Frontline people are at top of the career ladder

You’re supporting those above you’

The most interesting thing about the "leadership ladder" for access employees at Children’s Healthcare of Atlanta is that the frontline employee position is located at the top. "It’s labeled that way," says Millie Brown, senior director of the revenue cycle, "specifically because you’re not really going up the ladder. You’re going down the ladder, supporting the weight of what’s above you. Usually, people think they climb up the ladder [as they get promotions], but I tell them, No, you’re really climbing down.’

"Our concept," she adds, "is that those people are on top because they interact with the patients, and all of us below that are there to support them, rather than them supporting us."

The career ladder fits the concept of a five-point star — with the frontline employees represented by the top point — that the hospital uses to symbolize its mission, Brown notes. "We understand that it’s those people in our organization who will drive everything else."

The access career ladder has been in place about two years, Brown says, and in following it she has done almost all of the promotions in her department, which has a staff of more than 120, from within. A crucial requirement for being promoted — level by level — to the next position has to do with demonstrating the characteristics of that job, she adds.

For example, Brown says, she might ask a registrar who is interested in becoming a lead registrar, which is like an assistant supervisor, whether other staff members come to her for help. "I’ll say, When the lead isn’t there and employees have questions, do they come to you? Or is there somebody else they’re more likely to ask?’"

Brown has gone back to employees who have unsuccessfully applied for a supervisor job, she notes, and said, ""Let’s look at what a supervisor does. Can you say that people are looking at you like that?’ If I ask staff, Who symbolizes this [position]? Is it you? If not, you’ve got some work ahead of you, don’t you’?"

Tracy Wilson, a five-year employee of Children’s who now is the hospital’s interim manager of the central access verification team, has taken several steps on the career ladder — moving from emergency department (ED) registrar to team leader, to supervisor, to her current position, Brown says. But Wilson also has applied for a position and not gotten it, she points out. When she first went after the job of ED supervisor, Wilson explains, she thought she was the obvious choice because of her experience as an ED registrar.

"When Tracy was interviewed," Brown recalls, "she really botched the interview because she thought she had it in the bag. There were other people applying who were equally skilled and, while she was in the running, it was obvious she didn’t prepare. Her attitude was, Why am I even interviewing?’ She was not giving credit to those who had come to the department since she left."

A panel did the interview — as usually is the case — and when it came time to vote, the panel members picked someone else, Brown notes. "When I have someone come to me and apply for a job who doesn’t get it," she adds, "I always offer them the opportunity to debrief me as to why [she or he] didn’t get it, and what can increase their chances of being the top candidate next time."

Wilson’s coaching, Brown says, "was on how to present yourself and sell yourself, and how important an interview is, no matter how much you think you know the position."

After the interview, Wilson continues, "she told me how it went and that she thought I could do some things differently. She gave me a book to read. The next time I interviewed, I laid out all my qualifications, and gave them a copy. I acted like I was interviewing with somebody I didn’t know." The fact that she got the job that time, she adds, "was due to all that feedback and coaching and that book."

If an access employee expresses the desire for career advancement, Brown notes, "We give pretty much constant coaching."

"If there’s a scenario I need help with," Wilson adds, "she gives me her perspective — practical advice on how to handle a situation, and what she might do differently than what I’m thinking. Many times I’m not looking at the big picture."

In the case of an employee who needs to be disciplined, Wilson might give her the circumstances and describe the action she’s planning to take, Brown explains. "Then we role-play. I play devil’s advocate, giving every objection I can think of that the employee might come up with."

Before the leadership ladder was established, Wilson notes, "people didn’t understand what they needed to do to move up. You could interview from wherever — you didn’t need to be a team leader to interview for supervisor. Jobs were almost always opened up to outside [applicants]."

When she needs to fill a position, Brown says, she looks outside the hospital only if she doesn’t have a viable candidate within. "If I do go outside, I feel there is a failure on our part. We have either failed to hire appropriately or failed to teach appropriately."

"Even now, Tracy knows that her role includes teaching my team leads how to be supervisor," Brown adds. "If you move up, you need to have somebody to replace you. Last year, there were 11 internal promotions within our department."

Dealing with qualified candidates

The leadership ladder did not affect departmental salaries, she says. "What has changed is that staff now know there are opportunities [for advancement] if they do a good job. All they have to do is ask, and the path — the steps they need to take to personally advance — will be given to them."

Her own recent promotion, from director of access to senior director of the revenue cycle, is a natural outgrowth of the process, Brown points out. "I know that my success comes from my team. If everyone feels they can move up, it helps me move up and it creates more opportunities for them. It really works that way."

If there are too many qualified candidates looking for leadership opportunities, she notes, "We look for other places in the system where there are openings. We had a lead who was ready to be a supervisor, and I recommended her for a job in the transplant unit. She got a supervisor job over there, based on my recommendation."

Kim Wagner, interim manager of the case management unit — which reports to access — says that moving an employee to another area in the hospital directly benefits the access department. "We have a great advocate on the other department’s team."

"This is the first place I’ve worked where the leadership team encourages us to move up," Wagner adds. "It’s obvious they want to invest in us for our benefit, not just for theirs. When people know that is how we’re going to handle promotions, it adds a lot of trust with staff."

[Editor’s note: Millie Brown can be reached at (404) 929-7514 or by e-mail at]