Registrars need “de-escalation” techniques to respond to patients who are unhappy or upset due to financial obligations, scheduling problems, or other issues.
- Give scripting for top complaints.
- Role play, with the instructor playing an agitated patient.
- Check in with patients continually during waits.
“I didn’t see it written anywhere before I was serviced that I would have a copay.”
“I refuse to talk about money being owed while I’m receiving treatment.”
These are some patient responses reported by registrars to Victor O. Odoh, pre-access manager of surgical and pre-registration operations at Florida Hospital in Orlando.
While collecting at the bedside isn’t new for the department, the approach has changed somewhat. In the past, a single registrar had the patient sign consents, reviewed insurance benefits and financial obligations, then collected any payment owed.
“The process has now changed to two separate individuals,” explains Odoh. The first registrar collects insurance information and obtains consents. A second registrar reviews financial obligations and collects.
Some inpatients are just not willing to discuss money during their hospital stay, however, and aren’t shy about saying so. “Patients express frustration due to lack of price transparency or because payment is the furthest thing from their mind,” says Odoh.
The person who gets the brunt of their dissatisfaction isn’t a payer representative or hospital administrator, of course — it’s the registrar.
Some patients learn their insurance coverage still leaves them with high out-of-pocket costs. Most have no idea of their financial responsibility for a hospital stay. “So when a registrar approaches a patient about their financial obligation, they are blindsided,” says Odoh. Scripting helps registrars to respond.
The scripting is based on the AIDET (Acknowledge, Introduce, Duration, Explain, and Thank) model. Here is a typical conversation:
“Good morning/afternoon/evening/ sir or ma’am. My name is Victor. How is your visit thus far?” (Acknowledge patient’s response).
“I will be here with you for five or 10 minutes talking over your visit’s financial responsibilities. I am here to answer all of your financial questions or concerns.” (Have conversation about financial responsibility.)
“Thank you for your time. Can I assist you in anything else?”
Odoh also developed “patient experience” training, which instructs registrars to do these three things:
- Hear the patient’s complaint fully without interrupting.
- Apologize, and assure the patient that the registrar will do all that he or she can to assist.
- Address the issue, and update the patient on the response.
ID Common Complaints
As the hospital’s patient experience coordinator, Odoh does “patient-centered rounding” on 150 ED patients each month. “I take note of their complaints, then set up a skills lab that specifically addresses the top reasons for complaints,” he says. Staff are graded based on how they respond to these three scenarios:
- The doctor was not empathetic.
- The nurse was mean and not informative.
- I wasn’t updated on my status timely. (See related story on dissatisfaction and wait times in this issue.)
Odoh asks patients these four questions:
- How is your visit so far?
- Have you been informed of any delays?
- How is your experience with your nurse?
- How is your experience with your physician?
“I keep track of these responses, along with the names of nurses and physicians associated with the patient,” says Odoh.
Rebecca Steve, training manager for revenue enhancement at Hennepin County Medical Center in Minneapolis, says registrars usually “get caught in the crosshairs” in these three scenarios:
- when a patient is upset about paying money;
- when a patient’s appointment was scheduled incorrectly;
- when a patient can’t get access to a physician right away.
Steve created a “de-escalation” course to teach registrars these techniques: actively listening to the patient, allowing a patient to vent, calming the patient, validating what the patient is saying, problem-solving, and giving the patient space.
Registrars are given these techniques to keep patients, and themselves, calm:
- Talk slowly and softly.
- Don’t match the patient’s tone or volume.
- Avoid saying the phrase “please calm down.”
- Redirect the patient to a different topic.
The class members do some role-playing, with the instructor playing the part of an agitated patient. They are given these phrases to use:
- “Excuse me, may I talk to you?”
- “… for your safety and mine …”
- “Could I ask you … ?”
- “Would you assist me with … ?”
- “Can you work with me on ... ?”
- “What can I do to help you with … ?”
- “I’m sorry you feel that way.”
Registrars also participate in “non-verbal” role-playing exercises. “This helps them understand the effect that non-verbal behavior has on any situation,” says Steve.
- Victor O. Odoh, Pre-Access Manager, Inpatient, Surgical, and Pre-Registration Operations, Florida Hospital, Orlando. Phone: (407) 200-2359. Email: Victor.Odoh@flhosp.org.
- Rebecca Steve, Training Manager, Revenue Enhancement, Hennepin County Medical Center, Minneapolis. Phone: (612) 873-2761.