Combat the top reasons staffers leave access
Make no-cost changes to convince employees to stay in access
Don’t accept status as a jumping off’ point
More pay, better hours, and the chance of advancement. These are the most common reasons patient access employees leave the department, says Betty Bopst, CHAM, CPAM, director of patient access at Mercy Medical Center in Baltimore.
"We have been working very hard to come up with non-financial incentives for employees, because pay increases are just not in the budget," Bopst says. Here are some changes made by patient access departments to improve retention:
• Patient access leaders at Northwestern Lake Forest (IL) Hospital, recently paid for all the department supervisors to take the Certified Healthcare Access Associate (CHAA) exam.
"All of them passed, and all were thrilled to add those four letters to their email signatures," says Elizabeth Burnstine, CHAM, manager of patient intake and access. (For more information on this topic, see "12 registrars in this system CHAA-certified each year!" Hospital Access Management, June 2013, p. 65.)
• Registrars and schedulers at Northwestern Lake Forest have the opportunity to become an "ambassador."
One representative from the main registration area, offsite registration, the emergency department, and scheduling is selected to become an ambassador for a three-month period, during which they meet monthly to address a specific topic.
"The initial group is selected by their supervisors. From there, they select their own successors," says Burnstine.
Bringing in someone from scheduling allowed staff in each area to get a sense of what the other area did. "Before, the schedulers would always say, Why don’t the registrars get this information?’ The registrars would say the same thing," she says. "They have done a little bit of sitting in each other’s shoes."
A recent group put together a computerized presentation about how the patient access teams work together to promote customer service. At the monthly staff meeting, one of the ambassadors gave the presentation to her colleagues. "Being able to stand up in front of a group of peers is hard. Having that skill can help anybody move forward," says Burnstine.
At first, the ambassadors were less than thrilled about their new role, since they assumed it would just mean extra work. "They thought it was just one more thing for them to do, but then they saw they were getting special treatment," she says.
Once a month, the ambassadors take a break from their work and sit for an hour and a half talking with their peers about important challenges the department is facing. "I have already seen the demeanor of previous members change, as they grow in their commitment," says Burnstine.
For their three-month term, the ambassadors also get the privilege of going outside the department’s standard dress code of a white top with a black, navy, or tan pants and are allowed to wear a colored shirt.
In the central scheduling department, where the dress code is more relaxed since employees don’t have face-to-face contact with patients, the ambassadors are permitted to wear jeans.
"It sounds like such a little thing, but they really appreciate us giving them that freedom," she says. "They know we can’t give them money." (See related story on creating a lead patient access role, below.)
• Employees at Mercy Medical Center are allowed to switch to another area of patient access.
Because the patient access area is mostly de-centralized, there are many areas that might be more appealing to staff members who are unhappy in their current jobs.
"If we want to retain someone who is looking to leave, I talk with them to discuss possibly moving to another area of patient access," says Bopst.
Some of the other areas don’t require weekends or holiday hours, and offer higher pay. These jobs require more knowledge and a different skill set, such as more insurance experience.
"It is our standard practice to move staff into these more desirable areas when openings occur, before we offer them to the public," says Bopst. (See related stories on making access positions more appealing, p. 113, and offering more flexible hours, p. 114.)
For more information on improving retention in patient access areas, contact:
• Betty Bopst, CHAM, CPAM, Director, Patient Access, Mercy Medical Center, Baltimore. Phone: (410) 332-9390. Fax: (410) 545-4044. Email: email@example.com.
• Elizabeth Burnstine, CHAM, Manager, Patient Intake and Access, Northwestern Lake Forest (IL) Hospital. Phone: (847) 535-6380. Fax: (847) 283-6909. Email: firstname.lastname@example.org.
• Tonia Metoyer, Supervisor, Emergency Department Registration and Admitting, Patient Access Services, Edward Hospital & Health Services, Naperville, IL. Phone: (630) 527-3889. Fax: (630) 548-8164. Email: TMetoyer@edward.org.
Retain staff: Create a `lead’ position
At Mercy Medical Center in Baltimore, MD, Betty Bopst, CHAM, CPAM, director of patient access, created a variety of "lead" positions for various areas of the department. "These jobs include different tasks and responsibilities that are not typical of their routine registration functions," she says.
Some of the lead positions require employees to review and correct accounts sent back from patient accounts. Other jobs involve re-running eligibility systems, reviewing Medicare members’ registrations to ensure the Medicare as Secondary Payer Questionnaire is accurate and complete, or attending revenue cycle meetings.
"This has been well-received by all," says Bopst. "They now come to me or their managers asking for things to do," she says. Staff members complete these levels in the department’s career ladder, to qualify for one of the lead positions:
"This slot is for nursing and college students, with a flat pay rate," says Bopst.
• Patient access representative I.
"This is an entry-level position in the emergency department or lab outreach, where someone with little or no experience could begin," says Bopst.
• Patient access representative II.
"This requires some experience and proven ability," says Bopst. At this level, staff members are able to move into the other areas of patient access, such as women’s imaging, admitting, outpatient, or chemotherapy.
• Patient access representative III.
"These are high-performing staff who are ready to move into lead or supervisory positions," says Bopst. Managers require Certified Patient Account Technician (CPAT) or Certified Healthcare Access Associate (CHAA) certifications for these jobs.
"Each level is a promotion with a pay increase," says Bopst. "The next step will be looking at our centralized scheduling center. This area would be a promotion from patient access representative."
At Edward Hospital & Health Services in Naperville, IL, a lead patient service representative role was created to allow aspiring employees an opportunity to advance. The job gives them some experience in managing the daily activities of the department.
"It allows the patient service representatives an available go to’ person to ask questions," says Tonia Metoyer, supervisor of emergency department registration and admitting. "They can get assistance and training on the spot."
Make access jobs more appealing
To reduce turnover, Tonia Metoyer, supervisor of emergency department registration and admitting for patient access services at Edward Hospital & Health Services in Naperville, IL, took a close look at the open positions in her department.
"We reviewed them to ensure they would be appealing to a large number of candidates," she says.
After reviewing the open positions, Metoyer made some changes to make the jobs more appealing to applicants. For some of the jobs, she removed the requirement to work every Saturday and Sunday, or every Friday and Saturday night. Instead of offering applicants only a Friday/Saturday/Sunday position, Metoyer offered Monday/Wednesday/Friday or Tuesday/Thursday/Saturday positions. She also offered applicants the chance to work Monday/Friday/Saturday shifts one week, and only Monday/Friday the following week.
"We also tried to ensure that the overnight full-time positions had two days off in a row, versus being split up by working a day, then off a day, then working a day," she says.
Turnover is challenge
Metoyer says turnover is a challenge primarily because the Patient Service Representative (PSR) role is typically considered an entry-level position, because it doesn’t require a degree.
"However, what we ask our PSRs to do in their daily activities is substantial!" she says. "The challenge of hiring and retaining PSRs has been one we’ve faced continually."
By making these changes, the department improved its turnover rates significantly, says Metoyer:
• Patient access managers plan for balance in staffing by hiring only a certain number of students at one time.
Many of the PSR candidates are in school and pursuing a career in healthcare, and they leave the department after they obtain their degrees, explains Metoyer.
"Depending on what stage they are at in their career path, they stay varying lengths in the PSR position," she says. "We are always happy for them to stay."
• Patient access partnered with recruiting.
"We came up with a plan to aid in the selection process, that lends itself to hiring for longevity," says Metoyer. The hospital’s primary recruiter came to the patient access areas to shadow employees, to gain a better understanding of the position and the type of applicant that would be the best fit.
• Metoyer asks candidates about their career growth goals.
"I ask where the candidate sees themselves in one year and also in five years," she says.
Metoyer says there is no right or wrong answer to this question, but the goal is to get an idea of the candidates’ goals. For example, the interviewer might learn that the candidate is pursuing certain educational or career goals in the short or long term.
"The hope is that the candidates’ response provides an indicator on where they are headed in their career and how the PSR role fits within their plan," she says.
• Metoyer provides explains the job’s responsibilities in depth during interviews.
An 80-hour shadowing training program is offered to all new hires, so they can learn their new job in the midst of everyday activities. "We also offer candidates a tour of the work area," she says. "They are introduced to employees and see daily activities."
What do your staffers want most? Flex hours
It can be more important than pay
When a registrar who had been in the department more than 30 years was thinking about leaving because of a problem with her hours, a solution was found quickly, says Elizabeth Burnstine, CHAM, manager of patient intake and access at Northwestern Lake Forest (IL) Hospital.
The registrar recently had been made a full-time employee, but she wanted to go back to part-time status. "We went to the VP and made it work," says Burnstine. "We got through it fairly easily, but I was prepared to substantiate exactly how it would benefit the organization if necessary."
Burnstine and the hospital vice president decided to do something they had never tried before, by splitting the registrar’s full-time position into two 0.6 part-time positions. "We had never done any job sharing in our department before. But we sat down and found a way to make it work for her, in a way that the department would not be shorthanded," she says.
Together, the two employees work more than 40 hours, equivalent to a 1.2 FTE, but because the other part-time person’s salary is much less due to her entry-level status, it comes out budget neutral, Burnstine says. As a result of the change and being able to keep her benefits, the employee not only decided to stay in the department until retirement, but thanks Burnstine profusely whenever she sees her.
Previously, other employees have requested a similar arrangement, and the department wasn’t able to accommodate it. However, because it has worked out so well in this case, Burnstine would consider doing a split position again. "It made such a difference in the employee’s life," she says.
Patient access leaders don’t have much control over salaries in their departments, but flexible hours are often even more important to employees struggling to balance work and family obligations, says Burnstein. In Northwestern Lake Forest Hospital’s central scheduling office, one employee works different hours during the summer because she has school-age children.
"Somebody in the department switches their hours with her over the summer, so the department still has the right coverage," says Burnstine.