Career ladder’ increases payments; reduces turnover

Positive feedback from and to managers

A new career ladder for emergency department (ED) registrars at Wake Forest University Baptist Medical Center in Winston-Salem, NC, has helped reduce staff turnover and is providing increased motivation for employees to perform at higher levels in cash collections, among several other categories.

Under the umbrella of the departmental goals of "accuracy, timeliness and friendliness," says Charlynne Lynch, ED registration manager, "we want to have an achievement rate (accuracy of patient registration) of 97%. Anything over 97% is above standard." Employees who achieve that ranking — along with meeting standards relating to teamwork, customer service excellence, high professional standards, and collection rate at discharge — are eligible to be designated "senior registration clerk" and receive a pay increase of between 4.5% and 7%, Lynch adds.

"The quality of work has to reflect that high standard," she says, noting that to qualify, employees also must not have been subject to any disciplinary action, such as tardiness, and must behave and dress professionally. "We look for those who are exceeding our standards," Lynch says, "for the value-added things. We have some [employees] who have conducted inservices for the staff. That plays into this as well."

An employee who has met the collection and accuracy goals, but was not a team player or did not interact well with patients, would not receive the promotion, she explains.

Standards must be maintained

To qualify, employees must have been in their position for at least six months and have maintained the high scores for more than six months, Lynch adds. After they’ve received the senior registration clerk designation, she says, if they don’t maintain the standards, they move back to the former position.

Since the program was instituted in February of 2003, the cumulative achievement rate for the department has increased from about 93% to between 96% and 97%, Lynch notes. Cash collection rates also have grown dramatically during that period, she says. (See ED Collections graph.) Collection goals "can be a moving target," Lynch adds. "In the past, we shot for $30,000 [a month], then we moved [that figure] up."

Good management reduces turnover

Keith Weatherman, CHAM, associate director of patient finance, points out that when Lynch assumed her position four years ago, there was a 116% turnover rate among ED registration employees. "It’s less than 8% now," he adds. "Just having a good manager" is as important as any salary incentive when it comes to employee morale and motivation, Weatherman suggests. That means "not micromanaging," he says, "but just being a go-to’ person and empowering [staff] to make decisions." Employees had a voice, for example, in the recent ED remodeling project, Weatherman points out.

Competition is good for business

The atmosphere of healthy competition that has been created around the cash collections effort, meanwhile, is keeping Lynch, Weatherman and the patient financial services director busy providing positive feedback to the highly motivated registrars, he notes. "It’s a game now," Weatherman says with a laugh. "We get e-mail messages saying things like, I collected this much by myself on one shift.’ We can’t slack off one day on responding. The first message we get that we don’t respond to will kill it." The hospital’s chief financial officer visits with the staff on a monthly basis to show her appreciation for their efforts, he notes.

Lynch marvels that she and Weatherman also have been the recipients of some pretty positive feedback — from staff. "We’ve actually gotten thank-you letters from employees," she adds. "How often does that happen?"