Turnover in patient access areas decreased from 30% to less than 10% at Texas Health Resources after a career ladder was implemented. At Navicent Health, where a career ladder convinced 35 employees to stay in patient access, the department leaders made these changes:
- They worked with Human Resources to give pay increases to employees with higher skill sets.
- They created team lead positions for each registration area.
- They created an insurance specialist role for complex inpatient and outpatient authorizations.
Emergency department registrars were given new positions handling medical necessity appeals and insurance verification. A surgery center registrar is now an insurance specialist. An ambulatory surgery registrar is now a financial counselor.
All of these employees were actively interviewing for other positions at Macon, GA-based Navicent Health. In some cases, they’d even accepted another position. All decided to stay when given new roles in patient access.
“Over the past year, we have internally placed over 35 employees to different positions,” says Kim Whitley, RN, CHAM, director of patient access and intake services.
A career ladder stopped the flow of patient access employees to the central business office or other hospital departments, says Whitley. Some wanted to leave because they resented being paid the same amount as peers with lesser skill sets.
“When I first became director, everyone was equal. We knew that equal pay for varying skill levels was an employee dissatisfier,” says Whitley.
At first, the department offered increased pay to employees who passed the Georgia chapter of the Healthcare Financial Management Association’s Certified Patient Account Representative certification. (For more information, you can go to http://bit.ly/1p0804L.) “This addressed some concerns, but there were varying levels in skill and responsibility, recreating disparity and dissatisfaction,” says Whitley. When Whitley did exit interviews with employees leaving the department for other areas, they often said unequal pay was their reason for leaving. Patient access leaders decided to implement a career ladder, and they took these steps:
- They evaluated each component of each patient access position, including knowledge of registration, scheduling in ancillary areas, scheduling in clinical areas, insurance, contracts, authorization requirements, governmental payer requirements, and charity assessment.
- They determined the skill level necessary for each task and they created levels of positions, ranging from patient access services I to IV.
- They created team lead positions in each area, which allowed staff members to begin to grow.
“Team leads keep the team on track,” says Whitley. The role includes quality monitoring, management of patient flow, staffing, and scheduling.
• They created an insurance specialist role for complex inpatient and outpatient authorizations.
“Not all staff want to be leaders,” notes Whitley. “Having non-leader positions created a growth track for their particular goals.”
Here are some challenges when Navicent Health’s patient access career ladder was implemented:
• Some employees thought the new tasks included in the career ladder put them outside their comfort zone.
“We do not see this often, as many of our staff members are goal-driven and want to learn outside the duties of their roles,” adds Whitley.
• The career ladder needs constant updating.
“As the industry changes, an IT system may become more sophisticated, creating new skills or reducing the skill level needed for various tasks,” says Whitley.
• It is difficult to obtain appropriate salary increases.
It’s necessary for patient access to work with human resources on salary increases. “There needs to be enough difference in the pay structure from one level to another for the staff to view it as growth and a move up,” says Whitley.
Since the career ladder was implemented, fewer staff members are leaving patient access. Many have moved to other positions within the department. “We are able to grow our staff to move up should a position become available,” says Whitley.
TURNOVER LESS THAN 10%
Morale was “terrible” when Alyssa Corallo, CHAM, started as pre-access director at Arlington-based Texas Health Resources. Employee engagement and satisfaction scores in patient access were just 68% in 2009.
“Turnover was near the 30% range,” recalls Corallo.
One reason for widespread dissatisfaction was that the department was newly centralized. “Most of the staff felt like they were forced to centralize, leaving the environments they loved and friends that they had worked with for years behind,” says Corallo.
In response, all of the staff members were put into teams, each with different work flows and a different set of goals to obtain. The floor plan also was changed. “Teams could sit by each other, and this created a fusion that worked,” Corallo says.
It’s challenging to find people who will fit into the call center environment and want to stay for the long run, says Corallo. One reason is that employees must work weeknights and weekends. “It is hard to keep and find staff that are willing to stay long term on this schedule,” says Corallo.
Staff members are expected to meet quotas on a weekly basis, such as doing 200 pre-registrations per week. If staff members fall below this amount, they are held accountable by the department’s corrective action policy.
“This creates some turnover,” she says. “Not everyone can work in a high-intensity atmosphere and handle the pressure that comes with it.”
By the end of 2010, employee engagement was up to 85% and turnover was down to 15%. In 2015, a career development program to train and develop patient access staff was created, with the goal of reducing turnover even more. “We accepted six employees into the yearlong program,” says Corallo.
One employee was promoted to a team lead position, and two are members of wellness and morale committees. “I am proud to share that we currently have employee engagement scores of 91% and less than 10% turnover,” Corallo says.
- Kim Whitley, RN, CHAM, Director, Patient Access and Intake Services, Navicent Health in Macon, GA. Email: Whitley.Kim@NavicentHealth.org.