200% increase in satisfaction scores

Patient access champions are key

Do you want a department that provides patient-centered registration, achieves excellent outcomes, and works well with colleagues in the clinical services you support?

"It has to start with staff who have the resources they need and who feel recognized and rewarded," says Steven R. Weiner, RN, MS, MPA, senior director of patient access at NYU Langone Medical Center in New York City.

Improving the patient experience is one of the patient access department's focus this year, says Weiner. (See list of behaviors identified as crucial to improve patient satisfaction, below.)

To ensure that staff members welcome patients and provide a comfortable waiting and reception area, managers identified staff champions in each registration area. "Supervisors met with them every week or two to identify steps we could take to improve. Then, the champions brought the plans back to their colleagues," says Weiner.

In the ambulatory surgery registration area, a registrar in the waiting area now greets patients and gives them the required information and forms. "They can begin looking them over before being called by the registrar," says Weiner. "We now provide standardized apparel — jacket or sweater, shirt or blouse, tie or scarf, slacks, or skirt — for all staff, which staff have very much appreciated."

The department's Press Ganey percentile rankings have improved as much as 200% in some cases, reports Weiner. "While we still have a lot of room for improvement, we can see that it's working," he says. "Registrars own the process of improvement and feel respected." In turn, this change creates an environment in which patients are treated with respect, Weiner says. Here are other ways patient access staff members are recognized:

• A three-step career ladder is available for patient access staff, with steps and requisites clearly defined.

"This is both to recognize and reward our best performers, but also to help chart career paths," says Weiner. "We also adapt schedules for staff going to school."

• Supervisors provide extensive training and support.

"Experienced staff serve as trainers, super users, and mentors," says Weiner.

• Patient access leaders receive feedback before changes are made.

"We have instilled in the department the idea that the people who do the work need to be consulted and heard whenever possible about changes in the procedures and tools they use," says Weiner.

For example, a work station on wheels was set up for completing admissions at bedside, external transfers, labor and delivery admissions, and emergency department admissions, as well as arranging payment for private rooms when requested. "But the registrars assigned to bedside follow-up found it unwieldy going up and down elevators and into patient rooms," says Weiner. They now prepare forms and materials ahead of time and use a special clipboard with attached storage compartment for papers.

"They use their workstation to manage work queues that track patients who still need to sign forms or pay for private rooms, maintain logs, and exchange emails about specific situations," he adds. For example, a registrar might note that "Mr. Smith will be in therapy all afternoon and asked for time to rest after he returns. Please stop by after dinner tonight."

• Executive leadership give special acknowledgement to patient access staff after emergencies and natural disasters.

"We have successfully staffed all our registration areas through hurricanes, electrical blackouts, and snowstorms — you name it," says Weiner.

In anticipation of flooding from Hurricane Irene, patient access staff helped the hospital evacuate all patients in an orderly way. "After each situation, we used to order pizza, but now offer a gift card instead so that staff can purchase a meal of their choice," says Weiner. "We have found they appreciate that."


For more information on improving satisfaction of patient access staff, contact:

• Cortney Gundlach, CHAA, CHAM, Director, Patient Access Services, Indiana University Health, Indianapolis. Phone: (317) 544-9623. Email: cgundlac@iuhealth.org.

• Steven R. Weiner, RN, MS, MPA, Senior Director, Patient Access, NYU Langone Medical Center, New York City. Phone: (212) 263-0776. Fax: (212) 263-7007. Email: Steven.Weiner@nyumc.org.

Top service skills for patient access

Patient access leaders at NYU Langone Medical Center in New York City identified the below behaviors as critical for patient satisfaction, based on its Press Ganey surveys and Press Ganey's support resources, says Steven R. Weiner, RN, MS, MPA, senior director of patient access.

• Physical appearance. Keep reception/registration spaces welcoming, organized, and comfortable.

• Greeting. Greet patients and companions immediately. Make eye contact and smile; introduce yourself.

• Interviewing. Manage expectations. Inform the patient what will happen after the interview; give reasons.

• Privacy. Maintain privacy.

• Caring. Practice simply being present. Show concern for people's comfort. Strive for helpfulness, not simply information provision. Be prepared to address language, hearing, cultural, and communication needs. Anticipate and address common concerns. Leave the desk to speak with patients and companions.

• Waiting. Provide frequent updates, and perform quick rounds.

• Handoffs. Escort and "hand off" the patient directly to clinicians.

• Service recovery. Take their requests and expressions of concern seriously. Listen, empathize, speak calmly, make a blameless apology, and offer options to the visitor.