Let\'s pretend that you are a manager in a hospital system, you have noticed tha

ID: 123729 • Letter: L

Question

Let's pretend that you are a manager in a hospital system, you have noticed that the check-in process patients go through at the front desk is very cumbersome and many of the steps repeat themselves. You believe that this is leading the patients and their families to become frustrated, before they are even checked into their appointment. You want to reorganize the process, but many people whose jobs are related to checking in, have been in their positions for a long time and are wary when changes are being made. Remember that a system with dynamic complexity can be identified through subtle cause and effect and these effects gradually build over time, so it's not obvious to participants what their actions are causing. What kinds of unique challenges might you find when trying to make changes in this kind of system? No one who is involved in the direct process of checking patients in has noticed that there are problems which should be corrected, what steps could you take to get them to see the problems and implement the solutions?

Explanation / Answer

Introduction:

Patient check-in is the process of signing-in of patients when they arrive at a healthcare facility, begin their registration, using a clipboard, electronic tablet, or with a paper work, sometimes with self-service before consulting a physician. It is a simple process, however, in reality, it is one of the most problematic areas in the healthcare system for both patients and receptionists.

There are various factors which cause breakdown in the patient check-in process:

1. Inadequate training for desk staff:

The check-in staff are not highly efficient meaning that they are not fully trained to meet the growing demands of patients and/or technology. For example, nowadays, many hospitals use computers for registration process and staff who are not well trained to use computers often register patient details very slowly and may commit mistakes. Additionally, staff who are slow in typing will take much time to complete the patient sign-in process. Furthermore, there is a lack of cross-trained staff to allow back-up for desk staff work.

2. The receptionist is not well-prepared for the day before it begins:

The number of desk staff working at check-in is not adequate to meet the number of patients arriving resulting in patients stand in line for the check-in process. It creates a delay in patient care documents reaching nurses and doctors for further care. As a result, patients and their relatives perceive hospital care negatively due to this long-wait time.

3. The reception desk is responsible for handling all incoming phone calls while the staff is trying to check-in patients who are waiting in line.

4. There are errors with demographics, referrals, pre-certifications, outstanding patient balances, and co-pays:

There may be errors in demographics when entering patient details into a computer creating insurance denials ant the resolution might take a long process and may consume more time. For example, insurance cards and driver’s license for new patients/patients with new insurance plans are not consistently scanned into the computer.

Similarly, information on referrals, insurances, pre-authorizations and/or eligibility is not reviewed and/or documented in the patient chart prior to his arrival. The staff may not obtain proper signatures for treatment and payments prior to a service being rendered. The staff may not consistently collect outstanding patient balances and co-pays. All these create, a negative patient perception, poor customer service and increased patient-waiting time.

What kinds of unique challenges might you find when trying to make changes in this kind of system?

There are multiple solutions with this problematic check-in process, however, there are also more challenges in implementing changes in the system.

These challenges are:

1. Resistance to new changes among staff:

Many receptionists do their work routinely and are well-adjusted to their work. They assume that they work hard despite a heavy workload. They often do their work in a standard way without learning ways to improve their performance or decrease their workload. This resistance-to-change attitude is very difficult to manage and any changes to be implemented should be gradual in a step-by-step fashion. They must be trained to work in a smart way and not in a hard way to improve their efficiency.

2. High-turnover of receptionists:

Another challenge is the high turnover of these staff. When a receptionist joins a hospital, he/she is ill-educated about the processing system and requires training. However, 6-12 months after training, he/she may leave the unit for better job opportunities leaving the position vacant resulting in the position to be filled with another new employee who does not know about the process; He/she once again require further training. This process repeats like a vicious cycle.

3. Inadequate training of staff regarding check-in process:

Often receptionists do not have adequate knowledge and skills regarding the check-in process making it cumbersome for both the patients and staff. For example, a newly employees receptionist does not know how to operate a computer or to use a new software. Furthermore, the staff also educated to manage basic problems in the computer hardware component (like more often shutting down the system due to some technical issue) or software component (e.g. system corrupts more often, software data is often lost, how to back up the patient details, etc.).

What steps could you take to get them to see the problems and implement the solutions?

To meet the healthcare standards, a desk staff should average 4-6 minutes per patient for the patient check-in process equalling approximately 12 patients per hour per staff.

To make appropriate modifications in the check-in process system, proper assessment of the current practice, identification of the problems causing poor patient satisfaction, appropriate planning, implementation and evaluation of the changes is essential.

S. No

Problem

Possible planning and implementation

Rationale for the proposed solution

Resistance to new changes among staff

High turnover of receptionists

Ensuring a contract between the newly employed staff and the hospital for a specific period

Less turnover reduces the hospital costs associated with recruitment and training of new employees.

Improves patient care

Conclusion:

To conclude, establishing a change among people, especially among old employees, is a difficult task, but it can be done through a gradual stet-by-step implementation.