It’s a mistake that Joseph Ianelli, MSW, MBA, has seen many times: Rewarding a loyal, long-term access employee with a promotion, despite the fact that the individual has no leadership skills.
“It’s a pattern I’ve noticed throughout my career,” says Ianelli, director of patient financial services at Boston-based Massachusetts General Hospital.
The employee typically gets along with everyone very well and has been in the department for many years. “He or she may be a subject matter expert and amazing in a hundred ways, but a leadership opportunity is just wrong for them,” says Ianelli.
This type of promotion is detrimental to morale, as peers quickly realize the leader isn’t someone they can learn from. “It’s not a matter of taking turns,” Ianelli says. “If it isn’t someone who staff are able to look at as a model or mentor, don’t put that person in a leadership role.”
There are other, better ways to reward your long-term employees. “The employee’s expertise could be very helpful with orientation, for instance,” says Ianelli.
Massachusetts General’s employees first become team leads, then managers, before they can be considered for a director role. Ianelli always promotes people with leadership qualities. “Ideally, you want a team lead who can someday be a supervisor,” he explains.
If a poor leader stays in the role for many years, it hurts the department in more ways than one. Morale suffers, and qualified team leads have no way to move up. “If positions are locked up because a manager is ‘stuck’ in a role, you keep new and emerging talent in a place where they can’t really grow,” says Ianelli.
When a talented employee has no opportunity for advancement, Ianelli doesn’t try to convince him or her to stay at all costs. “Sometimes people might be at the end of what they can do here,” he says. Ianelli enthusiastically writes glowing recommendations for medical, law, and nursing school, as well as MBA programs, for registrars who decide to leave patient access for those programs. He maintains good relationships with many who have left the department and even the hospital.
“Staff who have gone on to different jobs always stay in touch with me,” he says. “I’ve also had people who weren’t successful in moving on and were very happy to come back.”
Here are some considerations when choosing patient access employees for leadership roles:
• Be clear about what it takes for employees to advance.
Bob Stearnes, CHFP, CHAM, a Dallas-based patient access leader, says to collaborate with revenue cycle leaders and human resources (HR) to create pathways for advancement. This collaboration allows patient access managers to tell prospective hires exactly how they’ll be able to grow in the department.
“If you are unable to do that at an organizational level, how will you ever convince somebody they’ll be able to move up?” he asks.
• Work with HR to identify key attributes that are needed in patient access.
Stearns suggests starting with these qualities: open to new ideas, agreeable, extroverted, and even-keeled.
Patient access leaders must take the initiative to tell HR what to look for, though. “It is rare for HR to spend time in the department and evaluate what we do,” Stearnes says. “It is also rare for a patient access leader to reach out to HR on this.”
HR professionals have the skill set needed to design career paths and necessary training, Stearnes says, “but they need the subject matter experts — patient access — to tell them what to look for.”
• Set targets not just for directors, but also for employees.
Days in accounts receivable (A/R) were being reviewed at a previous organization where Stearnes worked, but only directors were being held accountable with a metric.
“I realized that the targets stopped at the director’s desk. There was no target for the staff,” he says. Stearnes met with supervisors to address this issue. “We knew a certain number of A/R accounts went to dispute. We developed aging goals based on inventory,” he says.
Managers gave staff targets to get their A/R timeframes down at the individual level. These were part of performance evaluations. “We talked about tactics and ways they could deal with situations,” Stearnes says. Managers created scripted responses to talk with insurance reps, and gave staff a weekly report on their percentage of aged accounts beyond 90 days. “We saw them being more conscientious,” Stearnes says. “We showed them what was important to the organization and made it important to them.” (See related story on customer service skills in this issue.)