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If you offer in-depth, relevant access training, your staff will line up to take part.
That’s the lesson at the University Hospital of Arkansas in Little Rock, where the Strengthen-ing Bridges program aimed at adding to and reinforcing the just-learned skills of new access employees has become so popular that existing staff are asking for the training.
"We really weren’t addressing this to existing employees," says Holly Hiryak, director of hospital admissions. "We were going to let them attend as needed, but they’re requesting it. They’re passing the word to each other."
Strengthening Bridges, the second phase of a comprehensive access training initiative, offers detailed information on the various payers, including the ins and outs of how they work and background on each payer or payer category, Hiryak says. "We’re explaining the whys and why nots, as well as how to do it, and the employees really appreciate getting that."
To further enhance the program, the access training advisory committee has expanded it from two days to three, and changed the training style to become more interactive, she notes. "Originally there was a more didactic delivery, with no hands-on training. Employees couldn’t practice the how to’s, and couldn’t sit in front of a computer."
Now, Hiryak explains, employees will get an in-depth description of the various players, including:
"Then we have scenarios — or case studies — that we have developed specific to the various clinics and settings on campus," she says. "The access staff will utilize the information to register a patient in the test system. The test cases will be completed at the end of each session, which is divided by payer categories such as Medicare, Medicaid, commercial payers, managed care payers, etc."
Trainers will attach an insurance card to a patient file and have employees proceed as though there is a patient in front of them, she adds. "They will enter information from this, [addressing such questions as]: Where do you put the referral number? Where do you put the effective dates?’ That way, if they hit roadblocks, they can ask questions."
Although Strengthening Bridges is exclusively an access program, the first phase of the training initiative, Building Bridges, has been extended to include all 2,100 of the clinical programs employees of UAMS, Hiryak explains. That includes anyone who works in a department or provides a service that contributes to the clinical activities of the hospital, she says.
Having billers and registrars sitting next to pharmacy and radiology technicians during soft-skills training sessions, Hiryak notes, has gone a long way toward tearing down the traditional silos that exist in a hospital.
Originally these new hospital employees went through the typical human resources orientation together before going their separate ways, she says. Now they spend two more days together, focusing on topics such as teamwork, professionalism, confidentiality, and effective communication, as well as a segment called "Introduction to the Revenue Cycle." (See more on the UAMS program in the July 2001 Hospital Access Management.)
Access managers introduced to the Building Bridges program at a retreat suggested that the revenue cycle segment gave employees too much financial information too early in the process, Hiryak says. Despite that feedback, she made the decision to go forward with the original curriculum and it got extremely positive evaluations from the new hires, she adds.
"We gave them an overview of the revenue cycle, where they fit in it, and what could happen if they were not team players," Hiryak says. "They said, We never understood this before. Thanks for taking the time to tell us.’" The new employees also gave positive feedback on the other soft-skills topics, she notes.
Having all the clinical programs employees together for this training also has helped build relationships among the participants, Hiryak adds, and in particular has helped elevate access employees, making them feel a part of the clinical areas.
The off-campus retreat for access managers, aimed at ensuring their buy-in for the training initiative, gave the managers a taste of the soft-skills curriculum, she says. "There were a lot of interactive activities, to address all of the various learning styles of adult learners. They absolutely loved it."
The training program originally called for employees to work with a preceptor for 60 days after going through the Building Bridges phase, and then to proceed to Strengthening Bridges, but that has changed, she notes. Now employees who are catching on quickly may take that step after 30 days, Hiryak says.
Establishing the preceptor program — whereby new hires are paired with experienced access employees for the first one or two months — has been somewhat difficult, she notes.
"Those we identified as preceptors didn’t really understand that role," Hiryak says. "We do have a four- to six-hour training session for the preceptor, explaining their responsibility. The difficulty is that some of the clinics are very small and the preceptor is the only [access] person currently employed there. The perception is that [this task] takes them away from their work station."
That perception is not altogether incorrect, she notes. In some cases — in clinics where the single access employee is training someone to replace her, for example — arrangements may be made for the training to be done in another clinic, Hiryak adds.
Generally speaking, she says, the preceptors are beginning to embrace the concept. "It probably is a little more time-consuming, but there is no more putting [a new employee] in front of a computer and telling that person to check with you if there are any problems. They’re now committed to be with that employee, not just walk away."