Low pay, high stress, working holidays and weekends — these are good reasons for poor retention rates in the revenue cycle. Still, some departments have found ways to combat the problem.

“We’ve made some really great headway with morale and turnover,” says Whitney Benedict, MHA, CRCR, senior director of contact centers, authorizations, referral management, and scheduling at Spectrum Health in Grand Rapids, MI.

Front-end staff received the chance for advancement and higher-paid positions. In late 2020, the patient access service center implemented a career ladder that designates positions as follows: associate positions handle inbound calls, outbound work queues, and scheduling referrals; intermediate positions handle daily management of providers’ schedules and reschedules; senior positions handle complex specialty tasks for service lines and provide support to other staff; and lead positions handle training and are responsible for daily metrics for process improvement efforts.

Staff are cross-trained, but only to work in similar areas. “It was cross-training burnout. Staff said they felt like a jack of all trades and master of none,” Benedict reports.

Cross-trained staff working in areas totally unfamiliar to them resulted in high error rates in 2019. For instance, the workflows of primary care and radiology or endoscopy and primary care are entirely different. As a result, some patients were not prepped for tests correctly. Others were sent to the wrong provider, wrong location, or scheduled for the incorrect test.

Staff were upset about the mistakes and asked for more expertise in their registration areas. “We re-engineered the access center to be more clinical service line-specific,” Benedict explains.

Patient access completely revamped the way they performed cross-training. Staff still cover other registration areas, but only if they are clinically similar to the employee’s regular area. “It’s a delicate balance,” Benedict notes.

For instance, a radiology scheduler can schedule “low-tech modalities,” such as mammography, ultrasounds, or bone density scans. Once those skills are mastered, the scheduler can move up and train in “high-tech” radiology. “These are areas of high complexity with safety protocols,” Benedict says. “For instance, staff need to coordinate with anesthesia for tests requiring sedation.”

Leaders gave registration teams a sense of purpose. The COVID-19 pandemic provided some unexpected lessons in boosting retention. One newly formed team has reported high morale — the 103 employees who are charged with scheduling COVID-19 screening appointments with physicians, COVID-19 testing, and COVID-19 vaccination appointments for employees.

Radiology schedulers received a similar morale boost when they had to redouble their efforts to reschedule thousands of patients waiting for diagnostic tests that had been canceled when the pandemic started. “Our schedulers were very concerned about patients who had high-risk symptoms and were going undiagnosed,” Benedict says.

Morale is high, even though the schedulers had to work much harder. Both of these high-morale teams had something in common: a sense of purpose. “They see their role is connected with the health and wellness of the community,” Benedict observes.

Staff can work from home. Previously, patient access lost some staff to billing positions. Pay was a little higher, and there was a chance to work at home. That kind of turnover is not happening any longer since the front end now is fully remote.

Of 550 staff, all but a handful work from home full time. Previously, only about 40% of staff at 12 locations worked remotely. “We are having conversations now on keeping people working at home going forward,” Benedict says.

Patient access staff complete satisfaction surveys quarterly. The most recent survey included a new question: What are you grateful for at Spectrum Health?

Surprisingly, most named working at home. Staff described all sorts of reasons, ranging from child care to health concerns. “That’s our biggest recruitment and retention strategy right now,” Benedict says.

Potential new hires ask specifically if they can work from home. Some even call to ask if they can work from other cities or states, something leaders are exploring. Meanwhile, remote staff are kept connected, busy, and able to advance. Turnover has plummeted from a high of over 30% to less than 10%.

At Hartford-based Connecticut Children’s, leaders developed a patient access career ladder to improve retention. “We try our best to keep our employees within our teams — or at least within our organization,” says Jessica Budri, RN, MSN, APRN, director of patient access.

The ladder includes Associate I, II, II and team lead, and assistant manager positions. Staff have to meet various criteria to advance, such as earning a CHAA certification or joining a hospital finance committee. Once staff pass their CHAA (or CHAM), the department reimburses for the cost of the exam.

In terms of advancement, staff are not left to figure it all out themselves. “We invite team members in their quarterly one-on-ones to share with us their career goals or education they are working to obtain,” Budri says.

Some employees who are in nursing school ask to be connected with HR when the time is right to move on to a nursing position. Other times, patient access leaders connect the employee to HR to see if there are any open positions that would be a good fit.

Some team members are working on their bachelor’s or master’s degrees and want to explore other jobs in healthcare. “We allow them to shadow or talk to other team members in those positions,” Budri says. Even if an employee leaves patient access, he or she might stay within the organization. For those who stay in patient access, they can expect more personalized attention from managers.

Before the COVID-19 pandemic, the department planned to do this in person, but shifted to virtual acknowledgement. A staff-led engagement committee was formed, which votes on the top three employees of the month. Their pictures are published in the newsletter, they earn a gift card, and they receive a handwritten note from their direct leaders.

To give staff even more of a personal connection, Budri started director “open office” hours in an informal group setting. Staff receive an invite to click on the link if they want to join. “I do not have an agenda or presentation, but rather invite them to share their concerns, ideas, or anything they want with me,” Budri says.