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Admitting is a success story from the inside out.
Customer Friendly, Inside and Out
A dynamic service excellence effort is under way in Admitting and Registration

Jamie Gray, left, admissions coordinator, Debra Ransom, department assistant director

Admitting's CARING team, from left, seated, Diszell Williams, Ebony Johnson, Nadir Abdullah, Pam Campbell, Debra Ransom; standing, Carol Duhaney, Kimberly Lineberry, Dan Wassilchalk, Mary Cook
A patient is slated for surgery. He doesn't know it, but his insurance coverage has been terminated. Who's going to tell him? Admitting.

Another arrives to check in, but discovers no bed is available. Who's going to keep this ailing patient comfortable and informed until a bed is freed up? Admitting.

Responsibilities in the Department of Admitting and Registration are vast and varied and extend far beyond simply checking patients into the hospital. Admitting manages beds and maintains the hospital census. It collects personal and financial information and verifies insurance coverage. It processes patients' accounts and feeds account information to Patient Financial Services so that accurate bills can be mailed and the hospital properly reimbursed for its services. Staff routinely interact with patients and their families, often to elucidate the byzantine maze of managed care-not to mention handling ticklish situations like the two described above.

Admitting is one place where customer service is key. "It's that first impression," says Debra Ransom, assistant director of the department. "Once you come through the Wolfe Street entrance and pass the security guards, you come directly to Admitting," where the experience, she says, can make or break a patient's or family's perception of Hopkins. Today, Admitting is the setting of one of the most concerted efforts to improve customer service currently under way at The Johns Hopkins Hospital.

The project started about a year ago when Admitting found itself at a crucial crossroads. The department soon would be called on to implement important safety and efficiency initiatives: a patient picture ID with bar coding technology and an "electronic bed board," software that would furnish real-time census information. And yet the budget had been slashed; staff, downsized. Payers were denying too many claims for errors or lack of sufficient clinical information (administrative denials). What's more, last year's employee satisfaction survey had laid bare a sagging esprit de corps. "You just came into work, did your job and went home," says Admitting's Ebony Johnson.

Long before Admitting could address the finer points of customer service, it would have to get its own house in order. Director Dan Wassilchalk began by radically restructuring the department, grouping accounts managers into dedicated teams that would interact with specific clinical areas (medicine, surgery, emergency medicine, neuro/rehab and peds/ObGyn) so that back-office billing could be better coordinated with actual patient care. "We have developed good relationships with the [physicians'] secretaries," says neuro/rehab team leader Diszell Williams. "Before, we never knew who they were." Team leaders attend monthly briefings with department administrators. "We give them information on payer issues; they give us feedback on our processes, changes and restructuring," explains surgery team leader Carol Duhaney.

Admitting has reached out in similar ways to its other stakeholders, including Nursing, Patient Financial Services, Medical Records, Patient Relations and, because the department also handles death certificates, to Pathology and the state of Maryland, with which the certificates must be promptly and accurately filed. Admitting now is working with the state government and funeral home directors to overhaul its death certificate work, aiming to simplify the process for doctors and nurses so that paperwork can be turned around in less time with greater accuracy. Meanwhile, regular meetings among team members and the leader group as well as all-staff meetings "have helped broaden communications within the department," says Johnson, medicine team leader.

Still, productivity lagged. Each account manager was processing on average only six accounts per day. Before reorganization, four Admitting nurses were handling the more urgent cases that required clinical knowledge. If, for example, a patient needed additional surgery, an Admitting nurse would review the plan of treatment and enter the proper codes in the billing system. But with the reorganization, these nurses had been downsized; account managers were more or less feeling their way. In search of clinical knowledge, Admitting turned to nurses in the Department Performance of Improvement/Utilization Management. Now, PI/UM nurses are obtaining more authorizations, each account manager is processing eight accounts per day, and administrative denials are expected to drop by 20 percent.

Having tackled problems inside the department, Admitting now could turn outward to consider ways to better project customer service. On April 12, at a daylong retreat, the entire staff gathered to launch a campaign called "Caring Starts Right Here," one that is intended to build and sustain a level of trust, confidence and pride. Facilitators defined what CARING (an acronym for courtesy, appearance, respect, integrity, needs and growth) looks, feels and sounds like to co-workers and customers.

Almost a year has passed since work began in the Department of Admitting and Registration. Relationships have been forged with stakeholders, morale is on the upswing, and the department, even as it prepares to roll out new technologies, is more productive. Admitting has been a real success story from the inside out, proof that service excellence can give rise not only to a more customer-friendly workplace, but to a more productive and efficient one, too.




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