Get better results with scripting, role-playing

Registrars at Kettering Health Network in Dayton, OH, reported feeling very uncomfortable with certain situations, such as asking patients for money. Jana R. Mixon, director of patient access and central scheduling, says that in response, she expanded the use of scripting.

Staff are given "cheat sheets" to refer to for certain challenging situations, but these are not necessarily used verbatim. Instead, employees are encouraged to tweak the wording to reflect their own personal style.

"We have provided them with specific responses that they can use if they are uncomfortable. But staff also have the ability to make up their own," says Mixon. "They can add their own spin to it, as long as they are touching on specific points of the script."

One registrar may stick closely to the script and say, "Mrs. Smith, I'm Jana from registration and I'm going to take care of you today," to every single patient. Another might be more conversational and say, "How are you doing today? It's nice to see you!" before continuing on.

"Basically, we try to script anything and everything," says Mixon. "We use scripting situationally, but it is also used related to processes, especially those that could be sensitive." These include requesting copays, asking about the patient's race, and talking about the patient's income to determine if he or she is eligible for charity discounts.

When Kettering Health's patient access department first started role-playing to improve their customer service, staff were noticeably uncomfortable. "They felt a little silly at first," says Mixon. "But we found a way to make it fun, and they got into it."

Staff worked with real-life examples, after the patient's identity was removed. Also, roles were switched, so staff got more than one perspective by playing both the patient and the employee for each scenario.

The role-playing exercise was used to develop appropriate scripting for employees. Since employees were the ones who came up with the wording, they were truly comfortable talking to patients. "We gave them the scenario and the outcome, and allowed them to fill in the blanks to get to the same outcome," says Mixon.

Monica Rei, director of patient access and patient financial services at St. Joseph Mercy Oakland in Pontiac, MI, says that scripting is most beneficial for a "short, easy type of response." When staff greet a patient, they always say the same exact words: "Hello, Mr./Mrs. XX, my name is XX and I will be doing your registration today. Thank you for choosing St. Joseph Mercy Oakland." All patients are welcomed in a uniform way.

"What we find more challenging with scripting is when it is used for more complex issues," says Rei.

Recently, staff were tasked with asking detailed questions about language and race, as part of a Robert Wood Johnson Foundation initiative. This was very different from asking routine questions about insurance coverage and contact information. Often, patients didn't understand why this additional personal information was necessary.

Once staff themselves understood the value of collecting the information, though, a lot of the awkwardness subsided.

"It was sometimes an uncomfortable conversation," says Rei. "But the reason for asking the question is so we can give them better clinical care. It was really important that staff understood their piece in this, and that we are actually enhancing the clinical care of our patients."

Staff also were informed about research showing inequality of care based on race. "By gathering this data, we could start to identify what the disparity is and work to enhance the care for all races equally," says Rei. "That really was very powerful."

The bottom line is that staff always need to comprehend the questions they are asking, and the reason for asking them. "Before you go into complex issues, the reasoning needs to be understood," says Rei.

Scripting gives a uniform and easy-to-understand explanation of a potentially confusing Medicare regulation that is developed specifically for a Medicare beneficiary.

"We have a uniform way that we talk through it, but access can go off the script if need be," says Rei. "A script is a wonderful thing, but if someone should ask a question about a Medicare regulation, the staff need to be able to answer in an intelligent way."

Otherwise, staff can come off as robotic or canned, which would defeat the purpose of the scripting. "Then, scripting would be more of a dissatisfier for the customer service initiatives that we are trying to put forward," says Rei.

Having a script to work from can put staff at ease during difficult points in the information-gathering process. "It can help you to get past uncomfortable conversations," says Rei. Point-of-service collection — a relatively new role for staff — is one obvious example.

"It used to be that when the patient was coming into the hospital, our role was only to get you well, and they received a bill afterward," says Rei. "Patients may ask staff, 'Why are you asking me for a copay today, when last month I had services and you didn't ask then?'"

Patients may have questions about unexpectedly high copays or deductibles. In this case, scripting is used to tell the patient to forward their questions to their payer about the terms of their contract. This helps to divert misplaced anger about insurance requirements that are not the fault of access staff.

"That simple explanation is something that patients understand very clearly," says Rei.

Scripting won't work, says Rei, if you are just sending staff out with a sheet of paper. "It is really imperative that the staff understand the reason why we are doing down a path we are," says Rei.

Even with something as simple as a scripted greeting, there is an underlying reason why it is important. This, says Rei, is because "we have a customer service initiative here. As part of that, we are standardizing this response." That's the reason why staff in every area of the hospital, including operators, answer the phone or greet the patient in the same exact way.

Role-playing is used to get staff comfortable with new concepts and unfamiliar terminology. Staff are paired off and given a few situations to practice. "First, we have them just get through the dialogue. They get the feeling of just hearing the words and being comfortable," says Rei.

The goal is for staff to know the script so well that they can deviate from it. Soon, they find themselves conversant with the issue and putting the same information in their own words.

"We are still working through some of the issues that are presenting at point-of-service collections," says Rei. "Generally, these are specific questions that patients have about their insurance. The staff direct them to ask these questions to their insurance company, but sometimes there is additional dialogue about this issue."

[For more information, contact:

Jana R. Mixon, Director, Patient Access and Central Scheduling, Kettering Health Network, Dayton, OH. Phone: (937) 384-4541. E-mail:

Monica Rei, Director of Patient Access and Patient Financial Services, St. Joseph Mercy Oakland, 44405 Woodward Avenue, Pontiac, MI 48341. Phone: (248) 858-3000 E-mail:]