THR's on-line training meets consistency goal

Modules are customized, interactive

A customized on-line training program for patient access employees at Arlington-based Texas Health Resources (THR) is improving performance, helping to ensure compliance with policies and procedures, and enhancing proficiency across the 13-hospital system, says Patti Consolver, CHAA, CHAM, corporate director of patient access services.

With hospitals scattered throughout the Dallas/Forth Worth metropolitan area in a 100-mile radius, maintaining training consistency was a major challenge, adds Consolver, and it was not deemed cost-effective to dispatch a trainer to all the health system's facilities.

With that in mind, the patient access directors from each facility that make up THR's Patient Access Services Operation and Performance Improvement Council (OPIC) came together in the fall of 2003, training manuals in hand, and identified the need for a learning model that would combine web-based and instructor-led training, she says.

A proposal to develop eight — since increased to 10 — on-line training modules was approved by THR corporate finance, Consolver says, with the content to be as follows:

  • patient access overview;
  • managed care and governmental programs;
  • customer service;
  • the art of collections;
  • regulatory requirements;
  • patient access forms;
  • importance of the employer table;
  • financial policy.

After considering several vendors, the group selected College Station, TX-based K2Share. Two training modules were completed in the winter of 2004, and all nine (including the additional reimbursement module) were in use in 2005.

To create the modules, Consolver explains, "I put together the material, in a PowerPoint slide or policy format, and [the vendor] pulls out the information and places it in an interactive module, which has vocals and action and holds the user's attention."

There was a photo shoot for each module using THR staff, she adds, so the people shown in the presentations are familiar to users.

"There were 25 or 30 people — two or three from each of the various entities — and it took about four hours to take photos to use for screen shots," Consolver says. "Those shots were built into the modules. We had the option of going with stock photos, but we thought [using staff members] would make it more user-friendly."

Modules are updated regularly — with policy changes, for example — to keep them up to date, Consolver says.

"The best piece from a corporate perspective," she adds, "is that we are able to track results. If someone from compliance or finance comes in and says, 'Are [access employees] familiar with this or that policy?' I can pull up something called a 'registrar's report,' which is a student listing that includes everyone who's passed or failed the tests. I can say, 'Yes, they've passed the test on that material, and here's the average score.'"

The information is generated into the reporting feature in real-time, she notes.

Before receiving their annual evaluation or merit pay increase, access staff must watch the modules again and retake the tests as a re-evaluation of their skills and knowledge, she says. "They can take the tests twice, but if they fail both times, they are required to schedule one-on-one remedial training with a supervisor."

Staff feedback sought

After implementation of the first three modules, management decided to gather input from staff on the program's usability, Consolver notes. "We distributed a survey to the users and made improvements based on their feedback."

While employees gave two of those initial modules — patient access overview and customer service — good reviews, they indicated that the one covering managed care and governmental programs needed some fine-tuning, she says.

"There were 53 slides, and it took almost an hour and a half to go through it," Consolver says. "We learned that was too much to take at one time, so we put governmental reimbursement in one module, and did managed care separately."

Staff have 30 days to do a module, Consolver says, and may go back and take it again, even if they pass the test.

In addition to promoting patient access training consistency across the system, she notes, the modules have enabled managers to pinpoint areas where employees need extra help and focus on those topics in an updated version.

"I met with the compliance auditor probably six weeks ago, and she had seen a significant increase in [staff] compliance regarding admitting forms," Consolver adds. "Before they were not completing them accurately, sometimes having the spouse sign instead of the patient, but the audits are getting better."

Consolver received a great deal of input from the chief compliance officer and the vice president of finance on that issue, she says, and redesigned the module accordingly.

Although it's difficult to say for sure, there are indications that the training module on upfront collections has contributed to the health system's success in that area, Consolver notes.

Upfront collections outside the emergency department (ED) totaled $35 million in 2005, she says, compared to just over $4 million in 1998, and $23 million in 2004. In the ED, upfront collections were almost $6 million in 2006, compared to $1 million in 1998 and $4 million in 2004.

"We have always been a strong upfront collector," Consolver points out, while noting that much of the credit for recent increases certainly goes to a strict new financial policy that has clarified the role of front-line staff.

"We were able to put [the new policy] together and roll it out to staff, so they were able to understand our expectations," she says. "It's easy to put a policy out on the web and say, 'This is it,' but if it's in a module, we know for sure it's being presented to everyone in the same way."

To further ensure that consistency, she says, the chief financial officers at THR hospitals took the module training as well, Consolver notes.

A 10th training module was added in 2006, she says, in conjunction with the implementation of a new Siemens registration system to replace both a homegrown system being used in THR's "west" hospitals (those that were part of Fort Worth-based Harris Methodist Health System) and an older Siemens system in use at the "east" hospitals (those that were part of Dallas-based Presbyterian Healthcare Resources).

To roll out Siemens' Envision Gold system to all the patient access departments, Consolver explains, "we created a module that went over all the screens and compared them to the old system. It is very interactive and self-explanatory, [saying], 'This is where you went in the current system, and this is where you'll go in the new one.'"

The module, which lasts about an hour and a half, is shown to employees before they go into an instructor-led training session, she adds, and has been instrumental in the implementation, which began in July 2005 and is ongoing.

Within the past year, Consolver notes, THR has received approval for employees who successfully complete the modules to gain CU hours from the National Association for Healthcare Access Management (NAHAM) that go toward its certified health care access associate (CHAA) and certified health care access manager (CHAM) designations. "We are so pleased with the modules," she adds. "I recently got an e-mail — from a new employee who wasn't sure who to direct it to — saying how wonderful the on-line training was, and how great it was to be able to access the material from home."

That individual, Consolver says, who actually was taking the training for the second time, added, "I'm amazed at what I didn't know that I thought I did."

(Editor's note: Patti Consolver can be reached at