Do staff see access as a long-term career — or just a stepping stone?

` Managers see 'growing level of respect'

A 22-year-old emergency department registrar working the night shift at Northern Hospital of Surry County in Mount Airy, NC, was obviously very intelligent. Equally obvious to her managers, though, was her complete disinterest in her job.

"I could see that she had amazing potential, but there was nothing to keep her focused," says Terry Hancock, CAM, a patient access manager at the hospital. "She would complete all of her tasks, find short cuts for registering patients, and frustrate her teammates by making it all look too easy."

Hancock decided to make it her mission to work with this staff member, who was at a professional crossroads. "I gave her additional and more challenging responsibilities and expected nothing but her best," she says. "I cut her no slack, showed confidence in her abilities, and praised her to other leaders."

Four years later, this employee is now the hospital's patient access supervisor. "She is extremely knowledgeable, well-respected for her abilities, and a 'go to' person for many other departments within the hospital," says Hancock. "One of the most rewarding tasks you can undertake is to liberate the potential inside an employee who is not challenged or motivated."

A foot in the door

Too often, though, a positive outcome like this one is the exception and not the rule. "Patient access jobs have often been viewed as just a way to get a foot in the hospital door," says Hancock.

All too often, access managers expend time and resources training a staff person who leaves their department soon afterward. Your employee may have decided to work in another hospital department or another field altogether, but regardless of the reason, you've lost a valuable resource.

"Turnover of staff is always difficult to manage in a complex, 24/7 operation. It typically takes at least three months for a new staff member to perform at acceptable levels on their own," says John Woerly, RHIA, CHAM, a senior manager at Accenture in Indianapolis. "This costs the organization and its customers in many ways."

These costs include staff productivity for the new staff member, his or her mentor, and the training staff; data integrity; and the department's level of customer service, which may be negatively affected as new hires learn hospital policies and procedures.

Another factor hurting retention is that other areas of the hospital perceive the duties of access as data entry or "a registration clerk" and nothing more. "Other departments may not recognize how central and important this work really is," says Hancock.

She adds that her own perceptions of the access role were similarly short-sighted when she first joined the hospital as registration manager in January 2005. "I soon realized that the role is much more intricate and required a great deal of training and experience to become proficient," says Hancock. "The turnover was very high back then. It seemed as soon as a new rep was trained, they would leave for one reason or another."

What the team really needed, Hancock decided, was "a sense of purpose, that they were making a difference and doing worthwhile work. They also needed to know they had a voice, and that their ideas were valuable."

More advancement possible

A growing number of opportunities in the field are paving the way for access to be viewed as a rewarding, fruitful career by many. "I think that the current recession has impacted staffing, in that staff may be less likely to job hunt," says Woerly. "Additionally, I have recently met staff at the team-lead level, who are truly excited about their position and the field of patient access. They are hoping to make this a long-term career."

By giving staff the opportunity to expand their roles, you're giving them a reason to stay in the field. "As patient access leaders, we can instill a level of excitement and inclusion in our profession," says Woerly. "This is being accomplished through management development training, providing individuals with lead roles in process improvement initiatives, and mentoring our future leaders." This might take the form of allowing staff to assist in the development of a new program, improve an existing process, or, where possible, promoting internally.

On a recent site visit, a relatively new coordinator told Woerly that she planned to make patient access her career because she had discovered a passion for it. "Of course, introducing her to the National Association of Healthcare Access Management, as well as her local patient access association, was a pure delight for me," says Woerly. "As a long-term 'admitter,' it was enlightening to see a staff member seeing the long road ahead in this wonderful profession!"

Even within his consulting firm, Woerly has found that new staff members are eager to learn more about management opportunities. "With this in mind, I know that the future of the patient access profession is bright and growing," he says.

Patient access also may be experiencing a growing level of respect within the medical community. "Hardly a week goes by that I am not contacted by recruiters in regards to new and exciting corporate positions. Multi-entity health care organizations are seeing the value of standardization and new thought that a corporate leader might provide," says Woerly. "Additionally, the 'C' team is seeing us in a new light."

Woerly says that senior hospital leaders are reasoning that if patient access leaders can successfully manage a highly customer-focused operation, "then surely we can be utilized in more advanced positions." Here are ways to get your employees to make a long-term career of patient access:

• Pinpoint each individual's strengths and talents.

"This can give you ideas of ways to provide opportunities for advancement," says Hancock. When Hancock started in access, the front end was only just beginning to play a significant role in the revenue cycle. "Although we audited work, it was too late to fix it before it billed. It made sense to do it right the first time, or get it fixed before it billed," she says.

Auditing for quality, eliminating billing errors, insurance verification, financial counseling, point-of-service collections, and managing liabilities are all areas in which your staff may have special strengths.

"Stay abreast of changes. Imagine 'what ifs' that lead to ideas for new jobs. These can be options for you to provide a career ladder," says Hancock. "Recognize and reward your best employees with a new role and a higher pay grade."

• Make smart use of technology.

Find innovative technologies that automatically perform tedious and repetitive tasks such as auditing, recommends Hancock, "thus, enabling staff to focus more on taking care of the patient. That is their reason for being here."

• Encourage staff to report problems.

Brad Davenport, director of patient access at The University of Tennessee Medical Center in Knoxville, says that he rarely finds applicants with related experience.

"Most of our new hires have a considerable amount of information to learn," he says. "Health insurance is complicated. Many employees are overwhelmed by the amount of knowledge required to do the job. Our highest turnover is in the emergency department, which is very high paced to begin with, in addition to the stress of learning a new job."

For this reason, Davenport says that he works hard to let all staff, especially the newly hired, know they can come talk to management any time about concerns or problems they may be having with their job. "They need feedback on their performance, and reassurance that we can help them meet our expectations by providing more training or explaining policies," says Davenport. "Other times, it may be that the hours are not a fit. Perhaps we can work with them on schedule changes."

• Use team members to support new employees.

"Co-workers have a tremendous impact on the success of a new employee. We often discuss this in department meetings," says Davenport. "They have an important role in making new employees feel welcome and to help them learn the job. They have the incentive to help new employees, because they realize turnover adds a burden to the entire team."

The hospital once had a formal mentoring program involving extra pay when a new employee met certain criteria, but that ended a few years ago. "Today, we assign a senior employee or team leader to all new employees," says Davenport.

• Offer some new options.

UT Medical Center's access department has created coordinator positions for precertification, coding, and denials. "We offer a few part-time jobs with benefits. We have had some employees who were seeking a nursing degree and wanted to gain hospital experience while attending school," says Davenport.

Job openings are always posted within the access department first for anyone wanting to change shifts or positions. "Of course, the employee must be in good standing and meet our requirements," says Davenport. "In most cases, our employees are wanting the earlier shifts or to move from nights or evenings to day shifts. We have split a full-time position into two part-time positions for an employee who wanted more parent time with her newly adopted child."

• Be a role model yourself.

Several of UT Medical Center's current patient access managers have been promoted through the ranks. In fact, most of the management team started with entry-level jobs, such as secretarial or cashier positions. Davenport has told his staff that his own first job at the medical center was working the evening shift in the supply room. "My plans at the time were to only work a couple of years to finish my degree and take advantage of the wonderful college fee waiver benefit," says Davenport. "I found plenty of opportunities. Nearly 30 years later, I'm still here."

[For more information, contact:

  • Brad Davenport, Director of Patient Access, The University of Tennessee Medical Center, Knoxville, TN. Phone: (865) 305-9018.
  • Terry Hancock, CAM, Manager, Patient Access, Northern Hospital of Surry County, Mount Airy, NC. Phone: (336) 719-7194. E-mail:
  • John Woerly, RHIA, CHAM, Senior Manager, Accenture, Indianapolis, IN. Phone: (317)590-3067. E-mail:]