Intensive training yields consistency, accuracy
Intensive training yields consistency, accuracy
What does everybody need to know?’
Large and growing health care systems with staff spread over multiple campuses often struggle to ensure that new employees receive consistent, accurate training on registration policies and procedures, no matter which area they go to work in.
With a highly decentralized patient registration department comprising 85 FTEs 105 people in total spread over four campuses, there were lots of opportunities for registration staff at the 490-bed Promina Gwinnett Health System to get different stories during on-the-job training, says Tom Morris, CHFP, patient registration manager. The lead worker in one area at the Lawrenceville, GA, health system, for example, might explain something differently than her counterpart in another part of the system.
To solve this problem, Promina Gwinnett created an intensive three-day training and orientation session for incoming registration staff that has greatly increased the skill level of new employees and made them more comfortable in their new jobs, Morris says.
"We wanted to standardize what people are being taught, the way forms are filled out, the way policy is implemented," he says. "We began to try and figure out what we wanted to communicate to everybody a core group of competencies and ask the question, What does everybody need to know?’"
Adding to the challenge is the fact that the health system is expanding in Gwinnett County, a suburb of Atlanta and one of the fastest-growing counties in the nation. "We’re always hiring new folks, and we lose a lot of good ones to higher- paying jobs within the system," Morris says. "My challenge is making sure people coming in have the tools they need to be successful."
To respond to that challenge, Morris and his staff developed three days of classroom training for every new registration employee, broken down as follows:
DAY ONE
In a regular classroom setting, there is a several-hour overview of the various patient registration services. The trainer either Morris, one of the registration supervisors, or the registration quality analyst goes over a checklist covering departmental organization and the primary functions of the patient registration department, including customer service, data collection, medical records, and account number generation. The different financial classes of payers are covered, as are insurance plans and legal issues.
The new employees are introduced to the system’s primary form of communication, intranet e-mail, and the importance of not only receiving messages from supervisors, but also, when appropriate, providing information themselves.
"We talk about communicating back to us," Morris says. "If something happens in the absence of a supervisor a physician is upset about something, or a patient is concerned, or [the employee thinks], I loaded this insurance, and I think it’s right, but will you look at it to make sure?’ we need to know."
The trainer discusses the absentee policy and policies regarding the probation period, requests for time off, calling in sick, media requests, and how to protect the patient’s privacy.
Later the same day, three hours are devoted to customer service training, a program developed with the health system’s in-house education department that features a list of competencies expected from all patient registration employees. These include, for example, smiling when you greet patients and addressing them properly with courtesy titles such as "Mr. Smith" or "Mrs. Jones."
Trainers also enact typical scenarios that registrars may encounter, such as handling telephone calls properly and how to respond when a patient asks, "Why do you want to know my religion?" Drawing from national studies on the subject of customer service, Promina Gwinnett teaches employees to use the word "connect" instead of "transfer" when sending a call to another department. "’Transfer’ feels like you’re passing them off," Morris explains. "One or two words can really make a difference. If you say, I’m so sorry you had to wait,’ it gives them the chance to respond, Yeah, I sure did.’ What’s better is, Thank you so much for waiting. We appreciate your patience.’"
The afternoon concludes with an overview of forms, including face sheets, consents, advance directive and patient rights information, and the "Important Message From Medicare."
DAY TWO
New registration employees are taken through the "auto flow" (a set of screens preprogrammed to pop up during the registration process) field by field and screen by screen. "We go through how to register a patient, from the database search to creating new medical record numbers, assigning guarantors, next of kin information, loading insurance, and, ultimately, printing the registration document," Morris says.
DAY THREE
The trainer takes a little time to review the registration flow learned the previous day, then covers the handling of Medicare patients and the Medicare questionnaire. Then trainers discuss additional registration functions, such as doing "out-to-in" and "in-to-out" transfers, assigning beds, and handling discharges.
The day concludes with instruction on the intranet e-mail system. Every person in the registration department is on an e-mail mainframe, which "facilitates a great deal of our communication," Morris notes. When employees begin a registration, they are notified immediately if they have an e-mail message.
Exit surveys of all the participants in the first class showed they felt much more comfortable going into their jobs than they otherwise would have, he notes. Supervisors and those who review charts reported exceptionally good work performance from the new employees who had undergone the training, he says.
Although the first three-day orientation session was held in late July, Morris and his staff had been preparing for it for about a year. Part of that preparation was the creation of a manual to complement the training effort. It includes key department policies, a checklist for requirements from the Joint Commission on Accreditation of Healthcare Organizations, a glossary of business office terms, and depictions of all the computer screens involved in registration functions. Each field is numbered for easy reference.
The manual also explains how to register patients if the computer goes down, the trauma registration procedure for the emergency department, and a list of all the codes, such as religion and marital status, needed to register a patient.
A team of registration supervisors, who also conduct the training, worked with Morris to prepare the inch-thick manual. Since the supervisors rotate being on-call for the health system on weekends, participating in the training helps them get to know more quickly the employees they may be called on later to assist, he points out.
Target the right areas for training
A key part of the preparation time was spent making sure everyone agreed on all the registration processes, he says. "We discovered some variation as we went along, and this helped us make sure we’re all playing from the same sheet of music."
As another part of the effort to strengthen his employees’ basic skills, Morris borrowed the idea of a competency test from colleague Carolyn Strange, patient access manager at Promina DeKalb Health System in neighboring DeKalb County. The training program uses a 50-question competency test of current employees to help prepare orientation materials and content. (See sample questions, at left.) The idea, he says, was to make sure he was targeting the right areas for training. In the future, it’s likely the test also will be given annually to all registration employees, not just to those finishing the initial six-month probation period for new hires, Morris adds.
After giving the test to staff, trainers determined there was a lot of confusion concerning the process of obtaining consent for treatment. As a result, Morris and the director of patient financial services met with the health system’s attorney and representatives from the risk management and medical records departments to ensure all were in agreement on who can sign for a patient to get treatment.
"We have a state law, but there is some interpretation involved," he explains. "For example, the law states that if someone presents themselves as being, say, a parent or guardian, you accept their word for it. If they’re not, most likely you will not be held accountable. But some hospitals may choose to be more conservative and require people to show guardianship papers."
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