EXECUTIVE SUMMARY

Clinicians and other hospital departments often lack even a basic understanding of the patient access role. At times, this leads to disrespectful attitudes. Consider these approaches to help interdepartmental relationships:

  • Create a video to explain the patient access role.
  • Inform physicians of the steps involved in scheduling their patients.
  • Ask nurses to observe the registration process.

“We have this struggle often in our facility. My staff was feeling disrespected and underappreciated by most of the departments that we interact with,” says Marci Mollman, director of patient access at Holy Rosary Healthcare in Miles City, MT.

To educate others on their role, lead associates created an eight-minute video titled, “A Day in the Life of Patient Access.” “We tried to put a face to all of our associates, so that everyone could see how many areas we really touch every day,” says Mollman.

The video was shown to staff and hospital administration. “The video was created by the associates making a script and creating cue cards,” says Mollman. “They recorded us on their phones, then another associate cut and edited all of the snips into a video.”

Afterward, patient access distributed a questionnaire asking how they could improve interactions with other departments. (See the department’s questionnaire in this issue.)

Ask Other Departments To Rate Patient Access

Below is a survey used by the patient access department at Sisters of Charity Leavenworth Health System in Miles City, MT.

Survey

“It generated some really good conversation, and opened some eyes,” says Mollman. “For the most part, we have seen improvements.”

Below are other ways patient access can respond to rudeness:

  • Address incidents right away.

Incidents of rudeness toward registrars at Sisters of Charity Leavenworth Health System have decreased noticeably. This is because of a concerted effort to educate people about the role of patient access. Occasional problems do crop up, though — and when they do, registrars aren’t silent about it. “We, of course, still have those who find it necessary to treat others poorly,” says Mollman. “I am always there to defend and help them.”

Tanya Hampton, manager of patient access services in the ED at Methodist University Hospital in Memphis, TN, takes a proactive approach if she overhears a registrar being treated rudely: “I don’t tolerate that, and I go tell them that right then and there,” she says. Although Hampton is always polite, the message is clear: Registrars are not to be mistreated.

Speaking face-to-face elicits an immediate response, says Hampton: “It’s not like an email or phone call that they can ignore. We are working really hard to change the mindset of these folks.”

  • Educate clinicians on the role of bed management.

Sometimes, clinicians are dismissive of bed management staff at Hackensack UMC Palisades in North Bergen, NJ. “The authority they are afforded to make decisions on where to place patients, depending on diagnosis and status is, at times, undermined by the clinical staff on the specific units,” explains patient access director Maria Lopes-Tyburczy.

Clinicians don’t realize the importance of telling bed management what’s going on in the unit. If there’s an emergency situation with a patient, for instance, another patient awaiting an available bed is delayed. If bed management staff are kept in the loop, they can be upfront about how long it will take to transfer the patient to a room, says Lopes-Tyburczy.

Sometimes there is a need to transfer patients within the unit. If bed management staff don’t know about it, an occupied bed might end up being booked for another patient. “This causes delays in placing the patient,” says Lopes-Tyburczy.

Getting clinical staff and patient access on the same page is the only solution. “Collaboration between clinicians and bed management staff is crucial for patient safety, positive outcomes, and experience,” says Lopes-Tyburczy.

  • Clear up misunderstandings about who is responsible for obtaining prior authorizations.

Part of a financial counselor’s job is to inform physicians’ offices about pre-authorization requirements, says Lopes-Tyburczy. Often, they get a less-than-polite response from overworked office staff who don’t appreciate what they perceive as additional work.

In this situation, says Lopes-Tyburczy, “Educate the referring office that ultimately it’s their responsibility to obtain pre-authorizations.” Doing this collaboratively avoids treatment delays.

  • Explain the registration process.

Many envision registrars’ role as simply sitting at a desk and checking people in with a few clicks of the mouse. Thus, they’re quick to place blame if any glitches arise. Marion Knott, manager of clinic access at Moffitt Cancer Center in Tampa, FL, says, “Many departments and providers don’t understand what we do exactly.” Knott finds it helpful to explain the registration process when other departments get testy. After she does so, the registrar probably won’t get an apology. “But it usually doesn’t happen again,” says Knott.

Nurses and physicians complain that orders aren’t scheduled quickly enough, without realizing the process. “They don’t see what it looks like from our side, and what we have to do with the information,” says Knott.

Recently, a provider put in multiple orders. The registrar wasn’t able to schedule the orders until the specialty orders — which are done in date order — were completed. “He sent an email copying the chair of the department and administrator, and wanted heads rolling,” says Knott. The physician was angry because he felt his patient wasn’t being scheduled quickly enough. After she explained that the process was held up whenever there is scheduling that is divided, the provider was more understanding.

  • Have good documentation at your fingertips.

Evidence of who gave what instructions comes in handy if registrars are unfairly blamed just for doing their jobs. “We play middle man a lot,” says Knott. “People don’t realize that we are just doing what we were told to do.”

In one case, a nurse practitioner asked a registrar to overbook the schedule at a physician’s request. That physician later angrily confronted the registrar — who gently reminded him that he’d given permission to overbook his template — and had documentation to prove it.

Although this kind of evidence is great to have on hand, things must be handled diplomatically. “We say, ‘Is this what you wanted? Because this is what I see here,’” says Knott. “We don’t want to cause waves. We want to smooth things out.” (See related story in this issue on having other departments observe registration.)

Invite Critics To Watch Registration Process

Staff at one particular clinic always seemed very critical of registrars at Sisters of Charity Leavenworth Health System in Miles City, MT. Realizing the clinicians had no idea what the registration process entailed, patient access leadership asked nurses to watch them at work.

“We asked their manager for dedicated time with them, and she allowed it. We then set the agenda to show them our workflows,” says patient access director Marci Mollman.

The nurses had no idea what it took to register a patient, complete an Advance Beneficiary Notice of Noncoverage, or process lab orders. “They were really shocked at all of the steps that it took,” says Mollman. “It has gone a long way to improve relationships.”

When Marion Knott started out as a patient access representative more than a decade ago, a manager seemed very confused about scheduling procedures. Knott explained the entire process in detail. “She was in shock and said in amazement, ‘You have to do this with every patient?’” says Knott. “It showed me that people really don’t understand what we do.”

Knott is now manager of clinic access at Moffitt Cancer Center in Tampa, FL, and still encounters the same problem today. Patient access currently is working with nursing leadership to arrange shadowing between the two departments.

“When new nurses or patient access reps start, we want them to spend a couple of hours sitting next to somebody and watching what they do,” says Knott.

Clinical researchers also have agreed to shadow registration, so they can fully comprehend the scheduling process. “Their orders are very date-specific, and can be pages long,” says Knott. “They don’t understand the complexity of what we have to do.”

SOURCES

  • Tanya Hampton, Manager, Patient Access Services, Emergency Department, Methodist University Hospital, Memphis, TN. Email: Tanya.Hampton@mlh.org.
  • Marion Knott, Manager, Clinic Access, Moffitt Cancer Center, Tampa, FL. Phone: (813) 745-3239. Email: Marion.Knott@Moffitt.org.
  • Maria Lopes-Tyburczy, Director, Patient Access, Hackensack UMC Palisades, North Bergen, NJ. Phone: (201) 295-4028. Email: maria.lopes-tyburczy@hackensackmeridian.org.
  • Marci Mollman, Director, Patient Access, Holy Rosary Healthcare, Miles City, MT. Phone: (406) 233-2607. Email: Marci.Mollman@sclhs.net.