Charged with developing a registration process for the new NewYork-Presbyterian David H. Koch Center in New York City, Brenda Sauer, RN, MA, CHAM, FHAM, kept customer service top of mind.
She created an important and ambitious new role: patient ambassador. These employees, wearing distinctive grey suits and white shirts, are the first people arriving patients see. “No longer is the person going to see a registrar, because we are not checking in at a desk,” says Sauer, director of patient access.
Patients still needed someone to assist them, identify them, and apply arm bands, allowing the patient to proceed upstairs to the clinical areas. The ambassadors do all of this with a friendly, welcoming demeanor. Twenty-eight people were hired for this new role. About one-third were employees currently working in the patient access department, one-third were hospital employees from other departments, and one-third came from outside the hospital. The mix was intentional. “When you start something new like this, having some new blood come in provides for a better team,” Sauer explains.
For registrars, the ambassador role was a promotion on the same level as senior registrar. The job requires top-notch customer service skills, problem-solving, and standing for long periods. A typical encounter unfolds thusly:
- When patients enter the building, they are greeted by the patient ambassador and directed to the kiosk. “The ambassador is right there if they have a question or get stuck,” Sauer says. Patients ask questions about the documents they are signing, want printed copies of the forms, struggle with moving to the next screen, or need a wheelchair.
- Once the patient is checked in, the ambassador verifies the patient’s identity, places an arm band, and asks for a cellphone number for text updates.
Some wonder whose number they should give (usually, the cellphone of whoever came with the patient, so that person can go eat without having to wait around for hours).
A second ambassador is stationed upstairs, and offers a greeting and directions to anyone coming off the elevator.
“The expectation is that they know the building inside and out. They also know the hours to restaurants and what’s open when,” Sauer notes. Most people have become comfortable with the new process. However, at first, some seemed overwhelmed with the spacious building. Some patients wanted to go straight to their service area as they normally did, and asked, “Why do I have to check in here?” The ambassadors cheerfully explained that the process for check-in was centralized. “It doesn’t please everybody, but now that we’ve been open for a year, patients have gotten used to it,” Sauer says.
That has happened much more quickly for frequent patients, such as those who come to the radiation oncology department every day. “They have developed relationships with the ambassador. They make a point of greeting these patients by name,” Sauer says.
Ambassadors offer casual, friendly remarks such as, “Mrs. Jones, it’s good to see you again. Let’s get you checked in and on your way as soon as possible.”
“The level of customer service is very high,” Sauer reports.
The ambassadors are highly satisfied, too. Alexander La Salle says, “It brings me joy to see a patient whose health may not be the greatest before treatment, but weeks down the line when all is complete they leave looking and feeling better than when they walked in.” Another ambassador, Nashira Guerrero Duarte, says the role’s meaning goes deeper than just assisting with check-in: “My day-to-day goal is to be a new friend, and make things easier and pleasant for patients.”
This patient-centric mindset is reflected on PressGaney and Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores. These surveys ask questions such as “Were you greeted when you came in?” “Did you feel welcome?” and “What was the ease of check-in?”
Previously, patients did not always connect all these interactions, which happened during preregistration calls, at registration areas, and on the date of service, with these specific questions. Since the ambassadors handle all the things the surveys ask about, it is easier now for patients to make those connections. “We always score very high on those,” Sauer reports.
Family members who want to know the best place to find a latte during off-hours really appreciate the “concierge” feeling. “You take away that cold, ‘nobody cares about me’ feeling. People see, ‘Somebody is watching out for me,’” Sauer offers.
For ambassadors, the challenge is to convey that feeling in a short period. “It’s a 30-second connection. They need to instantly connect with the patient,” Sauer notes.
When it comes to the ability to make people feel welcomed, ambassadors are held to a high standard: That of a five-star hotel. “In a nice hotel, everybody greets you,” Sauer observes. “That’s the experience that I want patients to have when they walk into the building.”
One of the first concerns when creating the new check-in process was how to avoid gridlock. “We needed to arrive our patients as expeditiously as possible so they wouldn’t be milling around in the lobby,” Sauer recalls.
A decision was made to set up self-check in, using a kiosk. “But in order to do that, we had to have all of our patients preregistered,” Sauer says.
Now, 99% of patients who come through the ambulatory care center are preregistered. “That can be something as simple as putting them on the schedule, and then we just check them in in the lobby,” Sauer explains.
Each service area had to ensure their patients all are preregistered prior to the patient coming into the building. Some physicians were in the habit of telling their patients directly to just come in, bypassing the usual process. The doctor does not tell anyone, so the patient is not scheduled.
“They’ll show up at the front door, and we can’t find them in the system. But we have a process in place where we can just add them on, and get them upstairs,” Sauer says.
Most service areas were preregistering most of their patients already. “We just needed to get them to do it all of the time,” Sauer adds.
Patient access leaders explained the reasoning behind it. “A little information goes a long way,” Sauer says. Administrative staff and clinicians realized that the new process was far more efficient. Since patients are in the system already, there are no delays. “They can go ahead and document. They can do the things they need to do,” Sauer says.
Staff in the clinical service areas now have less to do. No longer do they check patients in, secure signed documents, or place arm bands. “My staff took over that process for them,” Sauer explains.
When the center first opened, average check-in time was about three or four minutes. “We are now down to about 90 seconds,” Sauer reports. “Not only have our staff learned the process, most of our patients have, too.”
Some physician practices in the health system used kiosks, but this was the patient access department’s first experience with them. One major concern was the five different registration systems used to check patients in at various hospital areas. “We needed a system that would be able to talk to all of the downstream systems,” Sauer says.
The ambulatory care center covers multiple different services, not just ambulatory surgery and endoscopy but also the infusion center, radiation oncology, and the GI physician practices. The kiosks now send information to all these registration systems. Patient access worked closely with IT to achieve this. “We told them, ‘This is the vision. We need to get from here to there,’” Sauer recalls. “And they did it.”