A registrar is finishing up entering an emergency department (ED) patient’s demographic information. Suddenly, a clinician enters the room, closes out the registration screen without saying a word to the registrar, and begins talking to the patient as though the registrar isn’t present.
When patient access staff members encounter situations such as this one at their hospital, they “have to find a way to exit the room professionally,” says Patty A. Johnson, CHAM, manager of ED patient registration at Portland-based Maine Medical Center.
Most patients become uncomfortable if they sense tension between clinicians and registrars. Patient access leaders can point out this impact on patient satisfaction to hospital leaders. “Providing the patient’s take on this is the best motivating factor,” says Johnson.
At Children’s Healthcare of Atlanta at Egleston, a satisfaction survey completed by a patient included a comment about the disrespect shown to a registration coordinator by a doctor. Patient access manager Michelle H. Crumbley, CHAM, says, “She didn’t feel our staff respected each other or worked well together, and it gave a poor first impression. This comment was shared with clinical leadership.”
Johnson makes a point of addressing incidents right away by phone or in person with the chief medical officer. “That seems to have a better outcome than waiting until the end of the day or sending an email that may not get addressed until two weeks later,” she says.
For Maine Medical Center’s ED registrars, disrespect is not commonplace. Johnson credits this atmosphere to resolving problems right when they occur. “We have a new plan of attack on this, and it is working!” she says. When an ED registrar reports an incident, these steps occur:
Registration leadership immediately contacts the department head or his counterpart.
The department head addresses the situation with the provider.
The department head then follows up with Johnson or the registrar.
“We have seen a big decrease in this type of interaction,” reports Johnson. “I have not had a reported incident for several months.”
After one incident, Johnson had the registrar page the chief of the department to explain what happened. The registrar also reported that the patient had commented that the provider was rude. “He thanked her, came within 30 minutes to see me, and followed up with the provider,” says Johnson. “The rep’s shift had ended, so I sent her an email updating her.” In another similar case, the provider apologized to the registrar personally.
When the registrar goes back to complete the registration, he or she doesn’t complain about the provider’s rudeness. Instead, he or she says something to alleviate the patient’s concern, such as, “Our providers are very good at what they do, and their focus point is always on the patient. At times, that is all they see.”
“They try to keep it light,” says Johnson. “It all goes back to the patient experience — how the patient views our whole team here.”
Friction between clinicians and registrars most often occurs in the two locations where bedside registration is done at Children’s Healthcare of Atlanta: the ED and Day Surgery. Crumbley says, “Often, the interaction is rude, in that the physician talks over the registration coordinator or tells them to leave in the middle of a registration.”
Registrars notify a team lead or supervisor immediately of these unpleasant incidents. Crumbley immediately speaks to everyone involved. “If the family registers a complaint, the physician is written up for a peer review,” she says.
There are always two sides to every story.
“Sometimes abnormal test results or clinical deterioration of an ED patient results in the physician quickly going into the room to resolve it, not intending to be rude,” says Crumbley.
In some cases, a department head is the one who is involved. In one such instance, Crumbley met with a hospital leader to thoroughly explain the role of patient access. “After I shared with him how much money we collected onsite and how what we do impacts how everyone is paid, he was more respectful,” says Crumbley.
The department head asked Crumbley to speak about the role of patient access to a team of nurse managers and physician leaders. In turn, they conveyed the information to staff-level nurses and attending physicians. Crumbley explained patient access processes and what was expected of registrars, including point-of-service collection goals.
“Since then, things have gotten much better,” says Crumbley. “There is a lot more respect for patient access.” Registrars now take these steps at the start of each shift:
They introduce themselves to the doctors and nurses assigned to their unit within the ED.
They provide their phone numbers so the registrar can be contacted immediately if any issues come up.
They ask the clinical team, “How can we best work together today?”
It’s often difficult for registrars just to get in the room with the patient. Jamie Bruner, manager of registration services at Cape Coral (FL) Hospital, says, “They are competing with healthcare providers for the patient’s attention.” When a registrar is abruptly interrupted, it’s usually because a clinician is trying to examine or treat the patient.
“There will be times when a registrar can respond to these interruptions in a way that allows them to continue. It lets the clinician know that they can take over as soon as the registration is done,” says Bruner. Other times, the registrar sees the urgency of the situation and quickly steps aside.
“In our high-stress environment, it is best for the registrar to be kind but assertive when asking for more time to complete their function,” says Bruner.
First, registrars acknowledge that the clinical team has important things to do with the patient. A registrar might say, for example, “I know you really need to get in here. But if you could just give me a few more minutes, I won’t have to come back. Thank you.”
“This lets the clinician know that you know what they need to do is important, and once you’re done, there will be no more interruptions from you,” says Bruner. Here are other ways she’s educated clinicians about patient access:
• She looks for “teachable moments.”
Recently, an ED technician interrupted a registrar who was in the middle of completing financial assistance forms with a patient.
“The technician later expressed the uncomfortableness they felt overhearing the discussion with the patient about their household income,” says Bruner. A patient access leader asked to give a presentation at an upcoming clinical staff meeting. “We were able to educate the entire clinical team on our process and why the questions we ask are so important,” says Bruner.
• She displays a bulletin board in the clinical break room, with patient access collection goals posted.
“Our health system’s financial outlook is always at the forefront of the system’s leadership meetings,” Bruner notes. “This helps the clinical teams understand how important our efforts are.”
• She calculates the amount of revenue lost if patients are discharged before registration is completed.
“When we present the missed opportunities with a dollar figure attached to our clinical team, they better understand the significance of their actions,” says Bruner.
Jamie Bruner, Manager, Registration Services, Cape Coral (FL) Hospital. Phone: (239) 424-2659. Email: [email protected].
Michelle H. Crumbley, CHAM, Manager, Patient Access, Children’s Healthcare of Atlanta at Egleston. Phone: (404) 785-7742. Email: [email protected].
Patty A. Johnson, CHAM, Manager, Emergency Department Patient Registration, Maine Medical Center, Portland. Phone: (207) 662-2102. Email: [email protected].