Want to boost morale? Give more responsibility

Special projects and task forces can ID future leaders

Too often, patient access is an area employees come into only to get their foot in the door with a long-term goal of obtaining other medical positions in the hospital, says Vicki Lyons, patient access manager at Baptist Hospital East in Louisville, KY.

"Since patient access is a very important area and the information gathered is used for billing purposes by doctors' offices, ER billing, and X-ray billing, we do like to have employees that like admitting and do stay for awhile," says Lyons.

"I always say it takes a year to learn all aspects of a patient access specialist. The training is for at least six weeks. It is very discouraging to go through all that training and then hear that someone is leaving to go to another area."

The hospital has a requirement that staff cannot transfer to another area unless they have worked in an area for at least six months, which helps somewhat with retention in patient access.

"We hire a person and hope that they will at least stay for one year," says Lyons. "We hope that it is longer, but if we get that year, we are happy."

However, Katie M. Davis, director of patient financial services at Carolinas Medical Center in Charlotte, NC, says now more than ever, patient access is considered a career path rather than a job until an employee finds something better. "We now have college graduates who are working in our departments with the goal of becoming a patient access professional," she says.

Carolinas offers different levels for registrars who are looking for increased opportunity but without management responsibilities, and also offers programs for individuals who are looking to move into leadership positions.

Give staff new roles

It may seem counterintuitive, but patient access experts recommend giving your staff more to do - in the form of new responsibilities that can make them feel a part of the team - and possibly even motivate a few to switch gears and make a career out of patient access.

Here are criteria for patient access levels

Below are the criteria required for Level I, II, and III at the patient access department at Baptist Hospital East in Louisville, KY:

Patient Access I

1. Basic registrations.

2. Knows all patient access procedures.

3. Excellent customer service.

4. Pre-admits patients.

Patient Access II

1. Has all of the qualifications under Patient Access I.

2. Has good attendance.

3. Makes wise use of time.

4. Takes initiative to get the work completed and asks for more if time permits.

5. Meets quota for pre-admits.

6. Has a good attitude. If there are issues, employee sits down and discusses them in an appropriate manner.

7. Has performed registration functions for at least six months.

8. Answers phone with correct etiquette.

9. Assists others when necessary, and is willing to work extra hours if needed.

10. Error rate has been in the acceptable range for three months.

Patient Access III

1. Has all of the qualifications of Patient Access I and II.

2. Proficient in the ER, front and back.

3. Proficient at front desk.

4. Error rate is acceptable.

5. Willing to work front area, pre-admits, or ER and can do so effectively.

6. Knows Pathways Healthcare Scheduling (PHS).

7. Knows Medicare compliance.

8. Schedule patients in PHS.

9. Proficient at pre-registering patients and meets quota.

10. Urgent care employee - Schedules patients on PHS.

11. Collects deductibles/copays.

12. Is capable of floating to any area and relieves when needed.

13. Is reliable and arrives for work on time and in area to work when scheduled.

14. The third shift (11 p.m.-7 a.m.) can relieve staff in outpatient surgery or at the front desk if someone calls in sick.

15. Third shift - Knows room clerk functions.

16. Good attendance.

In your department, you'll have a range of people - some are below average, some are average, and some are above average but not management material. Then, a very small number of people are very good at their job and seem to have the skills, temperament, and personality to be candidates for possible patient access leaders, says Michael S. Friedberg, FACHE, CHAM, associate vice president of patient access services at Apollo Health Street and author of Staff Competency in Patient Access.

"One of the things I did in the past that was really effective was creating a registration task force," says Friedberg. He notes, however, that he had a very large staff at the time, and this approach would not necessarily work with a smaller patient access department.

Friedberg took a group of registrars and formed a task force to talk about issues within the department and concerns of the staff, with the goal of coming up with some potential solutions. "Once you get past, 'We all want to make $35 and only work two hours a day,' we were able to get into some interesting discussions," he says.

For example, staff discussed items that would improve their work environment, suggestions for process improvement, and talked about what motivates and does not motivate them to work hard.

A number of employees who participated in the task force went on to management roles in patient access, pursued advanced degrees, or went on to different professional careers, says Friedberg. "Some of the things I would point to as the greatest successes in my career are the people I have trained and what they have gone on to do," says Friedberg.

If you want to identify employees with leadership ability, special projects such as this are an excellent way, he says.

This could take the form of a task force to improve employee morale or analyze why claims denials occurred, or even putting someone in charge of decorating the office for the holidays. Some other ideas for task force activities: an evaluation of outside tools and products for patient access, reorganizing the physical layout of the department or the waiting room, or a patient satisfaction committee to allow staff to drive the initiatives for improved customer service.

Involve employees in decisions

Lyons says that she has started trying to get employees involved with different aspects of patient access. "For instance, if we have an issue, we will ask for volunteers to participate and allow them to give input," she says.

For example, when the issue of changing uniforms came up, some employees wanted to change and others did not. "So we asked for volunteers from both viewpoints and had them decide," says Lyons. "The ones on the committee talked with the other employees and took the issues back to the committee. It worked out well, and they even decided on what uniform to go to."

Another example might involve a high error rate in a certain aspect of the registration process, with volunteers coming up with ideas to correct the problem. "I like to involve the employees as much as possible in decisions. Then they feel they have a voice in the decisions that are made and feel more a part of the department," says Lyons.

Don't buy into these myths on patient access staff

Education doesn't mean everything

With turnover in patient access an ongoing problem, you'll want to think creatively to improve morale and use your resources wisely, says Michael S. Friedberg, FACHE, CHAM, associate vice president of patient access services at Apollo Health Street and author of Staff Competency in Patient Access. Here are things to consider:

Myth # 1: Only young staff will want to pursue getting a degree.

When encouraging staff to pursue educational opportunities, consider older workers as well as college-age workers, advises Friedberg. "Typically in patient access, you don't find people who are formally educated. So encourage staff to go back and get their degrees, even if they start with an associate's degree. That is another good way to establish a mentor/mentee kind of situation," he says. "And that person doesn't necessarily have to be young."

Myth #2: If registrars aren't formally educated, they don't have the ability to be good managers and good leaders.

"My experience was working in the inner city, where it's particularly true that you tend to have people who are not necessarily formally educated but who are educated in the school of life," says Friedberg.

When looking for someone who has that "special something" required for management, focus not solely on educational background - but, instead, on a specific skill set you are looking for. For example, look for someone with good customer service skills or a good attitude.

"You can teach anybody to register and you can teach anybody to manage. But you can't teach them to be a good person with a good work ethic," says Friedberg. "It is much easier if somebody already has those qualities naturally."

Myth #3: People who start out in registration are not high achievers.

"I have people who have worked for me as registrars that are doctors, nurses, lawyers, accountants, businesspeople, consultants, you name it," says Friedberg. "Sometimes it's just a matter of giving somebody the right opportunity."

Lyons also makes a practice of soliciting input from her employees when they approach her about a problem with the department, or ask her if they can change something about a particular process. "I ask them, 'What would be your solution?'"

Lyons says an employee asked her recently if they could close the front desk at the main registration area on Saturdays, which is normally open 7:00 a.m. until 11:00 a.m. "When she worked that desk on several Saturdays, she would only have a few patients coming through," says Lyons. "Since this would affect other staff that worked in the ER, I asked her to communicate her suggestion to them and get their feedback to see if that would also be agreeable with that or if they had other suggestions."

Career ladder

The department also has Level I, II, and III employees, as follows: Level I is a newer employee who can do a registration or a pre-registration, knows the basics of being a patient access employee, and displays excellent customer service. Level II is an employee with a good attitude, who makes wise use of his or her time, has good attendance, has performed registrations for six months, and meets the quota for pre admits. Level III is an employee with all the qualifications of Levels I and II, and is also proficient at working at the front desk, knows Medicare compliance, knows the scheduling system, can collect deductibles, is capable of floating to any area to help out, has an acceptable error rate, is reliable, and who can help train a new employee if needed to do so.

"In this way, staff have an opportunity to move up if they do a good job with their error rate, attendance, and knowledge of procedures in registration," says Lyons.

Lyons says that she has seen improved results with morale and retention as a result of implementing the levels. "Employees actually will come to me when they feel they have improved enough to go the next level," she says. Lyons can either approve the request or, at times, has to tell employees that they need improvement on a certain area before they can move up.

"This can be done at any time after their six months in the position," says Lyons. "We also have diagnostic centers that I have to staff and the employees can apply for those positions. At these areas they pretty much work on their own. I think it gives them a feeling of self-confidence that they perform all the functions themselves."

There are also lead positions on the different shifts, and the trainer position that employees can apply for if they become open. "Some of my staff have also started learning how to access the benefits on patient insurances, learning the scheduling software, and entering Medicare compliance into the computer," says Lyons. "There is a lot to learn besides just registering a patient."

[For more information, contact:

  • Michael S. Friedberg, FACHE, CHAM, associate vice president, patient access services, Apollo Health Street, 2 Broad Street, 4th Floor, Bloomfield, NJ 07003. Phone: (973) 233-7644. Fax: (732) 876-0385. E-mail: Michael.friedberg@apollohealthstreet.com.
  • Vicki Lyons, patient access manager, Baptist Hospital East, 4000 Kresge Way, Louisville, KY 40207. Phone: (502) 897-8159. E-mail: Vlyons@BHSI.com.]