Failing to take action with a problem patient access employee can hurt morale in the department. If terminating an employee is a possibility:

  • ensure employee has received sufficient training;
  • give clear timeframes for expectations;
  • schedule frequent status meetings;
  • consider if another role is a better fit.

A registrar constantly came to work with a bad attitude at the University of Tennessee Medical Center in Knoxville. “She was very disengaged and started having a pattern of unscheduled time off,” recalls patient access manager Michelle Reno.

The registrar was a long-term hospital employee who had recently transferred internally to patient access. Even after coaching and corrective action, her attendance continued to be a problem. Eventually, the employee was fired.

With the problem employee gone, “the team had better morale, and was even OK working short-staffed,” Reno says. The lesson for patient access: Failing to act if employees aren’t meeting expectations can cause others to become disengaged. “During the first coaching session, there need to be clear consequences so there aren’t any surprises,” Reno advises.

At Texas Health Harris Methodist Hospital Southwest Fort Worth, a registrar missed work constantly. A patient access manager warned her for many months before finally considering termination. “After meeting with human resources, they determined that disciplinary action taken by the manager should have come sooner. Too many opportunities were granted,” says Laura Rasor, director of patient access services. After the employee was terminated, the manager learned about expectations for timely action.

“Terminating is never the ideal option,” Rasor says. “But with patient satisfaction and financial sustainability as our main focus, sometimes it is the only option.”

Best Chance at Success

Timely feedback to staff is essential. “We do this so they are aware of their performance status,” Rasor explains. “They have an opportunity to improve moving forward.” Managers meet with their employees monthly to review “scorecards,” which cover productivity, point-of-service collections, quality assurance scores, and usage of required tools and programs.

“When the expectations are not met or improved upon after a certain period of time, corrective action and/or termination of employment is something that must be considered,” Rasor concludes. She advises patient access leaders to ask two questions if they’re considering terminating someone:

  1. Has the employee adequately been made aware of his or her errors or opportunities, and have those efforts been documented?
  2. Has the employee been appropriately trained and/or offered ample refresher training?

“We have an obligation to provide every employee with the very best chances at success,” Rasor says. “If we don’t do that, then it is my opinion that their failure is our failure.”

Not for Everyone

Patient access isn’t for everyone. “What used to be an entry-level position now requires some pretty savvy computer skills, with the ability to work in many applications at once,” says Jill Pfeifer, revenue cycle educator at Springfield, MO-based CoxHealth.

Top-notch customer service skills have become an essential part of the job. However, this isn’t a strength for everyone. “Working with patients takes a special kind of person, especially when exceptional customer service is expected with every interaction,” Pfeifer notes.

It’s possible that sufficient training and feedback can turn things around. “You can’t improve if you don’t know you’re doing it wrong,” Pfeifer says.

Another possibility is that the disengaged employee just needs to play a different role to thrive. “Maybe we have a good employee that just can’t do this job,” Pfeifer offers. “We always need to ask, ‘Are you on the right bus, [but] just in the wrong seat?’”

When Pfeifer deals with employee issues, she schedules frequent status meetings. This way, the decision to terminate isn’t dragged out over a long period. This approach results in one of two things, she says: “An improved employee — or a timely termination.”


  • Laura Rasor, Director, Patient Access Services, Texas Health Harris Methodist Hospital Southwest Fort Worth. Phone: (817) 433-6600. Email: LauraRasor@texashealth.org.
  • Jill Pfeifer, Revenue Cycle Educator, CoxHealth, Springfield, MO. Phone: (417) 269-0021. Email: Jill.Pfeifer@coxhealth.com.
  • Michelle Reno, Patient Access Manager, Emergency Department, The University of Tennessee Medical Center, Knoxville. Phone: (865) 305-6971. Fax: (865) 305-6883. Email: mreno@utmck.edu.