Real-Time De-Escalation: Patients Leave Registration Happier
A loud outburst, tirade, or complaint coming from a registration area can stem from many things. High balances, long wait times, bad insurance coverage are among them. Maybe someone is just fearful of the MRI machine. There are countless reasons for misplaced anger directed at registrars, but all have one thing in common, says Angelina Anderson, team lead for patient access at Springfield, MO-based CoxHealth. “Everyone wants the same thing: to be heard.”
No matter what caused the problem, there is no reason someone has to leave the department upset.
“All the patient’s frustrations can be turned around in a moment,” Anderson says.
The moment a patient expresses any kind of dissatisfaction, Anderson says she listens to hear, not to respond. Further, Anderson assures the patient that she will take the appropriate steps to follow through with the issue.
“It is easy to feel the need to have your guard up,” Anderson says. “It is natural to want to defend yourself, co-workers, or facility.” Faced with an unhappy person, registrars stop and ask themselves: If this was my family, how would I feel about the situation? “That is how we can truly be the best for those who need us,” Anderson offers.
De-escalating techniques can work wonders for registrars; even better is a preventive approach. CoxHealth’s registrars work hard to prevent patients from ever growing irritated in the first place.
“I ask staff to pay attention to what they see in the lobby and what patients are saying,” Anderson explains. If someone is coughing, staff offer water. If someone says he or she is cold, staff offer a heated blanket. If children are growing restless, staff put out coloring books.
Registrars at Ochsner Medical Center’s ED make rounds in the lobby to update people on what to expect next. They start at 9:00 a.m., around the time when the ED starts getting busy. “The registrar introduces themselves to the patient and apologizes for any long wait times,” says Monica James-Harper, patient access manager at Ochsner Medical Center’s ED and North Campus clinics. The registrar ends by saying, “If there is anything I can do to assist, please don’t hesitate to ask.”
Patients almost always want to know: “How many people are before me?” Other frequent concerns: “Can I have something to eat?” “Can you please get me a blanket?” “Do I have time to go outside to smoke a cigarette?” Registrars explain that diagnostic testing might be needed, so no eating or drinking is allowed until the patient is evaluated by a physician. However, staff offer to confirm this with triage nurses. If the clinical team says it is OK for the patient to eat or drink, the registrar provides food and/or water.
If patients ask for pain medicine, need help going to the restroom, or express any medical concerns, the registrar escalates the request to the ED technician who works side by side with the triage nurses. This keeps people from feeling forgotten. “It also helps resolve any unasked questions the patient may have,” James-Harper adds.
Providing estimated wait times can defuse tension stemming from the unknown. When a patient checks in, registrars eyeball the number of other patients who arrived ahead of him or her, note how many registrars are working, and factor the estimated time to register each (five to eight minutes).
“We normally tell the patient it will be about 10 minutes to get to registration,” says Karla Dennis, patient access team lead at Cox Medical Center Branson (MO). Then, the registrar offers the patient an approximate amount of time (usually five minutes) before the laboratory technician will arrive. Registrars often hesitate to involve higher-ups if they believe they can handle the tense situation on their own. Dennis disagrees with this approach. “After the fact, you may think the situation has been handled, but it can be brought back up,” she argues.
Keeping managers or supervisors in the loop about what happened while it is still fresh in the registrar’s mind is best. This means nobody is blindsided at a later date by a written complaint about which no one can recall the specifics. “Be solution-minded,” Dennis recommends.
She asks two questions: How can we resolve this matter? How can we make the patient happier than when the issue first began? Outpatient registrars clean and disinfect lobby furniture every hour. While doing so, they ask everyone waiting, regardless of whether they are patient, if they need anything such as water, a blanket, or to check on a family member or find out a wait time. “This eases the tension of being in a hospital,” Dennis notes.
Finding out what led up to the complaint is important. “Sometimes, we pass the patient off to the next area or person without getting the entire story when we could have eliminated the issue altogether,” Dennis says.
Why Are Patients So Angry?
Karla Dennis, patient access team lead at Cox Medical Center Branson (MO), says these are the most common reasons why patients are angry:
- Wait times;
- The provider forgot to place the order in the patient’s chart;
- A registrar was unfriendly or unsmiling with a poor attitude;
- A registrar cannot answer a billing question;
- A registrar cannot direct the patient to a doctor or area of the hospital;
- The scheduler provided an incorrect date for a procedure;
- Finding out a procedure must be rescheduled because insurance authorization was not obtained.
There are countless reasons for misplaced anger directed at registrars, but all have one thing in common: Everyone just wants to be heard.
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