Patient access departments are assessing the customer service they provide by creating their own satisfaction surveys, conducting peer-to-peer critiques, and recording all registration interactions. This allows them to:

  • perform service recovery right after an encounter;
  • identify the level of service given by employees at annual reviews;
  • provide training targeting areas in need of improvement.

How happy was the patient with the registration experience? Surprisingly, patient access departments often have no good way to answer this simple but increasingly important question.

“The hospital survey has no questions directly pertaining to us,” says Mike M. Harkins, CHAM, director of registration at Sentara Leigh Hospital and Sentara Norfolk General in Norfolk, VA, and Sentara Albemarle Hospital in Elizabeth City, NC.

As the patient experience is a top priority at virtually all hospitals, data on satisfaction are not just nice to have, it’s essential for patient access to be able to demonstrate the department is on board with organization-wide goals.

“We are the front door. The patient’s experience starts with us,” Harkins notes. Relying solely on the organization-wide patient satisfaction survey caused two problems for patient access:

1. Results came back too late to do something to turn things around.

Contacting someone several months after a hospital visit, which is about the timeframe the survey results came back, just doesn’t carry the same weight as an immediate response. Since so much time had passed, it just gave patient access something else to apologize for. “We want to call the patient to try to do service recovery while it is fresh,” Harkins says.

2. Without any data on patient satisfaction, it was hard to reward registrars for giving excellent customer service.

The organization-wide survey offered no insights on the kind of service provided by the department. This left patient access leadership guessing about how they could improve. Instead of relying on it, registration areas now offer their own survey.

“We generally try to get patients to fill it out before they leave our area. We ask about their experience with us on that day,” Harkins says. (See the department’s survey tool at the end of this article.)

Registrars are required to offer a survey to each patient with whom they interact. The department expects to receive 10-12% of the surveys returned with comments, which are closely tracked. If there’s a complaint, a team coordinator from patient access calls the patient within a day or two. Most involve wait times, but patients have commented on virtually every aspect of the registration experience, from parking to wayfinding to TV channels. No complaint goes unanswered.

“We always listen. We have changed many things as a result of some of these calls,” Harkins reports. Here are some examples:

  • Registrars used to call patients by name, but some people didn’t feel comfortable with that. To protect privacy, registrars now use number systems and pagers;
  • Patients voiced concerns about the content of shows aired in the waiting room. TVs are now locked on weather or news channels;
  • Signage was added after many patients reported difficulty wayfinding;
  • Valet service was added at some locations. This change came about because some people couldn’t find a parking spot and were late for appointments. “Coffee and water is now offered at some registration areas, just as an added perk,” Harkins adds.

30% of Score

The patient access department doesn’t just talk about the importance of customer service — employees are held accountable for it.

“Customer service is valued at 30% of an employee’s overall annual performance review score,” Harkins explains.

Patient access job descriptions were updated to include customer service, as follows: “Must maintain highest level of customer service. Demonstrates professional behaviors expected by customers including but not limited to adhering to department dress code policy, exhibiting communications using appropriate body language, voice tone, word choice, and adjusting the communication style to best meet the needs of the customer.” Surveys are just one of the data points used to indicate the level of service given by a registrar.

“Employees are measured by reporting, patient feedback, direct observation, and internal and external feedback,” Harkins says.

If registrars are mentioned by name 25 times in a positive way, they get a gold star to wear on their uniform.

“This is a large source of pride for our registrars,” Harkins notes. “It can take six months to get 25 surveys with a name on them.”

At Texas Health Resources in Arlington, newly implemented peer-to-peer “call labs” became instrumental in improving the department’s customer service. Previously, supervisors conducted some one-on-one training if they noticed an employee needed help.

“It didn’t seem to make as much of an impact as we had hoped,” says Patti Consolver, CHAA, CHAM, FHAM, senior director of patient access.

Now, small groups of employees critique two calls together. One of the calls is a great example of excellent service. The other call is an example of a time when things didn’t go as well as they could.

“Staff have a white board where they scope out the learning opportunities,” Consolver explains. “They really seem to get a lot out of the process.”

Sometimes, managers bring the patient’s point of view to the discussion by taking a recent comment from a survey. “We play the interaction and have the employees see what transpired from the patient’s perspective,” Consolver adds.

Recorded insurance verification calls receive a high percentage of claims denials successfully appealed at Texas Health Resources. This is because patient access keeps a record of what the payer representative stated. “That is where the ROI comes from. But the real ROI, that you can’t put a dollar amount to, is the patient experience,” Consolver says.

Patient access leaders decided to use this same process, which was so effective at overturning denials, to analyze customer service. Pre-access calls, fax or online transactions, and face-to-face interactions that happen at the registration desk are recorded. All are indexed to the patient’s record. “We get a holistic view of the experience from each point in the patient’s journey, from scheduling to registration,” Consolver reports.

Previously, all patient access had to go on was key data elements. For instance, they could see accuracy percentages for each registrar. This didn’t tell the whole story.

“We are now able to experience it as if we were sitting next to the registrar,” Consolver says. The recordings reveal whether standardized scripting is used, if some additional training is needed, or if anything is hindering productivity. This paints a fuller picture of how the patient is treated.

“We learned that it doesn’t matter how much time you spend on training and revising scripting. An employee may still add their own twist to it,” Consolver says.

The recordings give added insight when an issue is identified “on paper.” A registrar may be collecting less than their peers or could be failing to meet requirements for accuracy. “By listening to what transpired during the registration, we get a better idea of what may be contributing to this,” Consolver says. “We are able to do more focused training.”

The department is now piloting an audio search feature as part of this QA process.

“This allows us to put in a data element and find all interactions with that data element,” Consolver explains.

Recently, managers wanted to know how many times a registrar asked, or did not ask, for the patient’s primary care physician. The audio search feature gave them not only the number of times, but the actual accounts to use as an example.

The audio searches can be conducted on any key phrases. For instance, the financial clearance intake center employees are supposed to end every call with, “Is there anything else I can help you with today?”

“We can search for all recordings at the intake center that did not have that phrase and identify those accounts,” Consolver says. “This has made the management of the quality a lot more thorough.”


  • Patti Consolver, CHAA, CHAM, FHAM, Senior Director, Patient Access, Texas Health Resources, Arlington. Email: PatriciaConsolver@texashealth.org.
  • Mike M. Harkins, CHAM, Director of Registration, Sentara Leigh Hospital and Sentara Norfolk General Hospital, Norfolk, VA/Sentara Albemarle Hospital, Elizabeth City, NC. Phone: (757) 261-8962. Email: mmharkin@sentara.com.

Example of Registration Satisfaction Questions

The registrars at Sentara Leigh Hospital, Sentara Norfolk General Hospital, and Sentara Albemarle Hospital administer surveys to patients as they leave registration areas that look something like this:

Please keep this survey throughout today’s visit and return the completed survey to the registration desk or place it in the designated drop off box. We value your feedback and it will help us in providing the best service to our customers. Thank you for choosing Sentara for your healthcare needs.

  • Patient Last Name/Patient First Name/Patient ID
  • Arrival Time/Reg Username/Registration Class (Scheduled or Walk-In)/Procedure(s)
  • Did today’s visit meet your expectations? Yes/No

If you are pleased with your visit, let us know about it! If your expectations were not met, please let us know the areas we need to improve:

  • Were the registration staff courteous and professional? Yes/No
  • If given a choice, would you use this Sentara hospital in the future? Yes/No
  • If you would like to be contacted by a representative of the area(s) you visited, please provide your telephone number:
  • And the area(s): Was it easy for you to find this facility? Yes/No