Successful recruiting is key to access creation

Goals, objectives viewed weekly

One of the first milestones Anthony M. Bruno, MPA, MEd, reached in his mission to create a brand-new department of patient access and business operations at Philadelphia’s Presbyterian Medical Center was the successful recruitment and hiring of four managers.

Those individuals — along with the existing manager of business operations — will help carry out the process of taking previously decentralized departments and putting together a centralized operation of business activities, says Bruno, who is giving Hospital Payment & Information Management periodic updates as he works to establish the new department. He became director of patient access and business operations in July 2001.

Newly created positions that were filled include the manager for outpatient access services, the manager for quality assurance and training, and the manager of the admissions center, he says. An existing position that Bruno filled is manager for emergency department access services.

These employees collectively have more than 100 years of patient access experience and more than 50 years of experience with the University of Pennsylvania Health System (UPHS), Bruno notes.

Employees: Most valuable asset

"I started off by sharing my management philosophy and management goals and objectives with the team," he says. "The direction in which we’re heading and will spend the most time with is working with our most valuable asset, our employees. You can’t do the job without employees."

Current operational goals and objectives include:

  • establishing a cash collection program;
  • setting up bedside registration in the emergency department;
  • accomplishing all "Code Green Workplan" objectives.

"Code Green," he explains, is a UPHS project — begun in 1999 — designed to improve management of the revenue cycle and increase profitability. His department’s piece of that includes reducing registration errors, billing rejections, and denials. On the front end, he says, the goal is to enhance the department’s collaboration with medical records, utilization management, and patient accounts, all of which directly impact its ability to manage rejections, denials, and the revenue cycle.

"To do any of these things, you need to have a staff that’s well educated and well trained," Bruno says. "We’re starting with a plan that centers everything around a management report — which is the way I like to work — that we work on weekly."

The report includes the department’s goals and objectives for the fiscal year, with a listing by each manager — including Bruno — of the activities with which they are furthering those objectives. "We give a status update of each of those on a weekly basis in order to communicate and make sure we are focused on what needs to be done," he says.

In line with his staff-centered approach, Bruno says he also is rewriting the job descriptions for all employees to make sure each description accurately reflects the desired duties and responsibilities for each registrar. Customer service skills, for example, will be a key part of those descriptions.

"We’ve pulled the team together, and now we’re focused on organizing," Bruno says. "We need to make very clear to everyone what our expectations are and what their responsibilities are. You can’t ask people to do something if they don’t know exactly what you want them to do. I think it needs to be in writing."

This facilitates the process of giving feedback to employees, of maintaining quality assurance, and of doing staff training, he notes.

A shared-value environment’

One of the things he emphasizes is "a shared-value environment." "Basically, that means developing role understanding and a shared vocabulary so you know what you’re talking about, with projects as well as insurance requirements," Bruno says. "It also involves strengthening trust among employees, letting them know the management team is there to work with them, not just giving instructions and walking away."

A key to fostering such an environment, he says, is promoting delegation and empowerment, having a staff who are empowered to do tasks when managers are not present.

"We define protocols and codes of behavior that we expect," he explains. "That can be something as simple as dress codes, which should be spelled out."

A behavior that is paramount, he says, is "a certain attitude toward patients, to be willing to reach out and assist patients no matter what they’re asking for."

Helping to define and promote the shared-value environment is a 24-page handbook on employee duties and responsibilities, Bruno says. It includes a mission statement, a confidentiality policy, orientation and probation information, a list of patient rights and responsibilities, a dress code and appearance policy, and a customer service policy, he notes. There also are guidelines regarding departmental safety, attendance and time records, work performance expectations and evaluations, Bruno adds, as well as information on clinical effectiveness and quality improvement programs.

"There’s another section called Thoughts Worth Remembering," he says, which addresses such subjects as proper attitude and telephone etiquette. "We also gave out something called The Measuring Stick,’ a document circulated among the business community that talks about testing the strength of the workplace. There are 12 questions that ask you about work situation. By answering them, you describe the situation you have." 

Now that he’s gotten together a staff with the necessary skills and experience to do the job, Bruno says he is trying to focus on building this department. "We’re just in the process of beginning to exist. The people are all new to each other. We’re trying to get our objectives across for this year and start to carry them out."

So far, so good, he notes. "I will say that since I’ve been here, we’ve been through a successful JCAHO [Joint Commission on the Accreditation of Healthcare Organizations] survey and Pennsylvania Department of Health survey."