Are you sure — really sure — that access staff aren't being rude?

Find out for yourself

Customer service is more important than ever for access departments. So managers can't afford to let "closet rudeness" go undetected. "Customer service is one area that patient access has no choice but to be on top of their game," says Suzan Lennen, CHAM, manager of patient access at Saint John's Health System in Anderson, IN. "We are the first contact for most patients. What we say and do sets the tone for the rest of the patient's visit to our facilities."

Patients want to be treated as though no one else matters, and "this is something that our associates just cannot get too much education on," says Lennen. "Treating people with respect and kindness is always the right thing."

If poor customer service is not dealt with immediately, poor habits will be repeated by the employee and perpetuated throughout your department. "The ultimate result is a negative reputation with our patients," says Susan M. Milheim, senior director of patient financial services at the Cleveland Clinic in Independence, OH.

Yet, frustrations are growing in access, partly due to patients experiencing more anxiety over their finances. "I think the patient population as a whole is struggling with the downturn of the economy. That means loss of jobs, increased patient financial obligations, and uncertainty about out-of-pocket costs," says Milheim.

At the same time, access staff are being challenged to do more with less. "As the economic hard times have hit the health care industry, open positions are not being filled as quickly. Overtime is being limited, and as a result, employees are being asked to work harder," says Milheim. "Delays may occur, creating frustrations for the patient. Patience lowers and tempers rise."

Can you be sure your staff are gracious under these considerable pressures? Here are some approaches to know for sure:

• Audit telephone calls.

Milheim says that she randomly audits calls made by patient access staff, as part of the department's quality assurance initiative. She makes a point of listening to any calls involving a patient alleging that an employee was rude or mean. After she's heard the call, the employee is brought in to listen to it.

"The employee can hear how they talked to the patient. Sometimes we say things and we don't realize how we're saying it," says Milheim. "That typically is a great coaching tool."

One employee was asked to listen to her own responses to a caller, which were short and sharply worded. After hearing how she sounded, the employee realized that she needed to say more than just a curt "yes" or "no" when answering a patient's questions.

If rudeness is an ongoing issue, the employee goes through another customer service training session. If more than three customer complaints are received, a corrective action process is used.

"We have a telephone etiquette training program that the employee will attend. We also have a 'Commitment to Service' training program and a refresher course," says Milheim.

All new access employees must attend the day-long commitment-to-service session. The refresher course is attended by employees every other year and is used as a supplemental program when needed. "Role playing is a large part of the program. By providing employees with the proper tools, we can ensure that both the employee and patient have beneficial encounters," says Milheim.

Role-playing is first done when a new employee is hired, during the eight-hour customer service training program. The new hire interacts with "patients" who are nervous or angry about various situations. Each year, employees attend a four-hour refresher course, which covers role-playing.

To come up with the role-playing situations, patient access trainers asked front-end staff to share some tough situations. For example, one scenario involves a patient who has come in as a direct admit and is waiting for a bed. The patient thinks it is taking much too long and becomes irate with staff.

For situations like this, staff rely on an "aggressive behavior" policy that outlines how to deal with abusive, angry patients, she says. The staff are able to set boundaries and inform patients of expectations for acceptable behavior. "But by doing regular quality assurance with phone calls, we hope to identify those situations before a patient complains," says Milheim.

At Intermountain Health Care in Salt Lake City, UT, quality review measures have been established for all patient access staff. "To mention a few, we quality review the accuracy of demographics, use of scripting, and documentation in account notes," says Denise Slane, director of patient access. "We also monitor financial requirements, payment arrangements, collections, and referral to eligibility staff for Medicaid screening or financial assistance."

To be sure staff are complying with all of these measures, telephone monitoring is done for pre-registration call centers. All calls are recorded.

"We monitor five calls per registrar monthly for those meeting standards and five biweekly for those who are not yet meeting standards," says Slane. "The recordings are applied to our quality standards. This ensures we are meeting both customer service goals and our database requirements."

By monitoring the calls, Slane says, "we have been able to recognize some incredible staff interactions with our patients."

On one occasion, an employee was pre-registering a patient who was scheduled for an invasive procedure. During the conversation, she also estimated the cost of the procedure, established payment arrangements, provided way-finding information to the patient, and reassured the patient, stating, "You are in very good hands. Take care of yourself. Hope you feel better soon."

When an interaction like this is heard, the example is held up as a training tool at monthly staff meetings. On the other hand, if staff interactions are not appropriate, the recorded call is played for the staff member. Examples of how the conversation should have been handled are shared.

"If the employee needs additional training to better understand our process, this training is arranged at this time," says Slane. "We have also recognized problems with our scripting and have been able to make adjustments."

On a monthly basis, supervisors share these quality results with individual staff members. Anyone who isn't meeting the department's goals is given additional training on recommended scripting to be used during the pre-registration process.

"We also provide a mentor for new employees. The mentor actually sits with the new staff member for one or two weeks," says Slane. "In addition, all of our training materials are available to staff at all times via our online training tool."

A pay-for-performance incentive program was recently introduced. If employees exceed quality and performance measures, they receive incentive pay on the first pay period of the following month. "Our staff have been very receptive to both our quality measures and the incentive program," says Slane. "Staff morale has improved. No longer are the poor performers compensated at the same level as those exceeding quality and productivity standards."

• Ask patients directly.

At Oshkosh, WI-based Mercy Medical Center, the patient access department does a "Secret Shopper survey." "Our receptionist is in charge of deciding whom to hand out the survey to. It's a great way to see in 'real time' what the public truly thinks," says Linda Swanson, registration coordinator. "Plus, it makes the patient feel special that they have been picked to do so. We haven't had a particular staff person mentioned as doing something wrong, but we have had patients mention staff people by name who went above and beyond."

Surveys are handed out randomly to patients about five times a month. "The survey is short and sweet. Otherwise, patients don't like to fill them out," says Swanson. Just two questions are asked:

• Did you have any trouble with parking or locating patient access?

• Is there anything about your registration experience you would like to comment on?

"We've found and resolved issues that we didn't know we had," says Swanson. For example, patients reported problems with finding handicapped parking spots, and patients with hip or knee replacements wanted higher chairs. Both of these concerns were addressed.

"If the patient is willing to put their name and phone number on the form, we will call to let them know their concern was addressed," says Swanson. "Even if we get complaints, we always follow up with the patient and staff, too, so they are aware of what caused the issue and resolution."

• Have higher-ups shadow staff and provide feedback.

About a year ago, Lennen presented her staff with a program called "Give 'Em the Pickle." This drove home the importance of showing customers that they are the most important people in the world at that moment. "This in-service worked very well for the staff. My immediate director and vice president sat in on this as well," she says.

The concept of the presentation, says Lennen, was "why should it matter if someone gets an extra pickle? If that is what is needed, just give it to them. Some people get so hung up on not giving people what they want, for fear that it will be reflected on them that they gave something away."

Access staff were told to treat every patient as if he or she is the only person in the world when standing in front of you. "Even more, if they got something the last time they were at your facility, they will expect it the next time. So it's also important to be consistent in what you do and say," says Lennen.

Shortly after the presentation, the hospital's CEO spent about four hours in the patient access department, shadowing staff through the outpatient, inpatient, and emergency department processes. "He wanted to see our interaction with patients and families. He was especially complimentary on how well the staff engaged in conversation and related to the patients and their families," says Lennen. "The 'pickle' teachings work very well here."

[For more information, contact:

  • Suzan Lennen, CHAM, Manager, Patient Access, Saint John's Health System, 2015 Jackson Street, Anderson, IN 46016. Phone: (765) 646-8136. E-mail:
  • Susan M. Milheim, Senior Director, Patient Financial Services, Cleveland Clinic, Independence, OH. Phone: (216) 636-7210. Fax: (216) 636-8088. E-mail:
  • Denise Slane, Patient Access Director, Intermountain Health Care, Salt Lake City. Phone: (801)-702-7973. E-mail:
  • Linda Swanson, Registration Coordinator, Mercy Medical Center, 500 S. Oakwood, Oshkosh, WI 54904. Phone: (920) 223-1890. E-mail:]