Sometimes, a patient who checked in later than others gets called back ahead of others who checked in earlier. At Cooper University Hospital in Camden, NJ, one patient was upset enough about a situation like this to complain to staff.

A patient access leader apologized and offered an explanation. Further, the department conducted a root cause analysis to find out what really happened. They examined the arrival time of each patient, which was time-stamped electronically, and the patients’ procedure time and location. It turned out there was a very simple explanation: The other patient was going to a different location. This happened often, since the same waiting area is used for multiple patient types.

“It became obvious an explanation needed to be a part of routine scripting to avoid patient dissatisfaction,” says Pamela Konowall, CHAM, assistant director of healthcare access at Cooper University Hospital. Today, registrars explain to patients that multiple patient types arrive each day. If any service area is running behind schedule, registrars say so. “A patient for OR may have arrived after a GI patient and is taken to their destination first,” Konowall says, noting that patients no longer assume someone is jumping ahead of them. “A simple explanation such as, ‘That patient is going to a different destination’ avoids dissatisfaction. Communication is of the utmost importance.”

Understanding the root cause of a complaint is “vital,” according to Maurice Winkfield, director of patient access at Beebe Healthcare in Lewes, DE. This tells patient access if the feedback is related to a specific site, process, or employee. “We make a point of tracking our patient complaints across all of patient access,” Winkfield reports. “We review them regularly to ensure there are no trends or patterns forming.”

During a root cause analysis, Cooper University Hospital’s patient access leaders:

  • verify the patient’s arrival time to identify if the patient was late or too early;
  • determine if staff skipped the patient inadvertently;
  • establish whether patients are registered quickly (two to five minutes);
  • resolve excessive delays in registration areas;
  • discover why if a unit was running behind;
  • learn whether patients were updated with an anticipated time they’d be going to the unit.

Recently, Beebe Healthcare noted a surge in complaints. Patients were asking for multiple providers not listed on the order for testing to receive their results. “We started receiving complaints from patients, providers, and our quality department,” Winkfield says.

Providers complained that results weren’t received because patients forgot to list them. Quality complained that incorrect providers were listed because the patient only knew the doctor by last name.

“This kept leading to misdirected results,” Winkfield explains, which he says opened the door for potential violations of privacy regulations.

The department switched to a standardized request form. “Patients need to complete it if they want their results sent to any provider not listed on the original order for testing,” Winkfield notes.

Jason Guardado, patient access services manager at Montefiore Nyack (NY) Hospital, says failure to institute formal prepayment policies (or an inability to enforce such policies) is a common root cause. Inadequate staffing resources during peak service times is another.

“A root cause analysis addresses the true source of the issue rather than placing a temporary fix to address the complaint,” Guardado says.

Actions intended to address a single complaint provide short-term damage control. “But failing to address where the issue truly lies can result in repeat occurrences of the same issue,” Guardado adds.

Patients who are not informed of copay or coinsurance amounts due for a scheduled procedure might complain about the unexpected expense at registration. A full or partial waiver of the copay amount may be granted as a patient satisfier.

“However, the ongoing issue of timely notification of patient responsibility is not being addressed,” Guardado says.

What’s needed instead is a policy, one that clearly defines the timing of prepayment and point-of-service collection efforts. It should include defined time frames for communicating with the patient, offering payment options and financial assistance, and following up with reminders prior to service date.

“This generates an institutional platform on patient financial education, which correlates with excellent customer service,” Guardado offers.

Now, there is an expectation of payment for services prior to, or at the time of, services rendered. However, this remains a challenge for patient access because of patient pushback. “Patients need to be educated and clearly informed,” Guardado says.

To head off complaints, patient access staff should explain why the need to collect prepayment is beneficial for the patient. Further, staff should make it clear that collecting preservice is important for the hospital to remain financially viable.

“If there is no formal communication and enforcement of the expectation to collect, successful attempts for collections will not occur,” Guardado warns. “You can bet a patient’s anxiety levels will go through the roof if they are informed for the first time of a hefty out-of-pocket expense on the day of a procedure.”