Cream puffs, quilts, and competency tests?

State fair theme educates with a fun twist

When the training and data quality staff took over the competency assessment of patient access employees at Milwaukee-based Aurora Health Care, they added a little regional flair to the process. A competency fair, which is inspired by Wisconsin’s popular state fair, replaced the previous practice of having supervisors with checklists review critical functions and material with individual registrars, says Sue Underbrink, CHAM, supervisor of metro patient access training and data quality.

"We wanted to do something that people would learn from and also have some fun," she adds. "Anyone who knows Wisconsin knows that cream puffs are a big deal. We decided to go to each hospital, provide refreshments and be there for several hours."

Required by the Oakbrook Terrace, IL-based Joint Commission on the Accreditation of Health Care Organizations (JCAHO), the annual assessment also is documented for inclusion in each employee’s personnel file, Underbrink notes.

To ensure that all competency-related bases were covered, she says, she and her team of two training specialists developed four categories of competition for the assessment, each with its own fair-related theme. Employees participated in three or four categories, depending on whether they were qualified as schedulers. "The way our jobs are set up, we have [positions designated] patient access specialist, and then levels one and two," she adds. "Level twos are expected to know more. Some people schedule, but also register."

Here are some of the categories:

Customer service/Ticket booth

Patient access employees attending the fair first encountered a ticket booth where they were asked to pull the appropriate "ticket" (answer) and — using Velcro — attach it to the correct spot on a poster containing 20 customer service-related questions, she explains. As with the other competency categories, employees who couldn’t be there in person — or preferred to answer questions the more traditional way, using pen and paper — were given a hard copy of the quiz to fill out, Underbrink says. In those cases, her staff corrected the papers and sent them to the person’s supervisor. "There were very few [who didn’t participate in the fair]," she adds. "We kept that to a minimum."

Regulatory issues/Prize-winning patchwork quilt

In the next event, employees assembled a prize-winning patchwork quilt by placing the correct quilt piece (question) to the spot on the "quilt" — a brightly colored poster — with the corresponding answer. For example, the first question was: "[Blank] is the regulatory agency whose mission is to protect the safety and quality of care provided to the public through the provision of health care accreditation and related services that support performance improvement in health care organizations," Underbrink says. "We did a lot of work [in advance of the fair] making sure everybody understood what JCAHO is."

Other topics included the Emergency Medical Treatment and Labor Act, the Medicare Secondary Payer questionnaire, the Health Insurance Portability and Accountability Act, and the Centers for Medicare & Medicaid Services. For the regulatory portion of the fair, which was fairly lengthy, employees were allowed to work in teams. At least one member of the training and data quality staff also was on hand to monitor the process, Underbrink adds, so that one person didn’t answer all the questions. "We made sure it was a real team effort."

Registration/Prize-winning sunflower

To "grow" the winning sunflower, employees placed petals — each with one of 28 registration questions — on a huge sunflower poster containing various answers. In this case, topics were drawn from the highest-ranking errors tabulated from quality audits, she points out. "We wanted to find out what they knew and help educate them." For example, questions were asked regarding the definitions of physician type, Underbrink notes, since audits had revealed some confusion over whether a physician was "admitting," "attending," or "ordering." Also addressed was the topic of identify fraud, she says. "We process a process to prevent that, and we wanted to make sure people knew it." As with the regulatory quilt, the registration sunflower usually was a team effort.

Scheduling/Prize-winning pie recipe

Only employees who performed the scheduling function entered this competition, in which 10 questions and answers formed the winning recipe. "We actually had answers on pie dough with rolling pins," Underbrink says. The training and data quality team took its competency fair on the road — staging it at five Aurora hospitals and at one urgent care clinic, where staff from a second clinic joined the process, she notes. "At least 100 [employees] were involved," Underbrink adds, whether in person or through answering the questions on paper and submitting them later.

At one hospital, the fair was held in the evening, in conjunction with a regularly scheduled staff meeting, while at the two largest facilities the event went on all day, she says. "We were there early enough that the night shift could stay over and participate, and late enough to catch the evening shift."

Although the competency assessment typically happens in the fall, the 2002 event was a little late, and actually occurred in January, Underbrink adds, still early enough to figure into employee evaluations. The 2003 assessment will take place before the end of the year, she says, but with one major change. This time, it will be conducted via Aurora’s registration training and support web site.

[Editor’s note: Sue Underbrink can be reached at]