Executive Summary
Patient access leaders have boosted satisfaction scores by educating patients on the registration process, adding customer service to job descriptions, helping patients to “navigate” the healthcare system, and offering financial incentives.
• Recorded calls allow registrars to identify ways to improve.
• Patients with recurring appointments can bypass registration.
• Patients are informed that the registration process is over, to avoid confusion about where their waits occurred.
While interviewing a candidate for a patient access position recently, Soraia Angiuoli, MHA, carefully considered the applicant’s credentials and experience. However, it was a story about going out of his way to help a customer that really stood out.
“He told me that the patient really needed help getting to and from the hospital and asked for directions on how to go back to his hotel,” recalls Angiuoli, administrator for international patient financial services at Johns Hopkins Medicine International in Baltimore. The applicant was about to leave his shift, so instead of just telling the patient how to get to the hotel, he walked the patient over to the bus stop and waited until the correct bus came. He also gave detailed directions on how to get to the hospital by bus for future appointments.
“I really liked his example, where he went out of his way, literally, to help the patient,” Angiuoli says.
When Angiuoli first started in the department, patient satisfaction scores were quite low. “Staff morale was bad. They were not working as a team, and the patients did not seem satisfied with the services received,” she says. Angiuoli’s first step was to rewrite patient access job descriptions with a focus on patient satisfaction. Two years of customer service experience are now required. “We have started hiring smart, based on our new job description,” says Angiuoli. [A summary of one of the department’s job descriptions is included with the online issue. For assistance, contact customer service at [email protected] or (800) 688-2421.]
Looking at experience
When interviewing applicants, patient access managers now focus primarily on previous customer service experiences. “We ask probing questions,” says Angiuoli. “We are looking for an experience where the candidates went out of their way to assist a client, or when they assisted an angry customer and ended the situation on a positive note.” Here are some other ways patient access departments are improving customer service:
• Managers are hiring bilingual staff.
This is a big satisfier at Johns Hopkins International, where patients sometimes complained that they wanted financial counselors who spoke their native language. “Our patients, who used to dislike Finance, are happy with the multitude of services we now provide to them,” says Angiuoli. “I receive many emails praising the work of our team.”
• Managers evaluate service by listening to recorded phone calls.
“How courteous was the person scheduling your appointment?” Scores for this survey question determine whether the 2015 individual patient satisfaction goal is met by patient access employees at Nemours/Alfred I. duPont Hospital for Children in Wilmington, DE. “The goal is 84% for this category,” reports Ecco Sutherlin, director of the Nemours Access Center of the Delaware Valley.
Recorded phone calls have “helped tremendously,” says Sutherlin. “We have seen a remarkable difference in the delivery of customer service as we allow associates to hear their delivery via the recorded call system.” Supervisors listen to a random assortment of calls. They pay attention to how staff members greet the caller, the way they communicate information, and how the calls are ended.
“If a complaint is received, we listen to the call along with the associate,” says Sutherlin. “Associates are often able to identify opportunities for improvement on their own, without the help of the supervisor.” One registrar realized that she failed to acknowledge a special event mentioned by the caller, who had just had a baby.
• Patient access staff members ask fewer questions during the registration process.
Members of Nemours’ Family Advisory Group complained that employees asked too many questions that were irrelevant to patients. “Although questions about race, religion, and ethnicity are important from a regulatory standpoint, they weren’t necessary for the scheduling process,” says Sutherlin. “Those questions are now asked at a more appropriate time.”
Navigating care
• Patient access employees are helping patients to “navigate” their care.
At Nemours, a Patient Navigation Department was created. Registered nurses “give guidance, break down roadblocks, and link families to the most suitable providers,” says Sutherlin. If Access Center associates have a concern about the patient’s need for a more expedited clinic visit, for example, they can turn to the navigation nurse for direction. “Having nurses available gives reassurance to the numerous hospital departments that patients will not be steered incorrectly,” says Sutherlin.
• Staff receive a financial incentive if patient access areas meet goals for patient satisfaction.
“During this visit, how satisfied were you with the registration process?” One of four annual goals for the patient access department is based on scores to this question, which is included in a satisfaction survey given to all patients treated in outpatient areas at University of Louisville (KY) Hospital.
“If we make our collection goal but not our patient satisfaction goal, staff get 70% of the incentive. If we meet the patient satisfaction goal but not the collection goal, they get 30% of the incentive,” says Laura Fry, manager of patient access. If the department meets both goals, staff receive 100% of the incentive.
• Patients’ wait times are closely tracked.
Fry tracks wait times from the point of arrival to registration, the time it takes to complete the registration process, and the time it takes from completion of registration to the time the patient actually receives the service.
“I drill down for 14 different entry points including outpatient center, radiology, surgery, and main admissions. We strive to get times down to 15 minutes or less,” says Fry.
Sometimes a long registration time is unavoidable. For example, it is not uncommon for a patient to experience a longer-than-normal wait time if an exam is added and needs an authorization or medical necessity check. “In these situations, staff document the delay on the registration. This assists management in our data reporting,” explains Fry.
• Patient access representatives make patients aware the registration process is over.
Patients at University of Louisville Hospital sometimes indicated on satisfaction surveys that they had waited too long at registration. However, when managers went back to check the account, they saw that the wait times actually occurred in clinical areas. To clear up the confusion, “we had to do some creative scripting for staff,” says Fry. Staff now say to patients, “This completes your registration. I am contacting your service area to let them know you are ready for your service to begin.”
When registration is completed, volunteers walk patients from registration to the service area. “That creates a physical space between the registration and the service area. The patient sees, ‘I am done waiting for registration, and now I’m waiting in the service area,’” says Fry.
It also improves patient flow by quickly getting the patient right where he or she needs to be. “If the patient is having a CT scan, for example, the patient can start drinking the contrast instead of sitting out in the waiting room,” says Fry. (See related story on decreasing delays in registration in this issue.)
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Soraia Angiuoli, MHA, Administrator, International Patient Financial Services, Johns Hopkins Medicine International, Baltimore. Phone: (410) 464-6597. Fax: (410) 464-6603. Email: [email protected].
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Ecco Sutherlin, Director, Nemours Access Center of the Delaware Valley, Wilmington, DE. Phone: (302) 298-7249. Email: [email protected].
