There is a simple reason why patient access often is called the “front door” of the hospital. “Our registration specialists are often the first person our patients see or talk to,” says Mary Wilkins, a patient experience consultant at CoxHealth.
All departments in the health system use the Studer Group’s AIDET communication tool. The acronym stands for five communication behaviors: Acknowledge, Introduce, Duration, Explanation, and Thank You. Here are some examples of how it sounds to a patient being registered:
For a new patient appointment, the AIDET process might go something like this: “Hi, welcome to CoxHealth. My name is Carol, and I will register you for your appointment. May I have your first and last name as well as your date of birth?” (At this point the patient gives their information). “Mr. Jones, it shows that you are here for a new patient appointment. I would first like to welcome you to our clinic. I’m glad that you have chosen us to be your healthcare provider. Your registration will take about five minutes as we will update your contact information, run your insurance, and complete your copayment.”
For an existing patient, the AIDET process might go something like this: “Mrs. Rogers, I have you registered for your appointment with Dr. Jones. Sam, your medical assistant, will be out in about 10 minutes to get you. Again, my name is Mary. Please let me know if you have any questions.”
“AIDET is especially important in registration, to help build a connection with the patient,” Wilkins says. However, there are two AIDET tool challenges for patient access:
• Many registrars do not feel comfortable using the tool when speaking with patients. Going down a checklist just feels awkward at first. “Staff are worried they sound like a robot,” Wilkins notes.
To help registrars, trainers tackle one portion at a time. For instance, registrars can make eye contact with a cheerful welcoming statement such as, “Good morning!” Next, registrars add the introduction and an explanation. Combined, the message becomes: “Good morning! My name is Mary, and I am going to register you for your appointment today.”
It is not just words that matter. “Eye contact, tone of voice, and body language can all be important aspects to providing an acknowledgment,” Wilkins stresses. Registrars make every effort to greet patients by name. This is especially important in settings such as primary care. “Staff get to see the same patients on a regular basis,” Wilkins adds.
• Registrars struggle to incorporate “duration” into the conversation. Providing people with durations is particularly important in registration areas. “We are keeping them informed and decreasing anxiety,” Wilkins says.
With no idea how long a wait will last, patients’ anxiety is likely to spike. Patients may start to wonder, “Have they forgotten about me?” or “I guess my time isn’t as important as theirs.”
“If I am using AIDET properly, I will tell the patient how long to expect to wait, and that if there are any delays that I will update them,” Wilkins says.
It works both ways. Great communication about durations sends a message that appointment times are taken seriously. “Patients are more likely to arrive on time, which minimizes delays for everybody,” says Kelsey Bagwill, a patient experience consultant at Cox Medical Center Branson (MO).
It is not always easy for registrars to give a wait time. Registrars worry the patient or family will get angry because they feel the wait time is too long.
“It is also because in healthcare, things change quickly,” Bagwill says. Registrars know that right after they tell the patient it is a 20-minute wait, the time could double due to an emergent situation. “Then, they’ve just unintentionally been dishonest,” Bagwill laments. The solution: Communicate the new expected wait time to the patient.
“I encourage [registrars] to think about themselves as patients,” Wilkins offers. Registrars are asked to imagine waiting in a room without any explanation of a duration. How would they feel after 30 minutes? “Once it’s put into perspective, staff are able to realize they wouldn’t want that for themselves,” Wilkins says.
Wilkins uses real-life stories to convey important points to patient access staff. One story she shares often is about a time when she accompanied a family member to a primary care physician appointment to follow up on her new medication that was prescribed a few weeks prior. Upon arrival, they were curtly told to take a seat. “We waited and waited, with no updates from anyone,” Wilkins recalls.
Every 30 minutes, they went to the desk to inquire about how much longer it would be. Each time, the answer was the same: “The doctor is running behind. Have a seat, and they’ll be out shortly.”
“The terms ‘shortly,’ ‘in a minute,’ or ‘soon’ are too vague and are open for interpretation,” Wilkins advises.
The wait became two hours. “Had we been told at check in that they were running that far behind, we would have rescheduled for another day,” Wilkins says. At the very least, all waiting patients would have known what to expect. “Due to this experience, no one in my family sees this provider any longer due to the lack of communication,” Wilkins adds.
Recently, Bagwill was working alongside the registration specialist at the triage desk in an ED. “One of the triage nurses gave a beautiful duration to a patient,” Bagwill recalls. There were several patients in the waiting room, and the ED was full. The nurse explained to the patient as she was taking the patient to the waiting room from triage, “My average wait right now is about an hour and 45 minutes. Our goal is to get you back sooner, but that’s what it is right now.” After a bit of initial shock, the patient decided to stay.
“Can you imagine if the patient had not been warned they may have to wait nearly two hours?” Bagwill wonders. If the patient had waited only one hour, the patient still might have been upset, even though it was half the original expected wait time. “In settings like the ED, when patients get frustrated by long wait times, they may just leave. That isn’t ideal for anybody,” Bagwill says.
Sometimes, satisfaction comes from choosing a certain word. Instead of saying “hopefully” or “probably,” registrars say “It is my goal to” or “I strive for.”
“When a patient hears the words ‘hopefully’ or ‘probably,’ they tend to get a little more anxious,” Wilkins explains. “We encourage staff to use terms to help instill confidence.”
Instead of saying, “We’re really busy,” registrars say, “There is a 30-minute delay today. Can I get you anything while you wait?” Next, registrars offer to show patients the nearest restrooms or water fountain. Registrars add, “I apologize there was a delay. What questions can I help answer for you?”
“It is not only unprofessional to tell someone you are too busy to help them. It is also disrespectful,” Wilkins says.