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Zero in on whether people are really satisfied with your access department
'All or nothing' questions aren't enough
If patients report being "very dissatisfied" with the admission process, does that mean they're angry because a registrar was rude and unfriendly? Or was it because they waited hours in the emergency department hallway for an inpatient bed to become available?
Without getting the specifics from that patient, you'll never know. This missing piece of information may prove very costly if your department gets tagged with an undeserved reputation for providing bad customer service.
One problem is that hospital satisfaction surveys often are too general in what they ask and fail to address patient access in particular. "Most satisfaction results do not focus specifically on the functions of the access/registration staff, even though staff are often measured on those results," says Jeanette Foulk, director of admitting/discharge at Methodist Charlton Medical Center in Dallas. "Often, the registration piece is only a small part of the survey question."
Although inpatient surveys at Methodist Charlton do cover the admission process, the questions don't break down the underlying reasons for delays.
A patient may be very unhappy about waiting several hours for bed availability. Yet that same patient may, in fact, be very happy that the registration process was completed in only 10 minutes. Regardless of that, the patient probably would report dissatisfaction with the admission process. "The survey does not make allowances for other variables in the process. It is an 'all or nothing' question," says Foulk.
Clearly, survey responses often are difficult to trace back to specific patient access processes. One reason is that among organizations there are varied structures and functions of registration.
"Multidisciplinary work units, decentralized registration models, and the complexity of patient access functions related to scheduling, pre-registration, and insurance verification are inconsistent industrywide," notes Michael F. Sciarabba, MPH, CHAM, director of patient access services at Advocate Illinois Masonic Medical Center. "These processes all have associated survey questions, but interpretation of the question and function is inconsistent and frequently misunderstood by patients."
Department-specific patient satisfaction surveys are a much better measure of satisfaction with access.
For this reason, Methodist Charlton's access department has developed a process involving volunteers rounding on the floors. These individuals, mainly retirees from the community, are given a questionnaire tool to assist them.
The volunteers ask patients these questions:
Would you rate the friendliness of the access/registration staff as very good? If no, please explain.
Would you rate the ease of the registration process at the time of admission as very good? If no, please explain.
Would you rate the timeliness of bed availability during your admission as very good? If no, please explain.
"I am hoping these questions will assist in narrowing down dissatisfaction in registration," says Foulk. "The patient satisfaction results may be truly a registration/access issue, or may be a bed availability issue. Right now it is of no use to us, because the focus is not on the correct reason for the dissatisfaction."
No matter how frequently satisfaction is measured, vague data are not useful, Foulk says. On the other hand, if you can come up with valid data showing that patients are satisfied, don't hesitate to share them.
"I would suggest quarterly reports to senior leadership focusing on access successes, along with goals to assure the continuation of those successes," says Foulk. "Also, provide an action plan for those areas that need improvement."
If patients aren't happy with something access is doing, that's important to address. However, there are also going to be areas in which patients are very satisfied. You don't want to miss the good news, either.
"Focus your surveys on the helpfulness and courtesy of the patient access staff, instead of focusing on the entire admissions experience," suggests Foulk. "Include other departments in the admissions process, such as ED admissions, surgery patients, and bed control."
Another challenge is that patient access staff members frequently spend time on "behind-the-scenes" tasks. Many processes involving patients, physicians, ancillary staff, and payers are not measured by surveys. "These informal encounters can be quite extensive and have a large impact on resources in the operation," adds Sciarabba.
The difficulties of coordinating the patient's test and treatment, and meeting all organizational, compliance, and payer requirements are often invisible to patients.
"Patient access departments depend on many sources to ensure a seamless process for the patient," says Sciarabba. Physicians, insurance companies, governmental agencies, and ancillary clinical departments all have a direct impact on the access of care to patients.
One of the primary roles of patient access is the coordination of all of these components. The result is efficient access.
"When there are challenges in coordinating these required components, many patients perceive patient access to be responsible," says Sciarabba. "These issues may or may not be directly linked to the department."
Regardless of any obstacles it faces, though, Sciarabba says it is still the role of patient access to do all it "can to coordinate the care, remove barriers, and communicate clearly with the patient so their expectations are met."
Tweak survey questions
At Emory University Hospital Midtown in Atlanta, a hospitalwide survey includes questions related to the speed of admission and the pre-registration process for inpatients. For emergency department patients, there are questions related to arrival and personal/insurance information.
The "speed of admission" question, however, may result in misleading information because the majority of scheduled patients are pre-registered. On the day of arrival, they are able to bypass registration areas and report directly to their point-of service area.
Since the general "admissions" questions cover all areas, it's hard to determine if responses are related to a specific admissions area or another "check-in" point of the hospital.
"From a patient's perspective, the point-of-service area may be considered 'admissions' when, in reality, it is not," says Elease Brown, assistant director of patient financial services. "Thus, scores may not be reflective of our specific admissions areas. If the wait times were particularly long or short the appropriate area may not receive the feedback."
At Greater Baltimore Medical Center, Press-Ganey surveys are used to assess patient satisfaction. "We found that some of the initial questions associated with the survey as related to patient access were worded or structured in such a way that was causing us to be scored or rated on elements that were not entirely in our span of control," says Duke Bowen, BS, CHAM, associate director of patient access.
One of the questions associated with patient access asks patients to rate the speed of the admission process. "Certainly, we were involved in upgrading the accounts to an 'admitted' status. But we were not in control of many of the other elements that could cause delays in admission," says Bowen.
Beds might not be immediately available to admitted patients because other inpatients are waiting for discharge orders, or environmental services might be unavailable to clean the room.
"The structure of questions on the surveys are not entirely in our control, as the survey questions are standardized via Press-Ganey for benchmarking and comparison purposes," notes Bowen. "After some negotiations with our service excellence department, we were able to successfully present our rationale."
Eventually, the wording of the survey question was changed; patients now are asked to rate the "waiting time to register." "The other survey questions are generally related to 'courtesy' or 'helpfulness' of the patient access staff," says Bowen.
Patients need to ID staff
There may be confusion because the patient is unable to identify patient access staff. "Ideally, we want to minimize the impact of especially negative survey comments or ratings if they, in fact, are related to hospital staff not associated with patient access," says Bowen. "Therefore, we have implemented patient access uniform requirements, which clearly identify our patient access representatives."
The department has considered implementing its own customized patient access surveys or questionnaires. "But, we have decided for the time being that the standardized Press-Ganey surveys are providing sufficient and appropriate feedback," says Bowen.
The department hasn't identified a need to measure satisfaction or dissatisfaction with its "internal" departmental customers. This is because there is a constant flow of both positive and negative feedback from co-workers and other departments.
"The lines of communication are wide open," says Bowen. "We pride ourselves on our responsiveness as related to these comments or complaints."
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