admitting

During the normal stress of being admitted to the hospital, it's not always clear to patients and their families who does what.

And if a nurse or clerk can’t answer a question on admissions, the patient can get frustrated.

So it was in the admitting department at Fremont Medical Center in Northern California, where patients gave low satisfaction scores regarding the process.

“Many different staff use the word ‘admitting,’ so we needed to make sure we stood out, and that patients knew when their admission officially began and ended,” says labor co-lead and admitting representative Joanna Nelson.

Team members thought one of their biggest challenges was making sure patients knew when they were dealing with admitting staff versus other employees.

They first tried using scripted language, the “Right Words at Right Time” (RWRT) approach to let patients know when the actual admission process had started and the representative’s role.

When that failed, the UBT added another level of patient service and rounding, which included a small gift and card.

The gifts were mostly Kaiser Permanente brand items including cups, tablets, aprons, vases or plants. Admitting representatives also gave personal cards to each patient.

“We came up with an extra-special plan for our new admissions. Once the patient was admitted, the Admitting rep went back up to the room—either later that same day or the next day—and gave our patients a welcome gift,” shop steward and OPEIU Local 29 member Nelson says, describing the gesture as a “thank you for choosing our hospital.”

And it worked.

In four quarters, polite and professional customer service scores improved 21 points, and efficient and easy customer service scores picked up three points.

The team also helped by letting patients know how all the pieces fit together.

“Personalize your admitting process,” says Fonda Faye Carlisle, manager, Admitting and Patient Financial Services. “Since the admitting department is not the only voice that says, ‘I will be admitting you,’ admitting needs to personalize so the patient can differentiate between them and others, such as nursing.”

There were team benefits, as well, beyond the scores. Department morale and attendance also increased.

“Our satisfaction is seeing our patients happy and watching our scores improve,” Nelson says.

When the Anaheim Medical Center Admitting department unit-based team set out to increase its collection of inpatient hospital copayments, it had several hurdles to overcome.

Some staff members had to get comfortable with asking for money from patients. Others had to learn how to calculate copayments. They also needed to notify Admitting of a patient’s pending discharge so copayments could be collected at the point of service.

And since the team goal of collecting copayments didn’t always dovetail nicely with individualized goals, that put some staff members at odds.

“We had created this unhealthy competition,” admitting supervisor/manager and union co-lead David Jarvis says.

They also had the problem of convincing staff members in other departments that collecting copayments from hospitalized patients was not a bad thing.

"They used to think of me as Public Enemy No. 1," says Patti Hinds, a financial counselor and member of SEIU UHW.

To educate and motivate staff members about the importance of collecting copayments, the unit-based team held a kickoff meeting in January 2010.

Staff members who were good at collecting and calculating copayments were deemed “master users” and received training so they could help their peers learn to correctly calculate amounts due. They also got pointers on speaking with patients about the money they owed.

"We wrote scripts, we role-played and, as people did it more, they became more comfortable with asking for money and with knowing when it is appropriate to do so," admitting clerk, SEIU UHW Patricia Hartwig says.

The team also had to teach staff members in other departments about the benefits of copayment collection.

"We showed them the bottom-line connection between revenue collection and their paychecks," Hartwig says.

Better working relationships developed between admitting department staff and the nursing units, prompting nurses to contact admitting staff more consistently before patients are discharged.

"They came to realize we’re not the 'bad guys,' " says financial counselor Marcela Perez, an SEIU-UHW member.