Successful patient access employees have two things in common: A customer-friendly mindset and plenty of compassion. “These attributes help us to provide excellent care and service. But it can also lead to burnout,” says Christina Harney, vice president of access management at Indiana University Health.

Usually, registrars are the first people who worried, anxious patients encounter. “Bearing others’ burdens in a fast-paced, rapidly changing environment takes a toll on those who are committed to delivering a high-quality patient experience,” Harney notes.

Patient access staff struggle with constantly changing health plan requirements and coverage options. “The pace of change is amplified by the significant number of changes. There are also new responsibilities resulting from the pandemic,” Harney observes.

Hospitals continue to devote many resources to combating burnout among nurses and doctors.1 “However, one cohort of healthcare employees they might not have thought of are those who work in patient access,” says Scott Andrews, chief customer officer at Kyruus.

Although the problem of burnout in healthcare is well-known, the focus remains mostly on clinical areas. “The tide is changing on this front,” Andrews observes. “Leaders are taking steps to address burnout across their organizations, not just with clinical staff.”

As manager of a 900-person call center, Andrews saw many staff suffering from burnout after dealing with constant stressful interactions. Perpetual upheaval during the COVID-19 pandemic has only exacerbated this problem.

“Priorities change on a daily or even hourly basis. Testing locations are updated, vaccine protocols evolve, procedures are canceled or rescheduled,” Andrews explains.

Andrews suggests leaders find some creative ways to help registrars de-stress in their daily jobs. One way is by holding walking meetings (in-person or remote) instead of sit-downs.

“This is a great way to get some exercise and break up the monotony of the day,” Andrews suggests.

As the first contact point when people enter the building, the patient access team at Grand Rapids, MI-based Spectrum Health “has definitely taken the brunt of the feedback about visitor restrictions and mask requirements,” says Mallory McKnight, a patient access manager at Spectrum.

Patient access staff are uniquely at risk for burnout, says McKnight, “given the volume of patient interactions they have, and how often they’re asked to deliver news that the patient might not want to hear.”

Burnout creates a real problem for staffing in registration areas. Burned out staff are more likely to call in sick, refuse to pick up additional shifts, or leave the organization entirely.

McKnight looks for these red flags: Sustained dips in quality or productivity, resistance to feedback or change, sharp tones when interacting with patients or co-workers, and changes in the level of customer service. More often, staff are making comments like: “I feel like everything is constantly changing and I can’t keep up.”

“Making yourself available for conversations with your team is crucial so you can build rapport and adjust before staff burnout,” McKnight says.

At Indiana University Health, burnout is becoming more apparent in patient access staff. “Some of the red flags we’ve seen include increasing use of leaves and absenteeism, and more complaints to our leaders,” Harney reports. These are a few ways the patient access department is addressing burnout:

• For existing staff: Some staff experienced burnout because they felt stuck in their roles, with no chance to move up. The next step in their career was unclear and seemed too complicated to attain. A new patient access career progression map offers staff the chance to advance to newly created senior and expert roles. “It identifies achievable next steps,” Harney explains.

The department has seen a 24% reduction in first-year turnover from 2019 to 2020.

• Before staff are hired: Poor fits for the department are more likely to end up with burnout. To hire the best possible fit, managers use an empathy- and values-based interview process. “This assesses whether someone is a good match for our team,” Harney says.

The interviewer plays the part of a nervous patient registering for an MRI. “It provides a glimpse of how the candidate will connect with actual patients,” Harney says. Ideally, the candidates provide reassurance that the radiology technician will provide great care.

• Shortly after staff are hired: Leaders make a habit of starting impromptu chats with new team members. The ratio of engaged to disengaged team members has markedly improved (from 3:1 to 4.5:1) in the past year. “It’s important that patient access leaders know team members well enough to connect with them in meaningful ways,” Harney offers.

The department also reduced the team member-to-manager ratio in patient access teams (from 50:1 to less than 30:1). Since leaders know team members well, they quickly pick up on behavior changes, such as uncharacteristic lateness or someone appearing depressed.

“We’ve empowered leaders to humbly approach team members to ask potentially awkward questions in the spirit of caring well for each other,” Harney reports.

Leaders ask: How is your work/life balance? How are you doing on a personal level? What is something I can do to better support you? “We have seen important work and personal issues raised that might otherwise have gone under the radar,” Harney adds.


  1. Schmidt A. We need to talk about burnout the same way we talk about benefits. American Hospital Association. Oct. 20, 2020.