Don't let negativity get a foothold in your patient access department

It can bring down an entire team

Imagine one person complaining nonstop about everything from rude patients to out-of-ink pens. Over time, that individual can manage to undo hours of hard work and morale-boosting initiatives, and send your customer service crumbling.

"If that kind of negativity continues, you can have one person bringing down the entire team," says Heidi Dunbar, manager of admitting/emergency department coordinator at Seattle Children's Hospital.

If nothing changes after talking to the employee one on one, providing coaching, and doing re-evaluation, Dunbar says, "you may have to help them to find a job somewhere else. Sometimes people just can't handle the stress of it all. I have done evaluations, and somebody can be great in every other way but still be negative. And what that does is bring down your customer service."

Hollis Scott, a patient access supervisor at The Children's Medical Center of Dayton in Ohio, says that one person's bad attitude has a number of negative repercussions on a department.

"Like a virus, it can spread to others, creating an atmosphere of discontent," says Scott. "Even when scheduling or preregistering by phone, it is important for parents to feel our staff's enthusiasm. This will not happen if the staff member is unhappy or disgruntled." 

In many cases, a negative employee needs others to validate his or her discontent. What starts as one individual displeased about the amount of work, discipline, or pay can quickly lead to a disgruntled group. "Often they will wait until a coworker is disciplined or unhappy and yell, 'See, I told you so!'" says Scott. "It is always convenient to vent to coworkers."

By generating friction between colleagues, an employee's negative attitude can make otherwise happy employees dissatisfied because they feel that others are poisoning the work environment. "Ultimately, it will undermine a leader's ability to guide the department," says Scott. Here are three strategies to combat negativity:

• Listen carefully.

"This sounds very basic, but I find that if someone is listened to, that person understands that somebody actually cares about them. And a lot of their frustration just goes away," says Dunbar. "Sometimes people just get overworked. There is a lot demanded of them, especially with our hospital being very full. And people need an appropriate way to vent."

• Ask for a positive comment.

If an employee is consistently making negative statements, Dunbar stops him or her and says, "Please say something positive."

"It always throws them off," she says. If complaining about a certain individual, the employee is pressed to think of something that person does well, such as filling in for shifts when needed or getting coffee for others. Or if their complaints are more general, they may say, "Well, at least I do have a job," or "This is a great place to work."

• Switch the focus to the patient.

Dunbar says that a good way to put staff complaints into perspective is to remind them of the patient and what he or she is going through. "You may not be having a great day, but think of a child coming into the hospital. In the end, no matter how bad it is, what you are doing is for a child who did not choose this particular incident," she says. "And whatever reason they are coming in for, they win just because they walked in the door today."

Get peers involved

When an employee complains about a co-worker, the first question Dunbar asks is "What did they say when you talked to them about it?"

"We try to do this peer to peer. It doesn't always work, because some people are stronger with confrontation than others," says Dunbar. "But if a peer says, 'You are awfully negative today. Is there something I can do to help you?' that can have a powerful effect on someone. We do try to encourage them to deal with conflicts themselves."

A the Cleveland Clinic, access staff are invited to join the Employee Advisory Committee, which has been in place for about 18 months. The committee members represent their peers and focus on how to improve employee morale, the work environment, and reward and recognition programs.

After a year, participants are asked whether they would like to leave the committee or stay on. "If they leave, we ask for another volunteer from that area to join. One of the things we are hearing is that a lot more employees want to participate," says Sue Milheim, the hospital's senior director of patient access services. "This takes them away from work, but we try to get as many people involved as possible without hurting our front-line staffing."

The committee developed an "EZ Pass" program for employees with perfect attendance. The pass can be turned in to erase points earned for tardiness or leaving early in the past or future. Recently, the program was expanded for employees with quality scores of 98% or better.

The committee also plans Patient Access Services Week. This year, the department had a pot luck day, an ice cream social day, and a raffle with more than 150 gift cards and baskets distributed. "All of the patient access areas are represented for each hospital. We probably have 12 to 15 employees who help us to understand what the front-line staff need," says Milheim.

To be sure that no staff members feel that they lack a way to be heard about anything they're unhappy about, an anonymous online survey is used. "We do it twice a year to identity their needs for tools or training. We also ask them whether they are getting enough communication from us, and if not, what they are looking for," says Milheim.

If a concern is identified, the committee comes into play. "In areas where we find deficiencies, the committee digs in and asks the staff, 'What does this mean?' If I were to go in and ask, 'How are things?' the staff might just tell me that everything is fine," says Milheim. "It's easier for frontline staff to talk to their peers."

The committee learned, for example, that staff were troubled because the printer often went down on weekends and that the scanner needed to be replaced. "The tools they needed at their fingertips weren't available. Anything we can do to make their jobs easier and less frustrating, we want to do," says Milheim.

Look for warning signs

John E. Kivimaki, director of patient accounts at Mary Rutan Hospital in Bellefontaine, OH, says that he looks for staff who are coming in late for work, calling in sick, having an excessive number of registration errors, are slow in registering patients, and are receiving bad results from customer surveys.

These changes in behavior are clear indications that something is wrong, says Scott:

• A normally talkative employee suddenly becomes quiet or unwilling to communicate with you or other employees.

• An employee is constantly complaining about other staff members.

• An employee fails to either accept responsibility for mistakes or to make corrections once informed of errors. "This usually means the employee has given up and lacks the motivation to properly execute his or her job functions," says Scott.

• The employee displays changes in attendance or excessive tardiness.

A counseling session is one way to initiate dialogue in hopes of uncovering what issues are causing the employee's negativity. "This does not necessarily indicate a disciplinary proceeding," says Scott. "It can be a simple matter of pulling the employee aside and telling them you sense that something is amiss and you are concerned."

Often, if employees do not feel valued, taking a moment to ask how they are doing can make the difference. "If the problem persists, you may need to initiate formal discipline," says Scott. "Many companies offer an Employee Assistance Program that provides counseling for marital, financial, mental, and/or substance abuse issues. If available, those types of services should always be offered."

Scott says that it is the manager's responsibility to ensure that conditions are conducive for a pleasant working environment. "If the manager is successful in this endeavor, the negative attitude should be the exception as opposed to the rule," he says. "When negative attitudes arise, that person will be conspicuous and may possibly be influenced by the positive culture that permeates the department."

To promote a positive work environment, your first objective should be to ensure that all employees have a clear understanding of what their job functions are, what behavior is acceptable, and the consequences of failing to adhere to hospital standards. Once these objectives are clear, it is also important to set goals for individuals, teams, and the department.

"Individuals should be publically recognized for positive contributions to the organization," says Scott. "A 'thumbs-up' board, where staff members can recognize fellow employees who promote a positive work environment, can work wonders. Staff members complimenting each other can generate positive vibes that the manager may not necessarily produce. Above all, always be open, honest, and fair. Listen to staff members and treat everyone equally and with transparency."

Kivimaki says a big impetus for negative employees changing their attitude is when their job is in jeopardy. "You just have to emphasize the fact that their negativity is not tolerated at all. And if there are any future re-occurrences, then there will be disciplinary action taken as stated in our hospital employee handbook," he says.

Continually remind your staff that the registrars are the "first impression" of the hospital for many patients. "We emphasize this at our yearly in-services," says Kivimaki. "Everyone here knows that a patient complaint from an employee's bad attitude situation will be reviewed with them to address the problem. It will not be tolerated."

[For more information, contact:

Heidi C. Dunbar, Admitting Manager/Emergency Department Coordinator, Seattle Children's Hospital, 4800 Sandpoint Way NE, Seattle, WA 98106-0371. Phone: (206) 987-3484. E-mail:

John E. Kivimaki, Director, Patient Accounts, Mary Rutan Hospital, 205 Palmer Avenue, Bellefontaine, OH 43311. Phone: (937) 592-4015, Ext. 5616. Fax: (937) 599-2143. E-mail:

Sue Milheim, Patient Access Services, The Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195. Phone: (216) 636-7210. E-mail:

Hollis Scott, Supervisor, Patient Access, The Children's Medical Center of Dayton, One Childrens Plaza, Dayton, OH 45404. Phone: (937) 641-4323. E-mail:]