in the weekly staff meetings and one-on-ones. If staff aren't happy, you can pick up on that."

Access staff at PeaceHealth facilities also get their point across by voluntarily completing surveys on organizational health. "We ask folks to tell us how we are doing anonymously. Each of our managers is required to do an action plan based on those comments," says McAndrews. "So even if nobody will admit to it, you may get back surveys that say, 'The schedule is all screwed up.' When you get that from enough people, management is going to be challenged to go back to work on the schedule."

Patients already unhappy

Every day, access staff deal with people who don't really want to be there. "Customer service, for us, is very different from a hotel or airline. It's not as though we can start out by saying, 'It's good to see you' or 'Welcome back," because the patient never wants to be back," says McAndrews. "It's a very, very difficult environment. The customer doesn't want to be here, and they think it's too expensive and they don't want to pay for it."

For this reason, it takes a very special kind of person to work in access — one with generous amounts of empathy and compassion. "Those are the attributes we look for in people," says McAndrews. "You want to build a relationship with the person, but it's not a 'welcome back' hotel or car rental relationship. It is more of a spiritual and healing relationship. That is what you want to build."

Here are some tips to boost morale of access staff:

• Use a "peer review" program to keep new staff happy.

At PeaceHealth facilities, new access team members are assigned to work with someone within the team other than a supervisor. "It is like a mentor program, with the most experienced person working shifts with the new person, passing on the tips and tricks," says McAndrews. "Certainly, you have to trust the mentor first. But the idea is, you surround the new folks with your best, most positive people."

• Encourage staff to voice concerns.

At Mercy Medical Center in Oshkosh, WI, there is an "open agenda" at unit meetings. "There are a couple of mandatory things that we cover, but otherwise it's a staff-run meeting," says Connie Campbell, director of patient access. This often leads to solutions for problems no one else has picked up on yet. For instance, an access staff person recently noted that the hospital's wound clinic business had increased significantly. Patients were always seen waiting when access brought them to their appointments. "They brought this to the wound clinic's attention. They are now looking into adjusting their schedules and giving patients a pleasing waiting area," says Campbell.   

• Encourage staff to personalize areas.

One of PeaceHealth's registrars is a breast cancer survivor, who tied a pink ribbon to a picture on her desk. A patient coming in for chemotherapy saw it, and they "instantly bonded," says McAndrews. "The littlest things can make all the difference. We encourage staff to bring in something about themselves. One woman brought in a picture of herself horseback riding, and the woman she was admitting asked about it because she used to have a horse. The next thing you know, they built a relationship."

McAndrews acknowledges, however, that not everyone can pull this off. "It has to be exercised very carefully. It takes a very special person. And when you find that person who can do it well, you have to hold onto them."

• Celebrate a lot.

"We are constantly eating," says McAndrews. "We celebrate all birthdays and holidays, and look for any and all little ways to celebrate. We celebrate perfect attendance, exceptional data integrity, letters about something positive; you name it."

McAndrews says he is a firm believer in lots of celebrating and "catching people doing things right. Our management philosophy is to be hard on standards and easy on people. That has been a real success for us. If you are hard on people and easy on standards, you will have a lot of unhappy people."

• Be public with your compliments.

Campbell says she sometimes gives staff a "recognition gift" on the spot, if she sees somebody giving outstanding customer service. "Or sometimes staff can make a really huge catch that financially saves you, so to speak," she says. "Managed care for Medicaid patients has been very confusing. We had one patient who had a brain tumor coming for surgery, but nothing would be covered." Access staff quickly referred it to the billing office, which helped the patient get her coverage changed to a managed care company that would be covered at their facility. As a result, the patient was able to have the doctor she wanted to do the rare surgery.  

Campbell always recognizes staff on the spot, but if the access person doesn't mind, she also thanks him or her during a unit meeting. "And sometimes, we go even bigger," says Campbell. Recently, a patient sent a thank-you letter to the president of the organization, saying that she came in for lab tests, she was already preregistered and things went very smoothly. The patient said everything was so efficient. "I was in and out of there before I even knew it. A really friendly person helped us with everything we needed."

"That particular [staff member] doesn't mind being recognized in front of a large group," says Campbell. "So instead of being recognized just in front of her peers, I brought her to our organization's management meeting. We recognized her on a grand scale there."

Other times, Campbell will give compliments in smaller settings. "Some people would sooner crawl under a rock than have you say their name out loud. So there may be five employees in the area, and I will take the opportunity to say, 'Yesterday, you really handled that well, so here is a $5 gift certificate or have a lunch on me down in the cafeteria," says Campbell.  

Amy Webster, director of patient access at Knox Community Hospital in Mt. Vernon, OH, says that if one of her access staff member receives a compliment from a patient or other department, "I will send out an e-mail to the whole department, recognizing that the employee went above and beyond."

• Hold competitions.

"I find friendly competitions help morale," says Webster. "Access has just started taking copays for the ED. So small contests are held on who collected the most for the month or who collected the most on one shift. This has helped this department get over the fear of asking for money."

[For more information, contact:

Connie Campbell, Director of Patient Access, Mercy Medical Center, 500 S. Oakwood Road Oshkosh, WI 54904. Phone: (920) 312-0002. E-mail:

Nancy Garrett, Patient Registration Supervisor, Sacred Heart Medical Center at RiverBend, Springfield, OR. Phone: (541) 222-1271. E-mail:

Vicki Lyons, Patient Access Manager, Baptist Hospital East, 4000 Kresge Way, Louisville, KY 40207. Phone: (502) 897-8159. E-mail:

Diane Manuel, Director of Patient Access, Admissions and Emergency Department, Wake Forest University Baptist Medical Center, Winston-Salem, NC.

Kevin McAndrews, System Vice President, Patient Financial Services, PeaceHealth, 123 International Way, Springfield, OR 97477. Phone: (541) 349-7653. Fax: (541) 984-4075. E-mail:

Amy Webster, Director of Patient Access, Knox Community Hospital, 1330 Coshocton Road, Mt. Vernon, OH. Phone: (740) 393-9880. E-mail:]