Self-directed teams replace the bosses

Reorganization includes new education piece

When the patient registration manager at Memorial Hospital at Gulfport (MS) left her position this September, the hospital’s chief financial officer (CFO) put an interesting proposition before the department’s four team leaders.

"Rather than replace her, he asked if we would be a self-directed work team," says Tammy Boudreaux, team leader in patient registration.

The team leaders accepted the challenge while reorganizing their responsibilities within the department, which has about 75 staff. A fifth team leader will be hired, and Boudreaux has been designated to develop a program for training employees on the hospital’s new computer system. After that, as compliance issues arise and regulations change, she will be responsible for their ongoing education, she says.

"Our hospital went through a reorganization a couple of years ago and was going to be team-directed," she explains. "Only a couple of units have really done it, so the CFO saw [the manager’s departure] as an opportunity to continue with that." In addition to providing training and education, the work team’s duties are as follows:

Two team leaders, one for the day shift and another at night, monitor the activities of patient access representatives. The access reps perform registrations, including precertification and insurance verification. Boudreaux will continue to handle the day shift until a new team leader is hired.

One team leader serves as quality control coordinator, tracking the accuracy of patient access representatives’ work. This person also is responsible for training the information associates, employees who register patients at bedside. The information associates, formerly unit secretaries, handle only repeat admissions — patients already in the hospital’s history file. In the case of new patients, they call an access representative, who comes to the patient’s room to do the registration.

Another team leader oversees the financial piece of the patient registration department, supervising financial counselors and precertification specialists. These employees follow up on registrations to make sure they are in compliance. If the access reps are unable to verify insurance or start precertification, these staff complete the process. The financial counselors also assist access reps in setting up payment arrangements that are outside the norm, and they help patients apply for financial assistance.

Although the various employee groups report to different team leaders, the work is not compartmentalized, but "just flows through," says Boudreaux. "We’re all responsible for the process, although each area has its own function."

Using the information compiled on errors and productivity, she provides performance feedback to all staff, including patient access representatives at Memorial’s two urgent care centers and two off-site rehabilitation clinics. "They don’t report to us, but we’re responsible for their process. We’re using [the new education role] as a learning tool to help identify problem areas." As team leader for daily access activities, she didn’t have time to focus on correcting errors.

The department’s standard error rate is 4%. Due to high turnover and other issues, it has been higher (5% or even 6%) at times during the past year, she says. Each month when the quality control leader reports the outcomes of quality tracking, Boudreaux meets one-on-one with employees whose work falls below the 4% standard. "With those who don’t reach that, we try to find the problem area, and the employee may have to go through retraining. Just with what we’ve already put in place, [the error rate] has dropped to 3% in the past month. We want it even lower."

Dividing the duties

Meanwhile, the new self-directed team has been faced with splitting the duties formerly handled by the department manager, Boudreaux points out. "We’ve had to decide who will do the interviewing, who will give the information to human resources, who will do the payroll, who will do the budget." Participation in the manager’s various committees and meetings also has been divided among team members.

Team leaders meet weekly at a set time no matter what else is going on, she says. "That’s when we can finally talk, learn what’s going on for the week, learn each other’s schedules. If one of us needs a pep talk, that’s when that happens."

When the fifth team leader is hired, the team plans to set aside a day to develop a mission statement and goals for the department, she says.

"Before this, we were team leaders who reported to a manager," she notes. "Now we report to each other, and we will do each other’s evaluations. Mine is due first."