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Doing two access jobs fills need for challenge
ED supervisor also department trainer
When Tara Tinsley, CHAM, decided she needed an additional challenge in her role as access supervisor in the emergency department (ED) at Children’s Health System in Birmingham, AL, she didn’t have just an occasional extra project in mind. Instead, when the access director asked her what she’d like to do, Tinsley opted to take on the task of access department trainer, revamping the position into a proactive, hands-on job far different from the way it had been done in the past.
The need was there, she explains, because the previous trainer’s position had been eliminated in a cost-cutting move. "We lost one of our management staff, so the trainer became the supervisor of an area."
Access employees needed a neutral person, apart from their supervisor, to perform the training function, Tinsley contended. "I’m a sponge. I like to build my knowledge and tend to absorb and try to learn as much as possible. At the time I had the least number of employees of any supervisor, so it seemed appropriate." Tinsley was given a little extra compensation, she adds, and "free rein to develop the position as I saw fit."
The result has been an ambitious agenda of providing on-call, one-on-one training, re-engineering the on-line insurance verification process, and standardizing a quality assurance (QA) process for the department, she notes. In addition, Tinsley issues regular communiqués to staff that she titled "Something New" and "Vital Reminder."
While the previous trainer had focused on distributing training materials to staff and writing policies and procedures, she notes, Tinsley had a different vision of the position. "If an employee’s QA scores fall below a certain point, I work with the person’s supervisor to identify her weaknesses, where she needs help, and then I sit with that employee," Tinsley says. "I keep the lines of communication open, and give them one person they know they can come to."
"Not that I receive a training call every day, but I do have an open-door policy," she adds. "Employees don’t have to go through their supervisors to get to me. They can page me, call me, or e-mail me when they need help. They might be right in the middle of a registration and something unusual occurs, so they page me."
Tinsley lets employees know they can call her for help even when she is not at work, and with the access department open 24-7, she says, "I do get called after hours." Every month to six weeks, Tinsley says, she produces the one-page flyer called Vital Reminder. (See sample flyer.) "It encompasses key training opportunities we see with our staff," she adds, "like continued improvement with customer service."
The flyer also might inform staff of problems she has noticed with customer accounts, such as an incorrect insurance entry, Tinsley says. "I like to say I do one every month, but it may be six weeks. It is e-mailed to all [hospital] access personnel, as well as to nonaccess areas — such as outlying clinics — that use our computer system to register patients."
The other publication, Something New, is used to announce new policies or procedures, or changes that are to be implemented at a certain point, she notes. "For example, some changes to the way our staff enter insurance go into effect on Monday. Rather than let them come to work that day and experience this live, I created a training sheet that tells them what the changes are, how they will impact [employees], and gives a step-by-step process for working through the change."
Tinsley’s biggest training effort, she says, has been the re-engineering of the hospital’s on-line insurance verification system. As part of that process, she rewrote the 30-page insurance training manual and, with the help of an information systems (IS) person, conducted the training for all the employees who register patients, Tinsley adds. Several training sessions were held over about a two-week period prior to the changes going live, she notes. The manual is revised periodically, Tinsley says, and she maintains those revisions.
QA process standardized
Also in her role as trainer, Tinsley developed a standardized quality assurance process for the department. "Before, each supervisor had her own way of reporting information," she explains, "and there were different standards for what was acceptable and what was not acceptable. One supervisor might have felt 95% or more was a great accuracy rate, whereas the director’s vision was 97% or better."
What Tinsley devised, she adds, is "basically a manual process in which each supervisor pulls his or her access facilitators’ [registrars] paperwork at the same time every quarter. They check 12 key data elements in the registrations to make sure they’re all filled in the same way."
The work is scored, reviewed, and entered into a spreadsheet, Tinsley says. "We do the same thing for the electronic verification system. We get on-line reports of [employees’] percentages. They tell us how many insurance verification requests they sent out in a quarter and, out of those, how many were not verified and how many were duplicates."
When registrars send out a request, she notes, they don’t get a response right away, perhaps because the system is temporarily down. "They may not know how to read [the message] and think they need to initiate another request, which is a duplicate." The point, Tinsley says, is to reduce the duplicates since every time a request is initiated, there is a charge to the hospital. When a registrar’s scores are out of line in some way, she adds, "is when I’m summoned to work with a person."
Another facet of the training program, Tinsley points out, is a buddy system, whereby more experienced access facilitators in different areas provide training to new hires. "Training is also based on the progression of the new employee, which is good and, I think, unique with our program," she notes. "Of course, we have an expectation of when new employees should be able to "fly on their own. Intervention by me takes place if an employee exhibits needs beyond that point, usually four to six weeks out."
About the same time she was revamping the insurance verification system, Tinsley says, she also was working with the IS and managed care departments to improve the insurance plan code process. With a large number of insurance entities listed in the master file, it was hard to define which patients qualified for certain discounts, she notes. "I worked with managed care to streamline the process and to decrease the number of errors [associated] with certain plan codes."
In addition, Tinsley says, they minimized the number of plan codes by purging those that were no longer in use, but whose presence in the list increased the likelihood of error.
Tinsley provided registrars with an insurance plan code guide sheet that includes the insurance company name, the plan code, and hints to help in selecting the correct one, she adds. (See plan code sheet.) "Some of the insurance companies may lease the network to other managed care organizations, so we only have one code in our system." With the help of the plan code guide, Tinsley says, registrars know to use that code for the other plan names. "It was a huge effort," she says. "I even collected insurance cards so [employees] could see the different types — what cards looked alike and could be confused."
There are a couple of things, Tinsley says, that help her manage her training responsibilities while also meeting the demands of being a supervisor. "The redirected focus on how to train our staff has made the difference," she notes, as has personalizing the training to address the specific needs of one person. And, she adds, "While I am always thinking of ways to improve the jobs our access facilitators do, I am not on a training call every day." To access departments without designated training personnel, Tinsley strongly recommends having "one person or a few people who really know and understand the processes and who can convey [that knowledge] to staff members."
"Accountability is hard to place," she says, "if training is no one’s or too many people’s responsibility."
One of the most gratifying parts of the personal approach to training, Tinsley says, is that "it makes the employees feel they really have somebody to go to. I had one [registrar] say I made a difference in her deciding to stay."
"I sat by her side for a week to make sure she didn’t feel out of the loop and really understood what she was supposed to do."
[Editor’s note: Tara Tinsley can be reached at (205) 558-2380 or by e-mail at Tara.Tinsley@chsys.org.]