Executive Summary

Two additional registrars are cross-trained to cover absences in ancillary departments at Cottage Hospital. At Cooper University Hospital, registrars also work at the patient information desk.

• Experienced registrars are trained for two weeks before working independently.

• Backup registrars keep skills current by working in each other’s departments once or twice a month.

• Monitored cameras allow registrars to assist when long lines form.


Few patient access applicants at Cottage Hospital in Woodsville, NH, have a strong background in registration and insurance. Many have never even worked in the hospital setting. Finding qualified per diem staff is also not easy.

“It is hard to find individuals who are just looking for per diem in today’s economy,” explains Jennifer A. White, director of patient access. “Two-deep” cross-training has solved both of these problems.

“We find that it is crucial that each ancillary department have two additional registrars trained to cover during a scheduled or unscheduled absence,” says White, who supervises ancillary office staff such as rehab, radiology, the emergency department, specialty clinics, surgical, and ambulatory care. These steps are taken:

1. Seasoned registrars who are experienced with software and scheduling are sent to an ancillary department for two weeks of training.

“The training in ancillary departments consists of their internal workings and departmental processes,” says White. In radiology, for example, training covers entering orders, prior authorization, daily reports, and requirements for each exam.

2. At the end of the two weeks, the registrars work independently in the ancillary department.

3. The ancillary registrar is moved to the patient access department for cross-training, or for skill-building if he or she already is trained.

“The ancillary registrar does not register patients on a daily basis. The philosophy ‘use it or lose it’ is true,” says White.

To keep skills of cross-trained staff current, she sometimes schedules the backup registrar to work in the ancillary department. The registrar from the ancillary department works in patient access for the day. “By flipping seats once or twice a month, they are not just placed in the department during limited time off throughout the year,” says White.

This system keeps both registrars current on any changes in the department they’re covering, such as authorization requirements. “It is challenging for someone to be a backup and only cover once or twice a year,” says White. “They cannot be expected to perform at their best when they have not been given the tools to stay current.”

Reception staff at the patient information desk at Cooper University Hospital in Camden, NJ, are responsible for greeting patients and visitors. They also supply passes to patient’s rooms, provide wayfinding throughout the campus, contact patient transport as needed, and perform various other duties.

“Our challenge was to balance staffing with that of expected visitor flow, in order to prevent long lines from trailing through the lobby. This was not an easy task,” says Randy Smailer, manager for patient access quality assurance at The Cooper Health System.

If they saw too many idle receptionists, hospital administrators raised questions about overstaffing. On the other hand, understaffing resulted in long lines and dissatisfied patients. “Our solution was to combine cross-training with technology,” says Smailer.

Managers asked seven patient access insurance specialists, who were stationed near the information desk, whether they were interested in cross-training. Four agreed. “This provides them with the opportunity for overtime if the situation arises where their services are needed,” notes Smailer.

The four patient access employees worked alongside the information desk receptionists until they felt comfortable on their own. A camera was installed that focused on the queue area in front of the information desk, which allows a nearby patient access manager to monitor line volumes. “At the first sign of congestion, assistance is dispatched to the information desk. If congestion continues, more relief is sent,” says Smailer.

It’s now very rare for hospital executives to express displeasure over long lines in the lobby.

“Elimination of wait times always results in an increase in satisfaction,” says Smailer.



Randy Smailer, Manager, Patient Access Quality Assurance, The Cooper Health System, Camden, NJ. Email: smailer-randall@cooperhealth.edu.

Jennifer A. White, Director, Patient Access, Cottage Hospital, Woodsville, NH. Email: jawhite@cottagehospital.org.