Urgent message: Embedding a clerical component within a relationship-based care approach has been shown to improve both financial outcomes and patient satisfaction.
Noel Clinton, BS
Introduction hen we hear the term “relationship-based care,” we tend to think first about the relationship between the clinical staff and the patient. However, a prospective program at Bassett Healthcare in Cooperstown, NY has shown that positive patient care and improved financial outcomes are also a result of developing a “bedside” business relationship. Bassett Healthcare Network is a system of physicians, providers, and hospital community health centers covering 5,000 © iStockPhoto.com square miles in eight New York counties. Around the region, the network provides primary, preventive, and outpatient care at 28 health centers—including urgent care at facilities in Herkimer and Oneonta, NY—and operates 13 school-based health centers. The Emergency and Trauma Services Department for Bassett is responsible for providing the professional staff for this entire network, and implemented a process in which clerical staff initiate contact with patients at specific points during a visit.
Background Significant growth within the network led to the addition of a management position whose mandate was to carry the department’s patient care approach to the operational level. The primary focus for this individual, initially, was to deal directly with patient complaints. The ability to listen to patients in a non-judgmental manner and “getting to ‘yes’” was the building block for learning about patient expectations. Consistent and visible support helped establish trust and respect with the individual affiliates’ leadership teams, paving the way for processes to be standardized. Historic and internal data from a callback program and patient complaints illuminated inroads to improving the patient experience. The network manager assembled a multi-location team to review that data and investigate opportunities to improve processes within patient flow. A nursing and business representative was asked to participate in a series of meetings that resulted in the “Fantasy Flow Workgroup.”
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T H E C A S E FO R R E L AT I O N S H I P - B A S E D C L E R I C A L C A R E
Figure 1. Relationship-based clerical care: Aligning clerical and clinical care workers for positive patient outcomes.
Patient presents at front desk
Patient triaged by nurse
Patient put in exam room/waiting room
Patient seen by provider
PATIENT IDENTIFICATION Registration staff • Identifies patient (name, date of birth) • Patient asked to sign Consent to Treat • Staff co-signs and dates as witness • Staff enters patient info on patient log • Quick registration – visit # created and 2 sets of labels printed • Patient identifies primary care provider • Patient identifies referral source • Staff puts labels on paperwork and places in nurse station
CLERICAL TRIAGE Registration staff • Introduces self and explains purpose of clerical function • Establishes rapport with patient and family members • Meets with patient/family to verify insurance and demographic info • Establishes copay expectations regarding discharge process • Follow-up assistance—transportation, Rx, appointments, copay expectations, survey
Registration staff confirms self-pay by checking resources for Medicaid status
Patient discharged by provider/nurse Selfpay? Nurse notifies registration staff of patient ready for discharge Confirmed as self-pay? No Yes CLERICAL DISCHARGE Registration staff • coordinates follow-up • collects copayment • coordinates transportation needs • coordinates financial assistances for Rx • reviews financial status • completes patient satisfaction survey No Registration staff • Distributes managed