Can't do what staff are asking? Explain

Tell them reasons for decisions

The results of a survey of registration staff at University Orthopaedic Center, part of Salt Lake City-based University of Utah Health Care, were a little surprising to managers.

"It wasn't that we didn't do what staff suggested. Staff simply wanted an explanation as to why some suggestions might not be implemented," says James Carey, CHAA, patient access manager at that facility and Huntsman Cancer Hospital.

While managers obviously can't do everything that registrars suggest, they can certainly communicate the reasons behind the decision, says Carey. "We had some issues with team morale, and communication was one of the biggest things we needed to work on," he reports. "Our message to staff is that they are the experts."

Registrars often pick up on problem areas that managers wouldn't necessarily notice, says Carey, and they often come armed with possible solutions. It might be necessary to change processes as a result of a staff complaint, but in many cases an explanation is necessary for why things can't be changed, says Carey. Carey's registrars expressed frustration with the new registration system, for example, because it was taking them longer to register patients.

"With our previous system, registrars could skip over certain things, and it would be dealt with on the back end," says Carey. "Now, because this is a front-end system, they can't get past those fields without populating them."

Carey explained to the registrars that it was necessary to enter the information upfront to avoid claims denials. "It will take longer to complete a registration, but we can get a claim out clean the first time," he says.

Share underlying reasons

Staff often complained to Carey about having to ask patients for the same piece of information multiple times. For example, a Medicare patient might be asked "Are you currently residing in a skilled nursing facility?" or "Are you currently employed?" more than once in a single day.

In some cases, it might be possible to change the registration system so that the answer to these particular questions will automatically appear on subsequent screens, says Carey.

"A patient is not likely to be employed at 8 a.m. and unemployed at 1 p.m.," he says. "In some cases, though, you really do have to ask certain questions at every visit."

For example, a patient might have an orthopedics visit for a work-related accident earlier in the day and be seen for an unrelated reason later that same day. Thus, patients might have to be asked, "Was this illness/injury due to a work-related accident or condition?" for each visit, says Carey.

In one case, Carey had to explain to registrars that entering authorization and insurance benefits information more than once was necessary because case managers only had access to the comments. If the information wasn't also entered separately on the comment screen, the case managers had no way to view it, he explains. In another case, however, registrars complained about having to make a separate notation if they collected any payments from a patient, when they had already entered the payment information on a previous screen.

"Staff told us, 'Why are we doing this? It's repetitive.' We literally just told them that we don't need to anymore," Carey explains. "It was needless work."