When registering patients at 3 a.m., pizza parties are hard to come by. So is face time with supervisors, who just might explain an important change in payer requirements, something the day shift already knows all about. “Our reps work 12-hour shifts. This makes it a little easier to get them to attend staff meetings and for me to see them,” says Vanessa Gordon Lewis, MBA, CHAM, manager of patient registration at Sarasota (FL) Memorial Health Care System.

Gordon Lewis makes it clear she is always available for urgent issues day or night. However, she also makes herself available a few times a month when the night team comes on shift. Previously, the night shift missed out on staff meetings, but this has changed.

“We schedule two staff meetings in the evening. This way, the night team can attend either one,” Gordon Lewis reports. Some meetings are at 5 p.m., while others start at 6 p.m. If a registrar is scheduled to work that night, the expectation is that he or she will attend the earlier meeting. “That way, they can still be ready for the start of their shifts,” Gordon Lewis notes.

At a previous hospital, employees worked eight-hour shifts, with the night shift beginning at midnight. “We had huddles at the beginning of each shift so no one felt left out,” Gordon Lewis recalls. “This boosted morale.”

Usually, staff ask questions about new processes and need clarification — not the following day, but immediately. Other times, staff raise issues they want to bring directly to a manager in person instead of by email.

Maintaining availability at midnight was a challenge for day managers.

“However, I’ve learned that if [employees] feel there is someone available to them and they see you often, it helps,” Gordon Lewis says.

At Maine Medical Center in Portland, “we have done several things to support our overnight team,” says Patient Access Manager Patty A. Johnson, CHAM.

First, a supervisor was hired specifically to work the night shift. “We changed the schedule to allow all overnight team members to arrive and leave at the same time,” Johnson explains. The employees arrive earlier so that a huddle can take place with all team members. The new shift was changed to a 4:45 p.m-5:15 a.m. window.

“Before, shifts were staggered,” Johnson recalls. “We actually changed the entire team so that we only have four shifts now.” The other three shifts are 5 a.m. to 5:30 p.m., 9 a.m. to 9:30 p.m., and noon to 12:30 a.m. “The overnight team loves getting in earlier to help the team during our peak time,” Johnson adds.

The huddle happens every day at 4:45 p.m., which is right at the start of the night shift. Employees from both the day and evening shifts attend. “We review all communication at that time,” Johnson says.

Monthly team meetings, lead meetings, and Key Performance Indicator meetings are scheduled during the overnight shift. As for clinical huddles, the day staff attend theirs at 7:30 a.m. This helped bridge the communication gap between clinical areas and patient access. “We get a sense of how the department stands and are informed of any patient issues that may affect us,” Johnson says.

Often, attendance was poor at the 7:00 p.m. clinical huddle. “We’ve made it mandatory for the lead to attend. However, everyone is welcomed,” Johnson notes.

Night shift registrars can communicate concerns to the clinical team to head off problems. “If we are down a team member, we inform the clinical team,” Johnson says. “We let them know to work with us and have the patient registration completed before discharge.”