Every patient access leader wants impressive satisfaction scores to share with hospital leadership. But unlike clinical areas, they face a daunting obstacle. Most people do not quite comprehend the patient access role, which encompasses registration, scheduling, and more, all conducted in many hospital settings. For this reason, Press Ganey survey results can be somewhat misleading.
“Patients often are not equating registration to a tangible service we are providing to enhance their visit,” explains Tiffanie Ball, patient access director at Rochester (NY) Regional Health (RRH). Patient access addressed this problem in several ways:
• All registration staff now wear blue scrub tops. “We purposely picked a color very different from what clinicians are wearing, so they stand out,” Ball says, noting this is a practice at all four hospitals in the RRH system. “This helps people to connect the job of patient access with the questions on the Press Ganey survey.”
• Staff use words similar to the survey questions. The department began to focus on the patient experience several years ago. At that time, RRH Press Ganey scores were much lower, despite registrars giving good service. “We attributed this to patients not truly understanding which group was indicated in these questions,” Ball notes.
The questions ask about “courtesy of the registration team member,” “ease of giving your personal insurance information,” and “privacy during giving personal insurance information.”
Patient access leaders worked on scripting to help patients connect the helpful registrars with whom they interacted to these survey questions. “Having team members utilize the same verbiage as the questions aided in raising our score,” Ball says.
For instance, staff state, “My name is Tiffanie. I’m going to complete your registration and update your demographics and personal insurance information.” Ball says this message is uniform across the four RRH hospitals.
Sometimes, patients marked a low score on the question about whether the hospital provided privacy, without completely realizing what that means. Registrars in the ED state, “I’m going to close this curtain so the information you provide is private.” The hope is that people will remember their privacy was respected when they complete the survey question on this point.
A barrier to satisfaction in a hospital’s busy ED involves timing. Many people are highly stressed and sometimes in pain when the registrar approaches. If registrars notice this, they say, “I see you are not feeling well. I can come back at a later time.” This approach stresses the “courtesy” mentioned in the survey. “[Registrars] can come back in 10 or 20 minutes instead of forcing the registration at that time,” Ball says.
Press Ganey scores are very important to the RRH organization. However, these scores do not tell the full story about patient access. For this reason, RRH’s patient access leaders created their own targeted survey for patients to complete right away using these questions:
- How friendly was the person completing your registration?
- Did they ask you for your primary care physician and update if it had changed?
- Did they explain the documentation you signed? Did you receive the Bill of Rights?
- Did they ask for your insurance card? If applicable, how did they ask for or inform you of your copayment?
- How would you rate your interaction with registration on a scale of 1 to 5?
Patients can hand the short survey to anyone wearing blue scrubs or drop their responses into a box as they leave the hospital. Patient access leadership has found this particularly helpful if satisfaction scores are dipping in a certain registration area.
Sometimes, Press Ganey scores are much lower than expected. RRH’s custom surveys help clarify what is really happening. “We have found those scores are much higher than our Press Ganey scores,” Ball reports. There is growing awareness that the first impression at registration sticks with a person throughout their entire hospital encounter. This realization is of great importance to patient access.
“For every patient, regardless of what service line they are seeing, patient access is going to be part of their visit,” Ball notes. The repercussions of registration, whether positive or negative, stick with people. “Ensuring this team is engaged in providing the best patient experience is how we are able to maintain a healthy system,” Ball says.
Traditionally, when hospital leaders thought about patient satisfaction, medical outcomes were top of mind. Registration was not considered at all. “Historically, when we thought of patient experience, we discussed the clinical care our patient was receiving,” Ball explains.
With the greatly expanded role of patient access, the idea of what patient satisfaction covers also has expanded. The problem is that most of the biggest dissatisfiers are unavoidable. One of these is wait times. Even the best possible planning, adequate staffing, and great training cannot change the inevitability of waiting. Of course, service delays and other unplanned events can exacerbate this reality. In this all-too-common situation, Ball says it is often the little things that count. “We have incorporated rounding in our waiting areas,” she reports. Registrars ask two questions: “How are things going?” and “Is there anything I can do for you right now?”
Receiving a blanket in a cold waiting area or a glass of water (registrars check with clinicians first to be sure it is medically permissible) can help patients feel they are not forgotten.
Calling attention to hard-won evidence that patient access at RRH is handling the patient experience well is an absolute must. “We huddle daily with our group around our visual management board,” Ball says. Key Performance Indicators are the main topic of discussion, with a strong emphasis on satisfaction. The latest scores are posted in the department so everyone is keenly aware where things stand. However, the process does not stop there.
“We then do a look back and discuss actions that aided in higher scores,” Ball explains. “For the times that we fell short, we are able to identify barriers that may have hindered our goal.”
High Press Ganey scores do not reach individual registrars, unless someone takes the time to write in comments pertaining to a certain employee. For this reason, great service is spotlighted in other ways. Recently, a patient received an unexpected phone call while awaiting an ED inpatient bed. The call was not from a friend or family member, but from a representative from his health plan. The payer representative warned that the visit could be denied, leaving the patient on the hook for the entire bill. At first, the worried patient was inclined to leave the ED, but a quick-thinking registrar intervened.
First, the registrar assured the patient she would look into his situation immediately. She consulted with the billing department, then came back to the waiting patient. The registrar explained that even if there was a denial, which was by no means certain, the hospital would intervene on the patient’s behalf. She added that the hospital had successfully overturned other similar denials.
“The patient was very grateful that the registration staff member took the time to explain what the hospital would do to validate why the patient was there,” says Ball, who used the registrar as an example of excellent service at the next staff meeting.
When patient access leaders wish to recognize a registrar who went above and beyond, they do not have to guess what the employee really wants. Each registrar completes an “About Me” form with these specifics. Some want to keep things low key during staff meetings. For these employees, leaders tell the story of their fantastic service without giving away their name. Others really love coffee and receive a $5 gift card to a local donut shop.
The constant emphasis on great service helps with morale. In patient access, says Ball, “we talk a lot about point-of-service collections and denials. This pulls us away a little from the money part of healthcare. It paints a picture: What we do matters to people.”