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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.

The Pediatric Neurosurgery team in Oakland couldn’t figure out why their staff courtesy scores were low.

They had a new office building and felt providing exceptional care was part of the routine.

Then union co-lead Tanya Johnson noticed there was very little for the department’s young patients and their families to do in the waiting room.

“Kids would be running up and down the hallway,” says Johnson, who is a medical assistant and SEIU UHW member. “Parents would be chasing after them and not being able to focus. It was crazy.”

The department of Pediatric Neurosurgery cares for children with a full spectrum of disorders, including tumors of the brain, spinal cord and peripheral nervous system.

“These kids are the sickest of the sick,” says service manager Jim Mitchell, RN PNP. “They have serious, serious conditions. Anything we can do to make their visit a little brighter, we do.”

So the team decided to create a child-friendly environment, and went to senior leadership for funding.

The improvements included a large, colorful playhouse, a treasure chest, books and toys in each of the patient rooms—as well as a custom-built train set.

“Everyone on the team had input as to how the clinic would be set up and where the items would be placed,” union co-lead and receptionist Leap Bun says of the improvements that cost about $18,000.

To ensure infection control, the toys are wiped down on a regular basis by Environmental Services employees.

And the atmosphere does a lot to ease tension for their medically fragile patients and their families. 

“The children are less threatened and want to come here to play,” Mitchell says. “It seems like every day we have parents on a regular basis having to coax their children to leave the clinic.”

In three quarters, department scores for staff courtesy increased from 69.6 percent to 90.3 percent.

“In addition to our MPS scores we can measure the change in the faces of the children we interact with,” Mitchell says.

For other teams interested in this type of project, they suggest field trip to other facilities doing the same work. The Oakland team visited Sacramento and Roseville to refine their workflow processes.

And the team also found that families with children choose to wait in the clinic, even if their appointment is elsewhere or they’re picking up a prescription from the nearby pharmacy.

"They tell us it’s a nice place to relax and to calm their kids down while waiting,” Bun says.