Take these steps if a staff person isn't measuring up
Take these steps if a staff person isn't measuring up
Documentation is key
With all the data typically collected by access departments on individual staff members these days, it's easy enough to tell if an employee isn't up to par. But what action should you take, if you see that an individual's accuracy, collections, or patient satisfaction data are poor?
"Of course, selecting the right candidate for this type of position is key," says Tina Williams, director of access services at Monroe Carell Jr. Children's Hospital at Vanderbilt University Medical Center. "Patient access is no longer a clerical position."
"Regulations and technical challenges for patient access are massive and ever-changing," says Williams. "They must have strong communication skills, as they are dealing with people in crisis and asking questions many are reluctant to provide. They must also have compassion, as the situations these patients or their family members are facing may be overwhelming."
Once you are convinced you are hiring the right person, "it is important to provide clear documentation and training, from the moment the employee begins work," says Williams.
Turnover reduced 51%
Monroe Carell Jr. Children's Hospital's admitting department created an electronic way to track new hires and tenured employees learning a new job function. A training questionnaire is used, with a specific group of questions set up by the employee's manager.
"We require staff who are training a new member of the team to complete the questionnaire at the end of each shift," says Williams. "This can be done with very little upfront money or skill."
The information is automatically sent to the director and the manager of that employee. "This allows us to get up-to-date information on the progress of the employee. We can address issues during the orientation period and allow the employee to self-correct," says Williams.
A typical new employee training evaluation form might contain these questions:
Under the "conduct" heading:
Was the trainee attentive?
Did the trainee appear interested and eager to learn?
Did the trainee take instruction and constructive criticism well?
Did the trainee provide excellent customer service?
Did the trainee display good teamwork skills and seem eager to help peers when able or needed?
Under the "principles" heading:
Was the trainee at their assigned work station on time?
Did the trainee take an excessive amount of breaks or abuse time limits?
Did the trainee violate company or department policies (for example, were there excessive personal calls, cell phone or Internet use)?
Did the trainee wipe down his or her station and keep it well organized, stocked, and presentable?
Under the "progress" heading:
Was the trainee's speed adequate for the amount of training he or she has received?
Did the trainee show an ability to multi-task and do so without difficulty?
Did the trainee comprehend the information without being told repeatedly?
Did the trainee appear comfortable enough to run the station without instruction from the trainer?
The trainer is free to provide additional information he or she feels is relevant in a comment section. This may include positive comments, additional training the employee needs, or examples of skills mastered.
The training tool is located on the department's web site, so that every employee can complete his or her evaluation easily. These are collected by management electronically and placed in the employee's file, to be referred to during the 30, 60, and 90 day time frames of the evaluation process.
"For the most part, the evaluations are on the mark. The staff know faster than the managers if they are meeting expected progress. It also allows us to remind others that people learn at different speeds and by different methods," says Williams. "We have reduced our turnover rate by 51% in the past two years since we implemented this process." The tool also allows staff to re-evaluate the type of trainer the employee is best suited to.
Williams currently manages staff in admitting, operating room registration, front-end radiology, the transfer center, bed management, environmental services dispatch, and telephone triage. Since each of these jobs is different, some of the questions are customized to the specific role that is being performed. Once the questionnaire is set up, though, there is no real maintenance other than to add the employees' names, as these are removed when the training is completed.
"This is not a quiz, so there is no right or wrong answers," says Williams. "It is an assessment tool that the trainer completes on how they think the employee did for the day. We also ask the trainer to tell us how many times the employee has been trained on the specific task." In addition, the trainer reports whether the employee was dressed appropriately, whether notes were taken, and whether the employee's performance reflected the amount of training he or she has received thus far.
"The beauty of the system is that it sends me, and the manager for that specific area, an e-mail. I can read and intervene based on the comments and scores, even though I do not get involved with the day-to-day operations of each area," says Williams. "It helps me mentor my managers in the growth of their management styles."
In one case, the trainer gave a trainee low marks in attentiveness. In the comment section, she added notes explaining that the employee was very nice but didn't seem interested and did not take notes. "We called the employee in immediately to ask them how they thought training was going. We relayed the observations that the trainers felt about taking notes and paying attention," says Williams.
It turned out that the employee was unaware that the trainer had gotten a negative impression. "We provided pointers on how to avoid things that could be mistaken for being disinterested," says Williams. "Even if you don't learn by taking notes, it is often perceived as a sign that you are interested when notes are taken. It is also required that each employee take notes during training, so they can refer back to them throughout their orientation period."
What you must document
Once it becomes apparent that an employee is not meeting expectations, Williams' advice is to "document, document, document."
Providing performance plans to assist the employee with self-correction is the first step. "If the employee does not stick with the plan, then the manager must hold the employee accountable," says Williams. "Documenting meetings, missed deadlines, and errors can make the difference in the manager, and sometimes the employee, feeling like they were given every opportunity to make it work. There are times when it is just not a good fit."
Here is an outline of what is covered in performance plans used by Williams:
List of concerns
Job performance.
Communication performance.
Job expectations
Deadlines and re-occurring assignment dates.
Performance Plan
Progress information, such as checkoff lists and organized notes, are reviewed.
Training questionnaires are reviewed.
The employee is required to communicate any information or tools they feel would assist them in their success. "Some employees request additional training with the departmental trainer, some ask for a different trainer than the one they have been assigned, and some ask for printed materials," says Williams.
Weekly meetings are required. "The responsibility of scheduling and keeping the meeting is on the employee," says Williams. "These meetings continue until management feels the employee is meeting expectations."
Carole Helmandollar, executive director of ambulatory services at Children's National Medical Center in Washington, DC says, "We have union-represented staff in our patient access department so we start out with verbal counseling to review where they are not measuring up," she says. "We re-train them on that area of weakness, give them a grace period, and then re-measure them."
If there is no improvement, then the disciplinary process is started. "It is much easier to get the staff person to turn around when the problem is based on a quantifiable area like registration errors or denials. When it is a customer service problem, it becomes much more difficult," says Helmandollar.
The department is about to launch a customer service training program that will define the behaviors the employees are expected to demonstrate consistently. "We hope that will help us hold the staff accountable in a way that is perceived as fair and objective," says Helmandollar.
The customer service training is still in development, but the goal is to tie specific behaviors with the department's standards for service. Staff are required to make eye contact, greet patients checking in for appointments, make sure that all concerns are addressed before ending a phone call, and never say "I don't know" or "That isn't my job."
"We do patient satisfaction surveys that ask questions specific to these behaviors," says Helmandollar. "We track these responses in an access database, and then identify training needs by area. While this tool doesn't identify the individual employee who isn't adhering to the standards, it gives us a sense of where the problem, even if we can't narrow the negative feedback down to a specific person."
A good quality monitoring program allows you to identify performance issues early on. "Early on is the key," says Catherine M. Pallozzi, CHAM, CCS, director of patient access at Albany (NY) Medical Center Hospital. Your program should track registration accuracy, Medicare as a Secondary Payer accuracy, copayment collections, and include a feedback tool to keep employees apprised of trends, she says. A quarterly dashboard can be used to track unscheduled absences and tardiness.
"Providing the data to the employee, and identifying trends, can assist the staff member to focus on areas of opportunity," says Pallozzi. "We have developed a legend for all registration and Medicare as a Secondary Payer errors. Staff members can easily identify the trends."
Armed with all of this data, you just may be able to turn a bad situation around. "The more specific the information you can provide to your staff member, the better the result," says Pallozzi. If coordination of benefits and insurance assignment needs work, a remediation plan can be developed specifically targeting that area.
On one occasion, a tenured staff member had inconsistency in her registration accuracy rate, which was in the 60th percentile. A training specialist trended her errors and spent focused time with the staff member away from the work area. "Her accuracy rate hit 89% within 45 days of the one-on-one remediation," says Pallozzi. "It was an extraordinary effort by the staff member and the training team, but a success!"
[For more information, contact:
- Tina Williams, Director of Access Services, Monroe Carell Jr. Children's Hospital, Vanderbilt, 2200 Children's Way, Nashville, TN 37232. Phone: (615) 322-0408. E-mail: [email protected].]
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