Don't hesitate to set high bar with staff goal-setting

Recognition is morale-booster

"The goal for our staff is to reach at least a 90% monthly accuracy rating for preadmits, activations, and discharges," says Bailey Holloway, admitting evening coordinator at Maine Medical Center in Portland.

Another standard calls for the registrars to be able to work at least eight accounts per hour if working in an office during the day. "During evening shifts when they are working preadmits, the standards are at least 18 calls and 18 preadmits per eight-hour shift. The reps strive to complete these standards on a daily basis," says Holloway.

If a registrar exceeds these goals, a supervisor calls attention to this during his or her annual performance review. "We, or their peers, present them with a 'kudos,'" says Holloway. This is a certificate thanking the person for going beyond the department's standard, or for helping patients, their family, or a staff member exceptionally well.

The department's director also personally writes thank-you cards to registrars who have done something "above and beyond" — for example, a registrar who has completed the most preadmits or has the highest quality percentage in the department.

"Recognizing the reps for their exceptional work has really boosted their morale. They are being recognized for their hard work," says Holloway.

Each year, the reps are able to set goals for themselves when they complete their annual review. "Maybe their quality was not as high as they were striving for, or did not meet the standard," says Holloway. "They may set a goal to receive at least a 95% quality rating by the next time they have their review."

When employees meet with their supervisor to go over the review, three things are covered: whether they completed their goals, what they can do to ensure they do complete them, and what may be hindering them.

It may be that work flow issues are getting in the way. "Many patients come through our department to be admitted, and it takes time away from working their functions," says Holloway. "Therefore, they may not be able to reach their goals of completing so many preadmits in an eight-hour day, because the patient always comes first."

Built-in accountability

Joy Wright, a patient registration supervisor at Lodi (OH) Community Hospital, says that the department's patient registration specialists are "the first line to our hospital. Excellence in customer service is a key area of focus, as is maintaining a high level of accuracy in the registration process."

Lodi Community Hospital has implemented a quality improvement program for ongoing internal monitoring of quality measures and patient safety. As part of this program, Wright tracks the goal data on a quarterly basis and reports out to the performance improvement board. In addition, annual assessments are performed on the data. A plan to improve is generated, where indicated.

Wright sets the following goals for her staff:

1. Achieve and maintain a 95% or higher accuracy level on all patient registrations.

This goal is tracked on a daily basis. Wright reviews individual patient charts for insurance information, completed forms, physician information and orders, necessary chart base sheets, and overall accuracy and completion.

Wright has built in an accountability initiative for the staff by making them personally responsible for correcting any errors she finds.

"This not only increases their accountability; it also reinforces the proper steps in the registration process," says Wright. "The staff understand that the accuracy minimizes billing issues. It expedites the billing process for both the hospital and the patient."

2. Adhere to the Medicare Advance Beneficiary Notification rules.

In compliance with federal regulations, staff must immediately input physician information and diagnosis and tests ordered to ensure proper and timely payment by Medicare, Wright says.

3. Obtain a signature on "Important Message from Medicare" letters for inpatients.

Registration for Medicare inpatients requires that a letter from Medicare be signed upon admission. "All relevant inpatient files are manually reviewed and information is tracked," says Wright.

4. Achieve patient satisfaction scores of 95% or higher.

This is necessary for Lodi Community Hospital to maintain the prestigious Summit Award given by Press Ganey Associates. The hospital has received the award four consecutive times for outstanding patient satisfaction in the emergency department.

"Patient registration plays a key role in this achievement," says Wright. "Our staff are committed to exceeding customer expectations with each encounter to help maintain this coveted award."

[For more information, contact:

Bailey Holloway, Admitting Evening Coordinator, Maine Medical Center. Phone: (207) 662-4248. E-mail:

Joy Wright, Patient Registration Supervisor, Lodi (OH) Community Hospital. Phone: (330) 948-5526. E-mail:]