EXECUTIVE SUMMARY
Investigations of complaints claiming registrars are unproductive might reveal that staff were on the phone with payers, experiencing computer downtime, or conversing with patients. Patient access leaders can take the following steps to prevent complaints about delays.
- Inform emergency department patients that registration doesn’t delay care.
- Use the electronic medical record to find out when events occurred.
- Ask for approximate dates and times registrars were observed.
An emergency department patient with a painful condition got back to a room quickly at Ochsner Health System in New Orleans, but no one came to do his registration for more than an hour. The man made two assumptions, both incorrect: First, he assumed registration staff were in no rush to get to him, and second, he assumed his care was delayed as a result.
In fact, the exact opposite was true. “We explained to the patient that we are legally required to wait until he was assessed and stabilized, so that our process does not cause a delay in care,” says patient access director Mary Neal, MBA, CHAM.
Patient access also took the opportunity to explain that the man already had been registered in the system, using only his date of birth. This allowed physicians to write orders and give medical treatment, with full registration done at a later point in time.
“We let the patient know that we did not delay his care. We delayed our process, so that his health could be top on the priority list,” says Neal.
The unhappy patient’s attitude changed after learning more about how things worked. “He was very thankful to have a different perspective and new understanding on the situation,” says Neal.
Unlike other departments, patient access employees are visible to clinicians, administrators, patients, and other visitors. “We’re in the ‘fishbowl,’ on display all the time. Everybody sees us, and perceptions are made,” says Marion Knott, manager of clinic access at Tampa, FL-based Moffitt Cancer Center.
EMR Can Shed Light
It’s not only patients who wrongly believe registration staff are slacking off. Registrars often are quick to accuse their colleagues of taking long or frequent breaks or not using downtime productively. “These types of complaints are ones that we can investigate relatively easily,” says Neal.
The electronic medical record (EMR) is the go-to tool when complaints of this nature come in. “It tracks the times that every was patient seen, the user who checked in the appointment, and what time the appointment was checked in,” explains Neal. Below are some common productivity-related complaints and how the EMR can help to determine their validity:
• Complaint: A registrar is doing nothing.
First, patient access managers review a week or so of data. The manager might notice a 30-minute gap of time where no patient was checked in by the registrar — yet others assisted many patients in that same 30 minutes. “That’s a great starting point for a performance conversation with the person in question,” says Neal.
• Complaint: A registrar is around when it’s busy, but disappears whenever things slow down.
The case of the “disappearing registrar” can be solved by running a registration timing report. “This shows check-in totals over longer periods of time,” says Neal.
• Complaint: A registrar is not using downtime productively.
The department expects registrars to use downtime to preregister the next day’s accounts and verify insurance. If someone isn’t doing so, there’s an easy way to prove it. “We have a report that shows insurances verified by user,” says Neal. “This determines if one person is doing the majority of the prep work for the next day.” (See related story on steps to address a patient access complaint.)
Mary Neal, MBA, CHAM, director of patient access services at Ochsner Health System in New Orleans, offers these practices when fielding a complaint about one of her employees:
1. Know everyone on your team well enough to make an educated guess as to whether the reported behavior is out of character.
“This is the best way to get an idea of what really happened in any given situation,” says Neal.
Registrars typically react similarly in stressful situations, regardless of who they are speaking to. “If a report of a rude comment sounds eerily similar to something said ‘off stage’ when that team member didn’t get his or her desired schedule, you can start to see those patterns emerge,” says Neal.
2. Listen to both sides, even if you suspect your team member was at fault.
“Any coaching to follow is much better received when there is a foundation of trust,” says Neal.
View the registrar as an impartial third party, and let him or her explain what happened. “You may think you know something and end up surprised at what you hear,” says Neal.
Patient access leaders tend to want to defend their employees — especially those who usually deliver great service. “It’s easy to think, ‘She would never say that!’” says Neal. After learning more information, however, it might become apparent that an innocent joke turned into a major misunderstanding.
3. Investigate what happened.
“There are lots of places you can go to find clues about what may have happened in a given situation,” says Neal. One easy source is the patient or family. By reaching out directly to whoever complained, it gives patient access a chance to apologize, and also to get the full story.
“There are also lots of clues present in your own EMR,” adds Neal. These include time-stamping of registration activities, gaps in productivity reports, and notes left by other team members.
4. Encourage your team to educate patients on their role.
This is a great way to prevent misunderstandings — but only if the patient access employee has a solid understanding themselves. “If a patient’s question is met with a short answer only because the team member does not know what else to say, things can escalate quickly,” says Neal.
5. Use role playing to practice difficult scenarios.
Patient access employees may lack confidence when speaking to patients, family, and colleagues. “I have mediated many situations that have escalated because one or both parties were lacking in verbal communication skills,” says Neal.
Hearing examples of positive, effective responses can help greatly in this regard. “We are often rushed during registration to keep the next patient from waiting in line,” says Neal.
Giving patients enough time to listen, read, and understand the information can head off many complaints, however. “The more financial and regulatory requirements are added to the registration process, the more skeptical patients become of signing their names on the dotted line,” notes Neal.
A simple statement such as, “I’m happy to give you a copy to review in detail. Please take as much time as you need and let me know what questions you have,” is helpful — even if staff don’t know the answer. Neal recommends stating, “That’s a great question! If you will have a seat, I will contact a supervisor to make sure I am giving you the most accurate and up-to-date information.”
Just the Facts, Please
An irate patient at Moffitt Cancer Center recently complained that a registrar was doing nothing but sitting and talking on the phone. “It turned out that her computer was down. She was on the phone with IT,” says Knott.
It’s wisest to stay neutral until you know the facts. Knott says to registrars, “This is the information that was brought to us. Help me understand what happened.”
Often, registrars are able to shed light on things. This was the case when a clinician claimed to have walked by a registration area several times on a particular day; each time, the registrar was “sitting there doing nothing.” The registrar’s explanation was surprisingly simple: He was doing his job — on the computer. “Because all our orders are electronic, the clinical team will walk by and say, ‘They are not doing anything,’” says Knott.
Knott always asks the person who’s complaining for an approximate date and time he or she observed the registrar. This way, the registrar can report what they were doing at that point in time. “When they give me their answer, I’m usually going to take the side of the employee, unless it’s something we’ve already addressed,” says Knott.
Knott then addresses two things with the person who complained:
- She tells them what she learned from the registrar.
- She encourages them to report problems immediately in the future. This way, patient access leadership can go observe what’s going on directly. “We can’t address it if we are not witnessing it,” says Knott.
Passersby might frown at a registrar engaging in seemingly idle chitchat about the weather or a sports game. This might be the best possible use of the registrar’s time, however, if a patient or family appears nervous or anxious. Knott encourages friendly conversation to put people at ease — as long as no one else is waiting. “It’s all about being aware of what’s around you,” she says. If a patient is sitting in the corner in terrible pain, for instance, excited chatter about a late night television show can come off as very insensitive.
Small talk shouldn’t interfere with the registrar’s workload, of course. If a patient gets too chatty, Knott instructs registrars to get back to work by saying, “Nice talking to you today! Have a great day.”
Some complaints are a case of mistaken identity. Recently, a physician complained that a newly hired patient access supervisor was wearing shorts and flip flops while eating a popsicle. Knott set out to investigate this strange complaint.
“I went to the supervisor and asked, ‘Were you onsite at any point wearing flip flops?’” says Knott. The employee responded that he didn’t even own a pair, and at that time, had been working elsewhere in dress clothes. When Knott went back to the physician who had complained, she asked an important question: Had the physician actually seen the employee doing this? “The physician admitted he’d never even met him, and had been told the information by someone else,” says Knott.
- Marion Knott, Manager, Clinic Access, Moffitt Cancer Center, Tampa, FL. Phone: (813) 745-3239. Email: [email protected].
- Mary Neal, MBA, CHAM, Director, Patient Access Services, Ochsner Health System, New Orleans. Phone: (504) 842-0322. Email: [email protected].
