When leaders in the Patient Family Experience department at Ann & Robert H. Lurie Children’s Hospital of Chicago learned that patient satisfaction scores were low in registration areas compared with industry benchmarks, they set out to find out why.
More than 100 registrations at four clinics were observed. “We wanted to identify any barriers that prevent staff from delivering an optimal experience to our patients and families,” says Cara Herbener, patient family experience consultant.
The team watched how the family was greeted, and they tracked the wait. “We call the observations ‘walkalongs,’” says Herbener. “We don’t want to give the impression that we are there to criticize or judge.”
Several opportunities were noted, including the way the family was greeted. “In our very busy clinics, we sometimes have the tendency to quickly rush through the registration and move on to the next family,” says Herbener. Instead of saying, “Welcome Mrs. Jones, we’re glad you made it,” staff members usually were businesslike and merely told families where to sign in.
To address this issue, staff will attend a 30-minute session with lunch provided, says Herbener. Making eye contact and introducing yourself and greeting the patient with “Good morning,” sounds simple enough. “But to be honest, in a very busy clinic setting, this isn’t always a natural thing to do,” says Herbener. “Often they are just used to getting people in quickly.”
Staff were trained to use proper names of individuals, instead of calling parents checking in their children “mom” and “dad,” and to use this scripting, “I’m here to check you in. This should take just a few short minutes.” The observations resulted in these changes:
The process to register families in advance of their appointment was improved to eliminate check-in delays.
About one-fourth of families aren’t preregistered and need to take care of this issue before they are able to check in. “They had to get out of line, go to a nearby phone, and contact the registration department to complete the registration process, and come back to check in,” Herbener says.
A multi-step process is used to ensure that as many patients as possible are preregistered. In many instances, the pre-registration is done at the same time as the appointment is made. “However, sometimes families are not able to stay on the call for this,” says Herbener. In these cases, registrars send a letter confirming their appointment and asking them to call to complete the pre-registration process.
Registrars also follow-up with families by phone at least one week prior to the appointment to complete the pre-registration process. “We are attempting even more reminder phone calls to ensure that families get pre-registered,” says Herbener.
Patients can now check in at any station, as opposed to being directed to one particular station.
Patients became frustrated when they had to go to a different place to check in. “The front desk staff were cross-trained so they can check anyone in for any of the outpatient clinics,” says Herbener.
Staff members were trained to handle difficult situations as they arise.
Patient access managers saw these situations occur often during the observations:
— A family has been waiting 30 minutes or more past their appointment time.
“People get pretty frustrated and want to know what’s going on,” says Herbener. Instead of dodging the issue, staff are encouraged to be upfront about it. Registrars tell families, “To be honest, we are running about 30 minutes behind. If you’d like to occupy your time, please feel free to visit our fire truck on the 12th floor or the beautiful sky garden on the 11th floor.”
“For extreme delays, we offer vouchers for our cafeteria and/or parking,” she says.
— A family shows up on the wrong day.
One family realized that their appointment was for the previous day after driving for several hours. The provider they were scheduled to see wasn’t in that day. “Unfortunately, they couldn’t be seen,” says Herbener. “A better approach would have been to call back to the nurse and ask if any other doctor could see the family.”
— A family arrives for their appointment and discovers that the hospital is no longer covered by their insurance plan.
Often, families have waited months for an appointment. In this difficult scenario, says Herbener, “we offer to see them but take time to explain that the visit won’t be covered by their insurance.”
It is better to prevent this frustrating problem from occurring in the first place. “We have done quite a few things to make sure this doesn’t happen,” says Herbener. “About 75% of patients are now preregistered, so if their plan is out of network, they are informed in advance.”