New department, manager push quality at St. Vincent
New department, manager push quality at St. Vincent
Effort includes mentoring, cross-training
As it grows by leaps and bounds, the patient intake department at St. Vincent Hospitals and Health Services in Indianapolis is making strides to ensure quality while managing at least 30 access points and more than 200 employees.
Comprehensive and consistent training for everyone who does registration is crucial to the process, says Sue Underbrink, hired in March 1998 as quality improvement and training manager. "We were in a decentralized environment for a few years, and now we’re heading in a different direction," she says. "Even while doing that, we still have registration scattered out among different areas, and we’re bringing smaller hospitals [into the health system]."
At present, she explains, preregistration is performed in the central patient access area. However, upon arrival at the hospital, the patient goes directly to the nursing unit where he or she will be an inpatient. Employees there finish the registration process.
"Eventually, in the next year or so, we will have centralized admitting again," Underbrink adds. "Patients will have been preregistered. When they come in, there will be someone on the first floor to hit the hot spots [of registration] and copy their insurance cards. Then someone will escort them to a room."
Like many health care organizations, St. Vincent has come full circle with the registration function. "In the late 80s and early 90s, there was traditional centralized admitting," she explains. "Then we went to patient-focused care, where registration was performed completely on the units. There were three or four years where the entire hospital was in patient-focused care, and then we started converting back."
There were good and bad aspects to the patient-focused care environment, Underbrink notes. "One of the problems with registration entirely on the units was that employees didn’t do it enough to become efficient with all the variables. The same was true with the financial counselors and insurance verification [employees], who didn’t report to a central department."
To ensure the accuracy and efficiency of St. Vincent’s increasingly far-flung registration sites, Underbrink is leading an ambitious training and quality improvement mission. Assisting her are two trainers and two auditors who assumed their positions in mid-October. Here are some components of St. Vincent’s program:
1. Intensive initial training. Any new employee who will perform registration undergoes an intensive two-week training course. "This training is fairly general. We go through registration pathways and make sure they know the different insurance [types] and how to prioritize," she says. "They learn good customer service, telephone etiquette, how to probe to get information to complete registration — information they need for any registration area."
2. On-the-job training. The next step is to put new employees in the workplace under a "buddy" or "mentor" system in which they learn skills specific to that area. "We’re getting ready now to bring on board those folks who are willing to be a mentor — not everyone is cut out for that."
3. Cross-training. Once employees have mastered the information specific to their area, the plan is to cross-train them so they will be proficient in any registration setting. That plan is on hold while the organization focuses on building the staff necessary to take on preregistration as a centralized function, she notes.
4. Annual competency fair. Any employee who registers patients will participate in this event, to be held every June at one site. "People will walk through and stop at different stations," Underbrink explains. "One might focus on insurance plan codes, to make sure they’re proficient at that. At another, they might sit down and be asked to register a patient. We’ll make it fun, while ensuring that everybody has the knowledge they need."
5. Annual inservice on insurance plan codes. In November, St. Vincent held six educational sessions focused entirely on insurance plan codes. Every registration employee was required to attend. "This is a joint project between patient financial services and patient intake," she says. "We struggle constantly with trying to match insurance cards to our codes." In the sessions, employees provide feedback on how to make the hospital’s insurance table more user-friendly. "We learn as much from them as they do from us."
To further promote quality improvement, the new auditors are developing various reports that will provide feedback on the registration process, Underbrink says. "The employees really want to do a good job, but they haven’t always gotten timely feedback."
Her department’s efforts already have had some impact. We’ve been able to provide feedback to those who don’t report to the central department — the unit representatives, for example. Their role is changing, but they won’t go away."
In addition, she says, "We’re providing the results of manual audits and also some electronic reporting on critical data fields that aren’t completed. We’ve added a new mandatory field for the primary care physician, which is one of the things we’re monitoring."
The error rate has gone down in a couple of instances, she adds.
The real benefit is in being able to work with registrars on how to perform the task properly. "We will manually look at face sheets and give feedback, but we will try to do as much electronically as we can."
In December 1998, her department began giving each registration area and its manager a report card, she says. "It will say, You’ve had this many registrations and this many errors. This is how many multiple registrations you’ve created.’ If we identify a particular area with a problem, the trainers will go there and do special coaching. Or it may be that everyone will need extra help in the beginning."
The idea is to look for trends, areas everyone is having difficulty with, and to be aggressive in addressing potential problems. "We want to give them the tools to do their job." For example, auditors have discovered inconsistencies in the way consent forms are completed. "We are getting that corrected."
(Editor’s note: Look for a closer examination of St. Vincent’s decision to move back to centralized registration in a future issue of Hospital Access Management.)
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