Take action if you receive a complaint

Stay visible and accessible

At times, patient access bears the brunt of many complaints. Some are justified; others are not. But either way, your response should be immediate.

"It is important for access leaders to be as visible and accessible as possible throughout their departments," says Cheryl Webster, director of patient registration services at William Beaumont Hospital in Royal Oak, MI. "This availability will allow your staff, as well as staff from other departments, to address issues early before small issues become big problems."

When a problem is brought forward, your first step should be to research it. Obtain as much information as possible, such as interviews with staff, service-related statistics, individual patient accounts, and any other available data.

"Sometimes the initial information is incorrect. Once the manager gathers the factual data, a clear picture of the true problem emerges," says Webster. A patient may report that he or she received a "bill from the hospital," when in fact, the patient is referring to an explanation of benefits sent by the insurance company. In reality, the outstanding amount already has been billed to a secondary insurer or is in the process of being appealed.

Similarly, if a patient reports "waiting a long time for registration," it may be that the long wait occurred in the doctor's office before the patient arrived at the hospital.

"If a computer system is involved in the error, the investigation should include a re-creation of the problem to help locate the initial cause," says Webster. "Capture screen shots also to help demonstrate to others, if necessary." She gives these examples:

• screen shots of the data as they were documented accurately;

• specific information that may have been entered in error;

• specific times of visit arrival, phone numbers, or other data in question;

• an audit trail showing who actually input erroneous information, and when.

Webster says that whenever she finds that another department has made an untrue accusation, she brings it to the leader's attention in a private discussion, either by phone or in person. After the situation is discussed, she then works with the manager to determine the best way to clear up the misunderstanding with all of the individuals who were misinformed.

"We all make mistakes, and I do not want to embarrass anyone. Sometimes it is difficult not to be defensive, but I work very hard to overcome the temptation to point fingers or make sweeping negative comments, as the other side only has half of the story," says Webster. "Mostly I try to treat them in the same way that I like to be treated."

One way to clear up misunderstandings is to send a clarifying e-mail, or explain the situation verbally in a meeting so it is documented in the minutes.

As the patient access department often is an "easy target for blame," Webster recommends taking these proactive steps:

• Make everyone aware of what you expect.

Webster says that, in particular, staff should be aware of these expectations:

• wait-time standards and what to do when the threshold is reached;

• how to handle specific patient concerns, how to respond, and who to call;

• scripting to follow to properly communicate legal requirements to patients and reduce misunderstanding and potential complaints;

• technical accuracy, as these errors flow to other areas, such as clinical areas and billing.

• Stay connected to the front line.

"In several key areas of my department, the staff send an e-mail to their supervisor and me at the end of the shift to let us know of any problems that occurred so that we can follow up appropriately," says Webster. Staff are required to report any customer service concerns to their supervisor, even if they are resolved, so that service recovery can be initiated, follow-up can be done, and appropriate people can be notified.

• Hold regular meetings with key departments to facilitate a positive working relationship.

"Staff can also be included if appropriate for the situation," says Webster.

A few years ago, the department noticed there were several service concerns from patients at one of the hospital's sites. The customer service survey scores also were the lowest in the hospital.

"The clinical manager and I met together with staff from both areas. We were very blunt about our expectations to work together and give the best possible service to our patients," says Webster.

They explained that the goal was to see the service score for the entire area increase to be comparable with other sites. "We wanted to replace finger pointing with teamwork and focus on our patients." says Webster. "The clinical manager and I set the tone by talking to them together and asked for their ideas for improvement. Today, this area is strong, their service scores are among the highest, and the staff show pride in their whole team."

• Round frequently to be sure that patient flow is moving along and any delays are being handled effectively.

"Keep wait-time and other service-related metrics to measure success. Data are always helpful to establish credibility," says Webster.

Encourage staff to bring problems forward quickly as they are observed.

When made aware of a negative situation of any kind, such as a staffing glitch that resulted in longer-than-acceptable wait times, Webster connects with managers from affected areas so they hear about the problem early and directly.

"They are made aware of what has been done to resolve the issue," says Webster. "If the problem stems from staff in another department, I let the manager know what happened but refrain from editorial comments, such as saying, 'My staff would never do this,' no matter how tempting it may be. Another department may not understand why an event occurred. They only know what they saw in one moment of time."

A registrar might have been working with a doctor's office on obtaining an authorization, and talked to the patient in advance about the problem. "The other department only sees that a patient is upset, and assumes that the access department did not do everything possible to assure the patient's experience was positive," says Webster. "Or, maybe the patient forgot their written order and we are working to get another copy. We are doing everything possible, but the department just sees a waiting patient."

• Audit crucial activities to identify human and process errors so that they can be corrected before they create complaints.

If there are consistent problems with orders or medical necessity causing patients to wait on the day of service, for example, you may need to work with the doctor's office. "They may have a new staff member or some other type of change. Or, if it is one of our staff who is making frequent errors, they may need more education," says Webster. "It is imperative to be on top of problems and put corrections in place early."

[For more information, contact:

  • Cheryl Webster, Director, Patient Registration Services, William Beaumont Hospital Royal Oak Michigan. Phone: (248) 898-0860. E-mail: cwebster@beaumonthospitals.com.]