Do an immediate consult with staff in these cases

Listen closely to employees

Rushing by a registration area on your way to a meeting with a hospital administrator, you think you hear an edgy tone in an access employee's voice while she's answering a patient's question. Do you stop to investigate further, or do you continue on your way?

It's a mistake to allow problems with staff to fester, as mistakes will recur, and poor service will generate ill will. John E. Kivimaki, director of patient accounts at Mary Rutan Hospital in Bellefontaine, OH, says that a negative attitude is one reason to have an immediate consultation with an access staff person.

"If it is not addressed immediately, then the shift that the person is on that has the negative attitude will continue to falter in displaying excellent customer service," says Kivimaki.

Hopefully, staff will take action themselves, by reporting all negative behavior to the registration supervisor. "Otherwise, it can potentially cause poor morale," says Kivimaki. "But with a very active supervisor that is on top of all department activities, the culprit will soon be confronted."

Either way, the key is to take immediate action. "This has to occur as soon as possible," says Kivimaki. "If you do not confront the person with the 'bad' attitude, others in the department will ask each other, 'Why does this person get away with this?' And before you know it, others will start slacking off with their job responsibilities."

Hollis Scott, a patient access supervisor at the Children's Medical Center of Dayton, says that when he first assumed his current role, several employees were clearly disgruntled. "This was supposedly due to issues that had been reported to my predecessor, which were not managed to the satisfaction of the staff," he says.

Scott made a point of meeting with each staff member to discuss his or her individual concerns. "I requested feedback regarding what she did or did not like about the department," says Scott. "I also asked her to share what she perceived to be the biggest impediment to the successful completion of her job duties. The staff appeared to appreciate those conversations. Overall morale has improved."

An individual employee's unhappiness may have less to do with your access department and more to do with other variables outside of the workplace. "We had an employee whose husband was ill. She was struggling to provide for him and their children. After discussing the situation with her, we realized a minor adjustment in her hours could help ease her burden to some degree," says Scott. "I believe the fact that we cared and were willing to assist meant more to her than the actual change in hours."

The simple act of listening closely to the way staff members speak and monitoring their tone of voice "can be immensely helpful," says Scott. "There have been staff who, by the way they said hello in the morning, or did not say hello, we could discern that there was potential for problems that day."

When this happens, take that opportunity to engage them in a short conversation. "Ask them if everything is OK. Gauge his or her awareness of their mood," says Scott. "Perhaps inform the employee that it would be acceptable for them to take a few minutes and collect themselves."

Don't embarrass staff

Christine F. Collins, director of patient access services at Brigham & Women's Hospital in Boston, says that that at no time should you embarrass your employee in front of a patient. "You have to intercede very tactfully," she says. "Without putting the employee in a bad predicament, you need to put the patient in another place. You want them to leave feeling like somebody cares, but without damaging your employee. I don't think any patient or family member really wants you to chastise an employee in front of them."

This calls for a good deal of finesse, and is not always easy to do. One rule of thumb is to give feedback to the employee only after the patient or family member has left the area. When you do so, avoid getting personal.

"You don't want to get into an argument with the employee. It's not about right and wrong. It's all about, 'How does the patient feel?' and 'How can we make the patient feel better?'" Collins says. "You may be having a bad day. Take it to another employees office, but don't take it out on the patient. You may have problems at home, but it has nothing to do with the patient."

Afterward, the incident also can be used as a learning experience for the entire department, but with no blame attached. "You can come out and say that this never should have happened and there really is no excuse," says Collins. "You need to be able to say that to an employee. There is nothing wrong with being honest."

You may overhear an employee giving misinformation at an admitting office. Don't hesitate to correct it, but do so tactfully. "You can say, 'Mary, I don't think you realized that the department moved,'' says Collins. "They know they made an error. And it is corrected immediately, without being disrespectful."

[For more information, contact:

  • Christine F. Collins, Executive Director, Patient Access Services, Brigham & Women's Hospital, 75 Francis Street, Boston, MA 02115. Phone: (617) 732-7453. Fax: (617) 264-6335. E-mail:]