The patient experience is a priority for hospitals, but typical patient satisfaction surveys are not much help to revenue cycle departments.
“Lumping staff into a single bucket makes it easy to identify overall trends of a department. But it is very difficult to identify individual staff opportunities or strengths,” says Ralene Cosby, corporate patient access director at Brookwood Baptist Health.
Surveys usually do not reveal which registrar is responsible for the patient’s impression. Also, some respond to every other question in the survey, but leave the registration-related question blank for some reason. “That counts as a negative, since it is counted as the lack of a positive,” Cosby notes. It is impossible to know why the person left the question blank, which skews data.
To better understand the patient experience, registrars hand out “Please tell my manager how I did” cards. The idea is to encourage patients to respond right after, or even during, their registration experience.
“Getting an immediate response allows us to recognize staff for positive experiences quickly, as well as address opportunities timely with specific examples,” Cosby says.
Patients in all registration areas except the ED fill out the cards. “The workflow in the ED is not as straightforward due to EMTALA, as well as our policy for the initial interaction to be with the triage nurse. That currently makes it difficult to offer the cards,” Cosby explains.
The cards include questions about registrars’ posture, demeanor, and tone of voice, along with more open-ended queries about what else could have happened to make the experience better. Hundreds of patients have completed the cards. “The comments section is the greatest source of genuine feedback,” Cosby says. The department uses the comment cards several ways:
• Responses are shared with all patient access personnel to model positive behavior expectations. “We utilize scripting with specific scenarios, as well as role-playing between experienced team members and leadership,” Cosby says.
• Staff who receive good responses are recognized with an extra 10-minute break. Staff who are rated poorly engage in a one-on-one conversation with a leader to discuss how the situation should have been handled. “We have found this to be exceptionally helpful, with a quick turnaround for positive behaviors,” Cosby reports.
• Comments are shared with other departments (ED nursing, outpatient therapy, or radiology) that are in some way involved in the patient interaction.
Although the department uses the comments to improve the way it handles challenging situations, some patients complain about things that are outside the control of patient access. “However, we still must respond in an appropriate and professional manner,” Cosby notes.
Patients with high out-of-pocket costs or long waits after registration believe patient access has failed them. “Some people claim that they were never contacted by anyone about a high deductible, when in fact many attempts were made by staff,” Cosby reports.
Nevertheless, perception of registration is important, regardless of the facts of what happened or who was to blame. “It transforms the dynamic of ‘us vs. them’ to ‘How can I help this patient transform their experience?’” Cosby explains.
Some negative comments showed a need for de-escalation coaching. Staff use this scripting: “I can certainly understand being frustrated in this situation.” In the end, many patients just want to be heard, without managers punishing staff.
At Sentara Healthcare’s 12 hospitals, patients receive a short questionnaire in registration areas. Registrars say, “This is a survey on how your visit was today at registration. If you could take a minute, fill it out, and drop it into one of our convenient boxes, we would really appreciate your feedback.”
“If they fill it out, it is entered into the system, and we get a printout at the end of each month,” says Mike M. Harkins, CHAM, director of registration at Sentara Leigh Hospital, Sentara Norfolk General, and Sentara Virginia Beach General Hospital.
The survey gives patients a chance to write in some comments. These are tracked in two basic categories: “good stuff” and “bad stuff.” One patient said the registrar “was very kind and explained everything during registration.” Another said the registrar “walked me to X-ray, with a pleasant personality and very good conversation as we walked.”
The compliments far outweigh the criticisms, which usually concern patients’ long wait times. “The monthly report is shared with all staff and administration. If a person is named specifically, we post that in the departments,” Harkins says.