Patient access staff are reallocated as needed at Montefiore Nyack (NY) Hospital — but only if they are equipped with the necessary skill sets. “It is not wise to simply move someone to another location if they have not been previously exposed to the area,” says Patient Access Services Manager Jason Guardado.

“Cross-functioning” is the term of choice at Texas Scottish Rite Hospital for Children in Dallas. “All too often, you see cross-training being a skill set that is only called on in times of need,” says Patient Access Director Mike Potter.

Short-staffed registration areas are the most obvious example. Registrars call out sick or are out on FMLA. Suddenly, volumes surge. “You then ask your cross-trained team members to dust off their manuals and do their best,” Potter says. Sometimes, this is successful; other times, it is not. The department decided to take a new approach by creating cross-functioning roles that are used all the time. This mirrors the “schedgistration” process used by some departments, which combines registration and scheduling. “One patient access member is used in multiple traditional roles without the concern of rarely used cross-training skills,” Potter explains.

Typically, registrars become experts in their particular area, whether radiology, clinics, or ancillary services. “Certain rules may only apply to that unit,” Potter notes.

Accurate registration is not enough to be successful. The registrar has to remember the nuances — and these apply only to a certain area. However, this has changed.

“We have worked with the leadership of many areas to streamline and standardize as many of the registration steps as possible,” Potter reports. This increases quality and efficiency.

The department also created competency checklists for every role. “As new duties and tasks are assigned, we train our teams and add the competency to the list,” Potter says.

These differ for every role. For instance, calculating adjustments to patients’ out-of-pocket costs are part of a financial counselor’s responsibility. Registration does not perform this function.

“We take a lot of time training on the competencies. We do not let an employee operate on their own without full signoff,” Potter says. Any staff member who floats between areas is required to complete the competency for each area. The checklists cover such tasks as scheduling follow-up visits, adding and removing coverage, updating demographics, and checking referral needs. “These differ from role to role, and we have one for each,” Potter explains.

Both the leader and the staff member sign off that they fully understand the requirements. “Any staff member who floats between areas is required to complete the competency for each area,” Potter says.

Generally, patient satisfaction is above 95%. Registration wait times are under three minutes. “Much of our success is due to the cross-functioning staff,” Potter observes.

Also, morale is noticeably higher. “Our employee engagement is measured and reported internally. Our department metrics surpass the benchmarks provided by the vendor,” Potter notes. Since cross-functioning registrars know the big picture of how their role affects the entire team, they know the “why” behind their tasks. “It also gives staff the ability to complete tasks on their own, with less of a need to ‘punt’ tasks to other areas for completion,” Potter says.

The department’s error rate, tracked by an internal QA process, has decreased significantly. “When there are fewer errors, you have happier downstream departments, happier patients, and happier employees,” Potter adds.