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Obtaining race, ethnicity, and language data at registration is for patients’ benefit. It is a way to identify the population the hospital serves, compare outcomes, and find areas that need improvement.
“Most importantly, we ask because we care. We strive to provide the same level of care for all of our patients,” says Pam Masters, MSHS, senior director of the scheduling center at Cincinnati (OH) Children’s Hospital Medical Center. Here, patient access leaders at diverse hospitals share their best processes:
At Cincinnati Children’s, “training is the most important tool,” Masters says. Schedulers and registrars are informed on how the data are used to improve care. Making it a part of their normal routine is a clear expectation. “We do have a robust auditing process for scheduling and registration staff, and these data fields are included,” Masters notes.
Registrars do receive occasional push-back from parents. “That’s definitely the No. 1 challenge,” Masters reports.
Staff engage in mock calls and role-playing exercises to respond in a clear and compassionate way. Either of these sample responses are used if families seem apprehensive about answering:
At Cooper University Hospital in Camden, NJ, trainers hold sessions for registrars specifically on why race and ethnicity data are needed. “In addition, they are familiarized with how they could answer patients’ questions, should the need arise,” says Pamela Konowall, CHAM, assistant director of healthcare access.
Trainers inform participants that New Jersey ranks as one of the most ethnically diverse states in the country. “Registrars are reminded that it is their responsibility to collect accurate registration information,” Konowall reports. This includes race and ethnicity data. “It’s explained to the registrars that the information that is collected is considered meaningful information that is used by clinicians to assist in determining patients’ risks for contracting illness and the best treatment,” Konowall explains.
The data also are used to assist hospitals across the state in giving all patients high-quality care. “The importance of collecting this information was reiterated,” Konowall says.
The data collected are the only way to identify the patient population that is treated. In turn, the data can measure quality, safety, and discrepancies in care. “This information is clear documentation of patient populations that are treated in the facility,” Konowall says.
Trainers review how to ask the questions, and how to explain why the information is needed “The registrars are able to respond with ease,” Konowall notes.
Registrars state, “We use the data to identify differences that may exist for quality of care, identify patients’ risks for developing health conditions, and create programs and services to provide quality care.”
At Augusta Health in Fishersville, VA, registrars ask, “Which best describes you as a person?” Then, registrars offer a list of options, and enter the patient’s response. “The vast majority of patients will easily provide answers by asking in this manner,” says Dolly Ellis, director of patient access.
Some people do ask why the information is needed. Registrars simply explain that it is used for safety and quality purposes. “Once we’ve stated the reason, it is rare for a patient to pursue additional questions,” Ellis reports.
At Rochester (NY) Regional Health System, registrars print a form with a checklist so patients can self-report the information. “We collect the information to plan quality improvement initiatives, to better understand patient demographics, and ensure adequate interpreter services,” says Tiffanie Ball, patient access director.
Staff use this scripting: “Our goal is to ensure all patients receive the best care possible. We would like you to tell us your racial/ethnic background and preferred language so we can meet your needs.” “This can often be a sensitive subject,” Ball acknowledges. “The first thing we address with our staff is challenging assumptions.”
Many registrars believe they can answer the questions themselves, based on patients’ appearance. The patient access department found a creative way to dispel this misconception.
During a recent in-service, staff viewed photos of 10 different patients. Managers asked them to identify the race and ethnicity of each person. “Many were shocked when they were wrong,” Ball says. “This exercise really helped iterate the importance in self-reporting.”