Access Management JournalThe Official Journal of the National Association of Healthcare Access Management Volume 36, Number 1

National Association ofHealthcare Access Management

TM

The NAHAM Government Relations Committee Stands Strong for Members 5

Change Management: What is It and Why is It Needed? 8

Is Performance Only Measured and Not Achieved? 13

Access Management Journal Author Guidelines

The NAHAM Access Management Journal is published by the National Association of Healthcare Access Management (NAHAM). It is designed to share ideas and experiences, and to learn about trends and developments in the field of Access Management. The Journal welcomes news, articles, and story ideas from members and other writers.

Article TopicsThe NAHAM Access Management Journal accepts unsolicited articles but does not guarantee publication of all submissions.The Journal accepts a variety of article types, including: • First-handexperiencewithtrendsinthefield• Newprojectsthatyourorganizationisdevelopingor

implementing • Newproductsorservicesthathaveincreasedyourjob

productivity • Newsfromcommitteeoraffiliatemeetings• Trendsorproblemsemergingintheworkplaceorthefield

in general • Reportsonlegislationorpolicyissuesthataffectthefield• The“lighterside”oftheworkplace• Bookreviewsrelatedtoworkorthefield• Articlesontopicsofspecialrelevancetofront-linestaff

The NAHAM Access Management Journal welcomes submissions from the industry. Specific products or companies cannot be endorsed in editorial pieces and therefore should not be mentioned in the body of the article. Company and/or product information may be included in a brief description contained in the author biography at the end of the article.

Submission FormatArticles should be submitted in English, by email in a Microsoft Word file. If email is not available, files can be sent onaCDviamail.TimesNewRoman12pt.orArial10pt.font is preferred. Articles should be accompanied by a cover sheet that includes the article title, author(s) name(s), address, telephone number, email address, brief biography (one to two sentences that contain the author’s name, credentials, current position, and committee name and/or chapteraffiliation,ifapplicable),andphoto.

Photosorgraphicsmustbecamera-readyandcanbesubmitted as an attachment via email along with the article. AcceptablephotographfileformatsareJPG,TIF,andPDF.Photosmustbehighresolution(300DPI).Hardcopyphotographs also may be mailed. Graphs, tables, and charts also may be submitted to further illustrate the article.

Quotes and statements from sources must be attributed. Facts(suchasstatistics)mustbereferenced.Donotuseabbreviations. Acronyms may be used after the first full reference.

Copy EditingAllarticlesaresubjecttoeditingbytheeditorialstaff.

ExclusivityArticles should not be under consideration for publication by other periodicals, nor should they have been published previously (except as part of a presentation at a meeting).

CopyrightAuthors must agree to a copyright release, transferring copyright ownership to the Access Management Journal before an article is published.

2012 Publication ScheduleIssue Materials Deadline Publication Date Issue1,2012(PrintedIssue) February21,2012 May2,2012Issue2,2012(OnlineIssue) June21,2012 August29,2012Issue3,2012(OnlineIssue) October12,2012 December20,2012

How to SubmitAll articles and accompanying photos or graphics should be submitted via email to the NAHAM editorial team at journal@naham.org. Additional information also may be found on the NAHAM website at www.naham.org. Microsoft Word files on CD, hard copy photographs, or supporting materials can be mailed to:

NAHAMAttn: Access Management Journal2025MStreetNW,Suite800Washington,DC20036

Ifyouwouldlikeyourphotosorfilesreturned,please includeaself-addressedstampedenvelope.

Alternatively, articles may be submitted via our secure online form, which can be found at www.naham.org.Beforecompleting the online form, please have an electronic copy (.doc or .txt file preferred) of the article ready for upload. Any accompanying attachments must be sent via email to journal@naham.org.

Submit an article to the Access Management Journal today! Authorsearn3.0contacthoursperpublishedarticle.Toviewissues of the Journal online, visit www.naham.org.

Access Management JournalThe Official Journal of the National Association of Healthcare Access Management Volume 36, Number 1

National Association ofHealthcare Access Management

TM

The NAHAM Government Relations Committee Stands Strong for Members 5Change Management:

What is It and Why is It Needed? 8Is Performance Only Measured and Not Achieved? 13

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Table of ContentsFeature Articles

5 The NAHAM Government Relations Committee Stands Strong for MembersBy Brenda Sauer, CHAM, RN, MA; and Michael F. Sciarabba, MPH, CHAM

8 Change Management: What is It and Why is It Needed?By John Woerly, MSA, RHIA, CHAM, FHAM

13 Is Performance Only Measured and Not Achieved?By Arnelius (Neil) Baker, CHAA, CHAM, CPAT, ACPAR, CFC

16 Job Satisfaction Creates an Ethical Mind-SetBy Maria Romeo

18 Improve Productivity: Identify Your Staff’s Motivating FactorsBy Diane Ciotta

20 Eight ‘Be-Attitudes’ of Holding People AccountableBy Bob Whipple, MBA, CPLP

Departments

4 President’s Letter

22 NAHAM Advocacy Update

24 Member Spotlight: Jeff Brossard

Access Management JournalThe Official Journal of the National Association of Healthcare Access Management

NAHAM BoArd of directorsHolly Hiryak, RN, MNSc, CHAM, PresidentPatricia Consolver, CHAM, Immediate

Past PresidentJeff Brossard, CHAM, Vice PresidentTammy Stone, SecretaryEd Spires, CHAM, TreasurercoMMittee cHAirsPolicy development/Government relations committeeBrenda Sauer, CHAM, RN, MAcertification commission Elizabeth Reason, CHAMeducation committeeTammy Wood, CHAMPublications/communications committee Jim Hicks, III, CHAA, CHAM, CAM, FHAMMembership committee Jeff Ferrell, CHAA, CHAMspecial Projects committee Tony Lovett, CHAM

reGioNAl deleGAtesNortheast regional delegate and executive delegateCatherine Pallozzi, CHAMNorthwest regional delegateDonna Aasheim, CHAMsoutheast regional delegate Paul Shorrosh, CHAMMidwest regional delegateSuzan Lennen, CHAMcentral regional delegateRebecca Holman, CHAMsouthwest regional delegate Yvonne Chase, CHAMex-officiolegal counsel Michael J. Taubin, Esq.

editoriAl BoArdJim Hicks, III, CHAA, CHAM, CAM, FHAM

Chair, NAHAM Publications/Communications Committee, MedAssets, Fernandina Beach, FL

Jane Severs Bayhealth Medical Center Dover, Delaware

Judi Steckler South Nassau Community Hospital Oceanside, New York

Charlene Smith Eaton Rapids Medical Center Eaton Rapids, Michigan

Millie Hast, CHAM MD Anderson Cancer Center Houston, Texas

Volume 36, Number 1

NAHAM NAtioNAl officeExecutive Director: Mike CoppsProgram Manager: Tiffany BoykinProgram Associates: Caroline Fabacher and

Belle McFarlandMarketing Coordinator: Lindsay PullenEditorial Manager: Dennis CoyleEducation Manager: Stacey BarnesCertification Manager: Delicia HurdleEvents Senior Coordinator: Alexandra Zapple

Access Management Journal (ISSN 0894-1068) is published by: NAHAM2025 M Street NW, Suite 800Washington, DC 20036-3309Telephone: (202) 367-1125Fax: (202) 367-2125Website: www.naham.org

© Copyright 2012, National Association of Healthcare Access Management.Indexed in Hospital Literature Index, produced by the American Hospital Association in cooperation with the National Library of Medicine.

The printed edition of Access Management Journal is not to be copied, in whole or in part, without prior written consent of the managing editor. For a fee, you can obtain additional copies of the printed edition by contacting NAHAM at the address provided.

The National Association of Healthcare Access Management (NAHAM) was established in 1974 to promote professional recognition and provide educational resources for the Patient Access Services field.

The Access Management Journal subscription is an included NAHAM member benefit. NAHAM 2012 membership dues are $165 for Full Members and $1,500 for Business Partner Members. For more information, visit www.naham.org.

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President’s Letter

Springisofficiallyhere,summerisrightaroundthecorner,andchangeiscertainlyin the air, too. The turning of the seasons brings with it hope and optimism for what lies ahead for ourselves, our families and friends, our careers, and our role in Patient AccessServices.Ontopofthat,ourcountry’sleadershipispreparingforanotherelectioncycle,aswell,whichissuretobringchangeforthoseinpoliticaloffice,justasthere is change underway with NAHAM leadership.

Forme,thatmeansmytermasNAHAMpresidentiscomingtoanend.IhavegreatlyenjoyedtheexperienceofservinginthisroleandenhancingthestrategicvisionoftheorganizationanddevelopingprogramsthatNAHAMofferstoitsmembersinPatientAccessServices.I’malsolookingforwardtoservingaschairoftheMeetingOrganizingCommitteeasweplananothertop-notcheventin2013atNAHAM’s39thAnnualEducationalConference&ExpositioninAtlanta,Ga.Icertainly hope to see you there.

While I will miss serving as your president, NAHAM is in good hands with IncomingPresidentJeffBrossard.YoucanlearnaboutJeffinthisissue’smemberspotlightdepartment.AlsoontheNAHAMBoardofDirectors,ourPublications/CommunicationsCommitteeChairJimHickswillbesteppingdownafteryearsofquality service overseeing the publication of this Journal as well as other NAHAM content.IwouldliketoextendmyappreciationtoJimforallthequalitycontenthehasbroughtusoverthepastfouryears.TonyLovettwillbetakingoverthatresponsibility and will continue the tradition of delivering valuable, relevant information and articles toNAHAM’s members.

This issue reflects the theme of change. We even have an article from John Woerly, MSA,RHIA,CHAM,FHAM,titled,“ChangeManagement:WhatisItandWhyisItNeeded?”Theissuealsofocusesonmeasuringperformance,jobsatisfactionandimproving productivity. And of course, the Journal features our usual sections dedicated toNAHAM’songoingadvocacyeffortsandtheaforementionedmemberspotlight.

Ihopeyoutakethetimetoreadthisissueandthevaluableinsightitwillbringtoyouinyourcareer.Iwouldalsoliketothankyouonceagainfortheopportunitytoserveasyourpresidentforthepastyear;ithasbeenanhonor,andIlookforwardtocontinuingourworktogether,movingforwardandflourishingintimesofchange.

Sincerely,

Holly Hiryak, MNSc., RN, CHAM, Access Director, Ambulatory Services UAMS Medical Center, Little Rock, AR

Change is in the Air

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Th eNAHAMPublicPolicyBlog(http://nahamnews.blogspot.com) was created by the committee last year to provide healthcare access leaders with current and relevant information.Th eGRCommitteealso develops relationships and coordinates activities with federal, state and local government agencies, and legislative bodies that promote NAHAM’s mission. Th e GRCommittee’sprimaryroleisto communicate to the NAHAM membership on regulatory, legislative, and healthcare reform topics and industry trends.

Introducing The ToolkitsTh eGRCommitteeiscommittedto providing NAHAM members with the resources they need to continue to meet regulatory challenges and be successful through regulatory audits. Participating in Th e Joint Commission(TJC)SurveyoraCentersforMedicare&MedicaidServices (CMS) Audit can be challenging and overwhelming in terms of the information needed by the healthcare access stafftobesuccessfulinthetracermethodology, group tracers or in an

auditsituation.Th eGRCommittee,though, is currently designing and buildingtoolkitstoassistNAHAMmembers in preparing for a survey oraudit.Th etoolkitswillconsistof survey description and sharing experiences and provide teaching materials and practice survey questions to be shared with the staff.Toolkitswillbeavailabletomembership on the NAHAM websitein2012.Inthisarticle,GRCommitteeChairBrendaSauerand member Michael Sciarabba introduce the fi rst two case studies forTh eJointCommissionToolkit.

Overview: The Joint CommissionTJC,anindependent,not-for-profitorganization,accreditsandcertifiesmorethan19,000healthcareorganizationsandprogramsintheUnited States. Joint Commission accreditation and certifi cation isrecognizednationwideasasymbol of quality that refl ects anorganization’scommitmentto meeting certain performance standards.

TJC’s Mission:Tocontinuouslyimprove healthcare for the public, in collaboration with otherstakeholders,byevaluating

The NAHAM Government Relations Committee Stands Strong for MembersBy Brenda Sauer, CHAM, RN, MA; and Michael F. Sciarabba, MPH, CHAM

healthcareorganizationsandinspiring them to excel in providing safeandeffectivecareofthehighestquality and value.

TJC’s Vision Statement: All people always experience the safest, highest quality,best-valuehealthcareacrossall settings.

FormoreinformationofTJC,visit www.jointcommission.org.

Engaging the Tracer Methodology at Three Major Focal PointsAdvocate Illinois Masonic Medical Center, in Chicago, alwaystakesacollaborativeandmultidisciplinary approach in preparingforTJCsurvey.Inthelastsurvey,whichtookplaceinFebruary2010,thisapproachwascritical to achieving success.

Th e tracer methodology that TJCutilizesinitssurveyisan interdisciplinary review of process steps. Patient Access is the fi rst step in every patient encounter and there are three majorareasthatwereevaluatedineach tracer, with connections to Patient Access—patient privacy, patient identifi cation, and patient

The National Association of Healthcare Access Management (NAHAM) Government Relations (GR) Committee is hard at work for NAHAM members. The GR serves members in many ways.

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throughput. Patient Access is expected to respond to these functions through the survey process.

Patient privacy is always a concern for Patient Access managers. There are many considerations to ensure the security and privacy of a patient’s personally identifiable information. Surveyors rounded to Patient Access areas to ensure thestaffwasmakingitsbesteffortto ensure patient privacy. They werelookingforvalidationinthefollowing areas:1. Registrationboothsandfront

desksproveanattempttolimit seeing or hearing other patientinteractions(staffandpatients) from each station and eliminate detailed patient specific information exchanged in public areas;

2.HIPAAnoticespostedinregistration areas and available copiesforpatientstotakewiththem; and

3. Hospital directory to ensure there is a function in the ADTsystemforpatientstobe removed from the hospital directory, when requested.

Although the evaluation was very informal and brief from the surveyor,PatientAccessstaffcouldanswer these questions when prompted. The Patient Access manager noted that during the rest ofthesurveyweekthesurveyorslookedintoPatientAccessontheir way in and out of the facility a number of times; each time, theycheckedprivacyandsignagerequirements.

Positive patient identification plays a critical role of Patient Access.Surveyorsaskedcliniciansto identify the primary patient identifiers. The Patient Access manager and team anticipated this and prepared clinicians to be able

to respond. Patient Identification isakeycomponenttoprovidingsafe care and is a national patient safetygoalofTJC.SincetheonsetofthisfocusbyTJC,PatientAccesshas done much to prepare.

Prior to the survey, Advocate Illinois Masonic Medical Center’s PatientAccessstafffocusedonareassuchasstandardizingprocess,standardizingtraining,andaddingakeyresultareatomeasurepatient identification monthly. Onestandardprocesswithruleswascreatedforallstafftoidentify patients. This was adopted throughout the facility and is commonly referred to as the patient identification algorithm. All patient identifiers were trained on the standard process and certified in patient identification before being abletoworkonthefrontline.

Lastly,duplicatemedicalrecords(controllable) are monitored and measured on a monthly basis to ensure individual and departmental accountability to the goals. Patient identificationremainsakeypriority, as it continues to have amajorimpactincreatingandsustaining a culture of safety at Advocate Illinois Masonic Medical Center.

Patient Throughput was another areaoffocusforTJCinthesurvey.Leadersfrommanyareaswereaskedtodiscusspatientthroughputwith the surveyors in the board room.TJCwasinterestedinseeinghowpatientthroughputstaffprioritizedandmonitoredonadailybasis.TJCsurveyorsaskedleaderstopresentandanalyzedata on patient throughput. They were particularly interested in the reports, showing how the reports improved performance and how staffprioritizedpatientmovementthroughout the facility. In addition, there were many questions about how nursing and other departments integrated their focus to improve patient throughput at the facility. PatientAccess/BedManagement,Emergency Department and Surgical Services received the mostattentionandTJCwasveryimpressed with Advocate Illinois Masonic Medical Center’s focus.

In retrospect, Patient Access leaders recommend the following to prepareforTJCsurveyonpatientthroughput: show data (historical and current), demonstrate how data is widely communicated interdisciplinary, demonstrate improvements made through data and their outcomes and be abletospeaktohowpatientsareprioritizedandmovedthroughthefacility when competing interests are present.

Constant and Ongoing Training: Patient Safety FridaysNew York Presbyterian Hospital hasauniqueandeffectivefocusonpreparingforTJC.Thesemethodshave promoted successful surveys. The principle behind their success is to prepare on a constant and ongoing basis. Their preparation starts at the conclusion of a survey. The main goal is to be ready at any time and in any area of the hospital;

The GR Committee is

committed to providing

NAHAM members with

the resources they need

to continue to meet

regulatory challenges and

be successful through

regulatory audits.

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Training materials and

survey questions will be

posted on the NAHAM

website. The committee’s

goal is to have the toolkits

for TJC and CMS on the

website by the end of 2012.

NAHAM and the committee

will continue to develop

toolkits in 2012 and beyond.

the entire hospital participates and has a role in achieving successful survey results.

EveryFridaymorningatNewYorkPresbyterian Hospital, with very few exceptions, is dedicated to patient safetyandorganizationreadinessprograms called Patient Safety Fridays.Theentiremanagementteam is required to round on an assigned unit and complete a survey. The manager acts as the surveyor and conduct interviews with the staffasifitwerearealsurvey.Therearesetquestionseachweekthatthestaffisasked.Ifcoachingisneededon a particular topic, it is completed at that time.

Nostaffpersonissafe.Membersof the survey team may question any employee of the hospital and any member of the medical team including attending physicians, residents, and interns. If there ispushbackonansweringthequestions, senior management will speakwiththepersontoexplaintheimportance of the rounds to that individual.

Topicsincludeeverythingfrompatient identification to medication safety to fire safety. There generally

Brenda Sauer, CHAM, RN, MA, has been on staff at New York Presbyterian Hospital since 1986 when she began her career as a staff nurse; she currently serves as director of Patient Access. Since 2000, she has held several positions in the local affiliate of the National Association of Healthcare Access Management (NAHAM), the Hospital Admitting Officers of New York, including

president, vice president and currently holds the position of member at large. She has been a member of the NAHAM Communication and Publications Committee and currently is chairperson for the Policy Development and Government Relations Committee and a member of the NAHAM Board of Directors.

Michael F. Sciarabba, MPH, CHAM, is the director of Patient Access & Support Services for Advocate Illinois Masonic Medical Center in Chicago. Sciarabba earned his Bachelor’s of Science (BS) in Healthcare Management & Sociology from Elmhurst College in Elmhurst, Ill., and received his Master of Public Health (MPH) from Saint Xavier University in Chicago. He holds

professional memberships in Association of Illinois Patient Access Management (aIPAM), National Association Healthcare Access Management (NAHAM) and is a certified Hospice Volunteer. He continues to serve as president of aIPAM.

is an hour lecture on the particular topics that the survey management team will be surveying that day and then for the next hour and half the management team is rounding. The focus of the rounds is not a “gotcha”butshouldbeusedasateachable moment; that is how the staffregardsthesesessionsnow.Staffusesthesurveyteam’stimeontheunitsasanopportunitytoaskquestions regarding policies and procedures.

In the Patient Access department, thestaffisalso“readied”astopicspertaining to them are surveyed. These include privacy policies, interpreter services, fire/safety and throughput initiatives.

The survey results reflected New YorkPresbyterianHospital’spreparation as it resulted in their best survey ever; the results even impressedthesurveyors.Thestaffwas prepared, ready, and engaged when the survey commenced and thesurveyorstooknote.

OneofNewYorkPresbyterianHospital’s emergency department registrars was interviewed regarding patient privacy and what she should do when a patient comes in with a cough. The registrar correctly answered the surveyor. The registrar reported to the Patient Access manager afterwards that she was very nervous, but that the preparation allowed her to respond correctly.

TheGRCommittee’sgoalistohavethetoolkitsforTJCandCMSonthewebsitebytheendof2012.NAHAM and the committee will continuetodeveloptoolkitsin2012and beyond.

TheGRCommitteeisalwayslookingtoexpandmembershiponthe committee to get numerous perspectives from healthcare access leaders around the country. IfinterestedinjoiningtheGRCommittee,pleasecontactBrendaSauer at bsauer@nyp.org.

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Change Management: What is It and Why is It Needed?By John Woerly, MSA, RHIA, CHAM, FHAM

Change management is a term recognizedbythemarketplaceas encompassing the activities required to prepare and lead an organizationanditspeoplethrougha change it is about to experience. Askingsomeonetodefinechangemanagementwilllikelynetmultipledifferentresponses.

Formal defi nition:yy Th eworkneededtopreparetheorganizationfor“change;”and

yy Effectivelymanagingbusinesschange to ensure that individuals receive the support and development they need through the program and equipping the workforcetorespondpositivelyto the program of change.

Practical Defi nition:yy Bringingdiscomforttothosewho are too comfortable while bringing comfort to those in need of it;

yy Communicating“seventimesinsevenways;”and

yy Th everb“manage”derivesfromthe Italian word maneggiare and means to handle, usually referring to horses. With strong thoroughbreds, this requires more attention.

Changeisajourneyandmustbeapproacheddifferentlyateachstage.Th ere are specifi c steps individuals gothroughtointernalizeorexperience the change and therefore,differentemphasisandmessages are needed for each phase.

Th roughawareness,peopleask“Whatisthisallabout?”andwantmore information. Informing employees of changes prevents confusion. In the understanding phase,peoplewanttoknowhowthe changes directly impact them andseekclarificationthrough

communication. Acceptance breeds personal accountability and people reach out to understand what they can personally do to deliver results. Th e last phase on the curve, commitment, is reached when people execute their daily responsibilitiesandlookforwaystocontinue the improvement process.

A change management strategy provides the structured methodology and toolset that prepares the organizationfortheupcomingchangeand provides individuals with the understanding of how they will be

Time

Design Build decoy

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Acceptance

UnderstandingAwareness

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Figure 1

Implementing change to any organization is not easy and there must be a good reason to undertake an initiative of the scope and size of process redesign. The failure of large transformation initiatives is often due to poor planning and a lack of understanding about how the change is going to affect the organization.

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affected,movingthemupthechangecommitmentcurve.Alackoffocusonthe strategy and its execution can lead tolessuptakeofthenewenvironment.

How is Shared Services Change Management Different?Improving a function or capability intuitively means changing it for thebettersoitmakessensetothinkthatallprojectsrequiresomeelement of change. However, not all initiatives are equal with regards tosize,scopeorcomplexityandtherefore no single methodology will fit every situation. The transition to a new operational model or the deployment of new computer systems are examples of a more complicated change program because each impacts people, process, and technology simultaneously.

Process redesign means real and significant change to the

business, potentially including the developmentofaneworganization,as well as significant changes to the existingorretainedorganization.Each of these change elements has associatedrisksthatneedtobemanaged in a structured change plan so as not to impede the overall success of the program.

The change management strategy should employ a set of tools and a provenmethodologytoeffectivelymanage the upcoming change and ensure that individuals receive the support and development they need to fulfill their roles and responsibilitiesinthe“futureworld.”

Fourofthetop10criticalsuccessfactors for process redesign are related to change management and communications. These four success factors include: 1.Well-definedvisionandmission;2. Executivemanagementand

sponsorship;

3. Communications and training; and

4. Changeandjourneymanagement.

The change management strategy addresses these success factors throughthefollowinghigh-levelobjectives:

yy Create awareness, understanding and commitment to the program acrosstheorganization;

yy Prepare employees for the potential change in process and procedures and for the transition of functional ownership;

yy Manageandminimizethedisruptiontoallstakeholders(internal and external) during the transition to the new model or service;

yy Maintain sponsorship throughout the lifecycle of the program and beyond;

yy Provide open communication channels and guidance to all those directly impacted by the change;

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yy Establishthe“rightkind”ofstakeholdersupportandstructureto visibly promote the new model orservice’sobjectives;and

yy Develop the business brand andculturetohavea“customerservicemindset”and“spiritofpartnership.”

Change LandscapePriortoembarkingonthechangeinitiative, it is important to understand how people perceive the currentstateoftheorganization,what their issues of greatest concern areandwhattheyhopetheprojectmay achieve. Defining the change landscape begins with identifying the sponsors and internal customers who will be most influential in shaping the program. Collecting feedbackfromarepresentativesampleofthosestakeholders(e.g.,fromdifferentpartsoftheorganizationanddifferentgeographies, if you have multiple worksites)willhelptodefinethescopeofchangeactivities,prioritizeprojectresourcesonactivitiesoflargerimpact,andsizetheeffortrequiredtoexecuteaneffectivechange program.

Questions that are typically answered include:

yy Why do the clinical, business, andfinancecommunitiesthinkthis program is needed?

yy Where and how are people going to hear about the progress projectstatus?

yy Have views already been formed?yy Istheorganizationtypicallyreceptive to change? Is change wanted? Is there fear of change?

yy What barriers exist that may impede progress?

yy Are there other concurrent projectsunderwaythatmaydistracttheorganizationandimpact the program? Do they have competing priorities or timeframes or require the same resources?

yy Is there change saturation in how muchemployeescaninternalize?

Additionally,duringtheproject,feedbackandprojectperceptionshould be monitored periodically toevaluatetheeffectivenessofthechangeefforts.Thisisaccomplishedthroughstakeholderinterviews(one-on-one,workshopsetc.)and/or wider distribution surveys. Targetassessmentquestionsshouldmeasure whether expectations for theprojectarebeingmet,strategicplansandobjectivesarewellcommunicated, concerns are being captured and addressed, etc.

Key Steps and TasksDetermine the timing for creation of the change strategy. It is useful to develop and gain commitment to the change strategy during the early assessment phase since it can influence the business case. It is also important to build and nurture confidence in the transitionapproachandhelp“sell”the program internally to secure funding for the design phase. If budget constraints prevent the development of a thorough change management strategy during the assessmentphase,somehigh-levelassumptions will be required to complete the business case. The change management strategy must then be one of the first deliverables developed during the design phase.

Prior to embarking on

the change initiative, it is

important to understand

how people perceive

the current state of the

organization, what their

issues of greatest concern

are and what they hope the

project may achieve.

It is useful to develop and gain commitment to the change strategy during the early assessment phase since it can influence the business case.

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Evaluate high-level program Impacts. All changes related to the project,acrosspeople,processandtechnology must be documented. It is important to gain the attention ofkeystakeholdersandensurethey understand and accept that the change may be substantial, and success will only be assured throughawell-conceivedchangemanagement strategy.

Assess the culture of the organization. The change management strategy should be customizedtotheprojectandthesetting (i.e., one change strategy does not fit all), addressing the organization’suniquequalitiesandculture. It is a leading practice to

interviewseniordecisionmakersto gain their perspective on the organization’sculture.Ultimately,aseries of success factors will emerge relative to this shared point of view. The change management strategy should be positioned to address each factor. This is one of the first steps to building ownership and involvement.

Define the required change activities. Identify all activities and outcomes required to successfully transitiontheorganizationwithminimal resistance and disruption. Itisimportanttoprovideahigh-level description of how the various activities will be applied during the designanddeploymentoftheproject.

easy failures with change By Charlyne Meinhard

Chief executive officers are the starters of change and stoppers of change. Nothing significant in an organization happens that the CEO doesn’t allow, including atrophy. Failure with change is easy. Leading change is hard. Leading change that works is harder still. Smart CEOs, acting as chief change agents, stay ahead of change to set the path that achieves the intended results. However, there are significant challenges when managing change. Below is a list of common failures related to change management.

Bad Decisions. The CEO who allows the organization to make flawed strategic decisions destines failure from the get-go. Too easily, CEOs get sidetracked by complacency, pet projects, executive ego, managing for outside opinions and/or following an unanalyzed industry trend.

Poor Leadership. If half of organizational changes fail due to bad decisions of what to change, then the other half of failures are caused by how the changes were executed. A bad change process or bad timing will ruin even good decisions.

Unclear Results. When the CEO hasn’t made clear where the organization needs to go, any path managers and employees choose will get them there.

Unengaged Workforce. Micro-management is the fastest way to kill employee engagement. When a CEO or top executive over-directs the organizational change, participation of other levels of employees is quickly squashed.

Invisible CEO. Under-involvement of the CEO and top leaders is equally as damaging as over-involvement. Low CEO commitment or visible support throughout the change effort is taken as a sure sign that the change is not important and no one is watching.

Charlyne Meinhard is a speaker, trainer and chief results officer of Next Level Consulting, a consulting firm specializing in change leadership, talent development and innovation. With more than 20 years of experience, Meinhard inspires and teaches managers to lead successful changes in organizations like Verizon and SunTrust. For more information about Meinhard, visit www.NextLevelForYou.com or email Charlyne@NextLevelForYou.com.

It is important to gain

the attention of key

stakeholders and ensure

they understand and accept

that the change may be

substantial, and success

will only be assured through

a well-conceived change

management strategy.

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Define the approach to institutionalize change.Thego-livedatefortheprojectimplementationrepresents only the start of the changejourney.Manyprojectsplan their change management strategytofinishjustaftertheinitialgo-live.However,dependentupontheproject’sscope,itcantakemore than a year for operations to stabilize.Therefore,anapproachtoinstitutionalizethenewprocessespost-conversionmustbedevelopedinorder to ensure that the change lives uptoitsobjectivesandissustained.

Estimate the cost impact of the change management strategy. A critical input to the development of the business case is people costs (i.e., hiring, training, severance, relocation, etc.). The change management team needs to estimate the costs related to the development and execution of communications, training,organizationdesignanddevelopment,andworkforcetransitionefforts.

Determine communication strategy. A comprehensive communication strategy will ensure that all groups impacted by the initiative understand and are prepared for the changes that will result from the new system, organizationandprocesses.Thecommunication strategy should address:

yy The context of the changes (why);

yy The content of changes (what);yy The timing of the changes (when); and

yy Which people will be responsible to implement the change (who).

Communication plans must provideopportunitiesfortwo-waycommunication—to listen as well as to tell. Integrating customer feedbackintotheprojectsolutionnotonlyhelpsbuildbuy-in,butalsocan increase the solution’s ability to meetcustomerexpectations.Projectteams should integrate customer

feedbackinmultipleaspectsoftheprogram, including process design, systemdesignandtraining.Formalmechanisms for collecting and implementingcustomerfeedbackneed to be part of the program.

While change management programs can never communicate too much or too often, they can poorly communicate. A thorough and flexible communications plan provides a tool to manage communications.

It is important to note that “thorough”hereimpliesthatitisjustas important for communication to be inbound as it is for it to be outbound for employees. The communicationsplanshouldoffermultiple options for employees to communicatebacktotheproject.

Develop final change management strategy deliverable. The final change management strategy deliverable must be able to educate thekeystakeholdersontheproject’sapproachandplannedjourney.

This deliverable should answer the question“Howwilltheorganizationmanagethelarge-scalechangeassociatedwiththisproject?”The format of the final change management strategy may be a standalone document or it may be incorporated into the broader final deliverable for the assessment phase.

Conclusion A thorough and thoughtfully executed change management effortthatincorporatesthesepractices will support the successful adoption of new processes by all its stakeholders.Leaderswillbebetterequippedtoassumetheirday-to-dayresponsibilities in the new operation, their team members will be willing and able to rise to the challenges set for them and customers will be ready to partner to achieve overall success of the program.

Without a doubt, change managementisthekeyfacilitatorin ensuring this success. The changemanagementworkdonethroughouttheprojectisaninvestment that shows dividends when the program is implemented. When it comes to successful projectimplementation,thejourneyisasimportantasthedestination.Thejourneywillonlybesuccessfulthroughawell-planned and executed change management strategy.

John Woerly, RHIA, CHAM, FHAM, is a senior manager in the Accenture Health Care Providers practice and has

more than 25 years management experience in healthcare revenue cycle management, specializing in Patient Access, healthcare contact center and health information management (HIM) operations. In recognition of his contributions, he was recently promoted to the level of senior principal within Accenture’s expert career organization. Woerly has served several terms on the NAHAM Board of Directors and has been recognized by NAHAM as a past recipient of the Marian Blankenship Distinguished Service Award, the Carl Satterfield President’s Award and the Doris E. Gleason Publications Award. He currently serves on NAHAM’s Special Projects and Membership committees.

A thorough and thoughtfully

executed change

management effort that

incorporates these practices

will support the successful

adoption of new processes

by all its stakeholders.

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13

Why is it that some companies stayaroundforwhatseemslikeforever, while other companies vanish overnight? When starting my employment at my current facility, a75-bedhospitalinsouthruralGeorgia area with a population of about17,000,IknewIwantedittobeinanorganizationwithlongevity.

Th ehospitalwasadjustingapproximately$5,700adayfornoprecertificationorauthorizations,increasingtheavoidablewrite-offs.Also, patients were having exams and tests without paying their portionupfront.Iwondered,“whywouldanyorganizationtakesuchamajorlosseachdaythatcouldleadtotheirultimatedemise?”Iknewthat either performance measures were not in place or if they were in place, they were not being achieved or monitored. As I began my journeyatthehospital,Ilearnedthere were performance measures in place but nothing had been implemented to correct problems in areas such as scheduling and upfront collections.

Whenbeginningaproject,itisimportant to plan ways in which projectresultswillbesustained.Th e data should be readily available

and credible. Th e point person for gathering the data and producing the reports should be clearly identifi ed. Also, it is important to identify the person accountable for managing the performance and the person who will review the

Is Performance Only Measured and Not Achieved?By Arnelius (Neil) Baker, CHAA, CHAM, CPAT, ACPAR, CFC

One day you’re driving to work and you pass a new company that recently opened; however, a few months later that same company has now closed. Not all companies or organizations have the longevity of Disney, Hospital Corporation of America (HCA), McDonalds, or Dorminy Medical Center in Fitzgerald, Ga.

results and hold the process owners accountable.Developinganaction-response plan that incorporates this accountability structure is a useful way to clarify the levels of performance that require action and the actions that will be needed to avoidout-of-controlprocesses.

Moreover, clearly aligning individualstaffperformancemetricsto those of the department and aligning department metrics to overallorganizationalmetricsareways to ensure that everyone in theorganizationisachievingthesame goals.

Asweallknow,thingsdon’talways go as planned. Th at’s whyitisimportanttothinkthrough unintended consequences of proposed changes prior to implementation.Organizationsneed to identify metrics that will measure performance early on and establish a baseline for performance. Performance should be continually measured once changes are implemented to ensure that unintended consequences do not diminish the impact of the projectathand.Forexample,ifthe radiology department decides tooffersame-dayscheduling

In addition to staff training,

it is necessary to have a

well-defi ned plan for training

physicians and other clinicians

on new regulations and

documentation requirements

especially if your organization

has a centralized scheduling

department. Putting

systems in place to measure

compliance and provide

feedback to the clinical staff

will provide a consistency

and constant incentive for

compliance.

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14 to improve referring physician satisfaction, then it will be necessary tounderstandtheeffectthatthis change will have on denials. Effortsmadetoimprovephysiciansatisfaction inadvertently decreased revenue because of denials.

So, is performance only measured and not achieved? Having performance measures in place is great, but without achievement then what is the outcome or where does it leads us? In today’s society where the right advertising company can sellalmostanything,organizationsfocus on bringing in new customers, yet they tend to forget about how performance is achieved and sustained, leading to repeat customers and longevity.

Whileorganizationsfocusonperformance measurement, they tend to forget about the achievement of what was measured.

Forexample,asthedirectorofrevenue cycle management, one of the many challenges I faced was upfront collections in Patient Access. I measured the performance foroneweekandknewrightawaythat collections were low due to lackofstafftraining.

It was relevant that without a performance measure in place, ongoing training of Patient Accessstaffandclinicalstaffwasessentialtorealizetremendousfinancial impact from revenue cycle improvements. With constant changing payer regulations and high turnover of Patient Access staff,organizationsarediscoveringthat having a position dedicated to training and quality assurance is the keytodrivingconsistentresults.

Typically,PatientAccesspositionsare among the lowest paid in a hospital and may attract individuals

whoaren’tasknowledgeable,committed to quality, or desiring a lengthy term of employment as candidates for other positions. Sporadic training is not enough to achievethedesiredbehavior.Bestpractices recommend creating a positiondedicatedtotrainingstaff,measuring individual performance and providing follow up, when necessary.

Also,top-performinghealthcareorganizationssuchasHCA,whichrequirestwoweeksofPatientAccess training at their shared services prior to starting, typically have a defined Patient Access training program that includes discussionsoftheeffectsontherevenue cycle from their actions, common insurance models and advice for improving proficiency whenfacedwithdifficultpatientsituations.Successfulorganizationsalso typically define a career path

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forPatientAccessstaffbasedonperformance and competency criteria.Forexample,apersonmaystart out as a registrar and advance to a biller and then move on to a team leader position.

Inadditiontostafftraining,itisnecessarytohaveawell-definedplan for training physicians and other clinicians on new regulations and documentation requirements especiallyifyourorganizationhasacentralizedschedulingdepartment.Putting systems in place to measure complianceandprovidefeedbacktotheclinicalstaffwillprovideaconsistency and constant incentive for compliance.

Oncecollectionsgoalswereimplemented, collections doubled the first month after training thestaff,whichprovesthattheperformance measurement was achieved bring positive results.

Having processes in place reduce the amount of time spent on performance measures of the same issueseachmonth.Furthermore,at some point during this process, a determination must be whether enough time has been allotted to the issue at hand and at what point willtheorganizationmovetoanewconcern.

In conclusion, reporting results is often an afterthought that follows thehardworkofunderstandingaproblemandmakingchange.Unfortunately, when results are not measured consistently or achieved, then performance tends to decline.

Developinganaction-responseplanthat incorporates this accountability structure is a useful way to clarify the levels of performance that require action and the actions that willbeneededtoavoidout-of-control processes.

Neil Baker, CHAA, CHAM, CPAT, ACPAR, CFC, started

in healthcare in

1993. Baker serves

as the secretary of

the Georgia Access Management

Association (GAMA) Board of Directors.

Currently, he is the director of revenue

cycle management at Phoebe Dorminy

Medical Center in Fitzgerald, Ga., and

holds a dual AA degree in Health

Services Administration and Business

Administration and a BBA in Business

Management.

Baker is also a member of American

Association of Healthcare Administrative

Management (AAHAM), National

Association of Healthcare Access

Management (NAHAM), GAMA,

GHA, GSMC, Healthcare Financial

Management Association (HFMA), ACHE

and GAHE

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Job Satisfaction Creates an Ethical Mind-SetBy Maria Romeo, CHAM

Gardner’s (MI) theory includes various disciplines of psychology such as experimental, cognitive, developmental, neuroscience, anthropology, and cultural studies. Th e theory provides insight regarding how the ethical mind is developed, which is critical information if one wants to understand how ethics can deteriorate.

Harvard Business Review(2007)interviewed Gardner, where he provides information on how cultivating ethics for oneself and othersisessentialforeffectiveand successful leadership in any organization.Gardner(2007)statesthat“Ifyouarenotpreparedto resign or be fi red for what you believe in, then you are not aworkerletaloneaprofessional.Youareaslave.”Importantly,onemust be able to have the ability to self regulate and maintain honesty, integrity, and ethics in the workplace.

Gardner defi nes the ethical mind as more of a concept in terms of cognitive capacities that

Howard Gardner is a cognitive and educational psychologist and professor at the Harvard Graduate School of Education in Cambridge, Mass. Over the course of his career, his research was focused on the development of moral and ethical values and how one develops an ethical mind. Gardner’s research and evidence regarding ethical development is known as the Multiple Intelligence Theory (MI), which focuses on the idea that individuals have multiple forms of intelligence rather than one, inclusive of linguistic, logical, spatial, bodily-kinesthetic, musical, interpersonal, and intrapersonal (Harvard Business Review, 2007).

feedoffeachotherinorderforindividuals to develop ethics. He classifi es these cognitive capacities as the disciplined mind, the synthesizingmind,thecreatingmind and the respectful mind. Interestingly, Daniel Goleman (1998)presentssimilaritieswithregards to cognition and emotions with the Emotional Competence Framework,whichincludespersonal competencies such as self-awareness,self-regulationand motivation. While ethical development begins at our youth, we can continue to develop an

ethicalmind-setthroughoutourlives where competencies can grow or change as the result of experiences and maturity.

Presently the global economy is in fl ux and as a result maintaining ethics in healthcare is becoming increasinglydifficult.Healthcareorganizationsaremakingcompliance matters a top priority in order to overcome the challenges of deceit and dishonesty in the workplace.Organizationsutilizeavariety of mechanisms to reinforce the importance of corporate compliance, regulations, and ethical practices such as anonymous call lines and mandatory annual online training.

What is also crucial with regards to ethics in business is the behavior demonstrated by leadership.Gardner(2007)statesthat employees listen and watch what their leaders say and do very carefullyandwork,whetherit’scompromised or outstanding, can be contagious. It is important for today’s managers to possess emotional competencies that will

Typically, it is easier to maintain

an ethical mind-set if you are

working within an organization

that consistently promotes

high standards, value-

and ethic-based missions,

and concise goals.

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facilitate a good lead by example, “Iftheyaredeficientinsocialskills,for instance, they will be inept at persuading or inspiring others, at leadingteamsorcatalyzingchange”(Goleman,1998).

Typically,itiseasiertomaintainanethicalmind-setifyouareworkingwithinanorganizationthatconsistentlypromoteshighstandards,value- andethic-basedmissions,andconcise goals. In addition, if leaders want to avoid counterproductive behavior they should directly facilitate behavior that can have a positive impact on achieving an ethicalmind-setthroughoutanorganization.

According to Stephan J. Motowidlo (2003),satisfactioninjobperformanceisakeyfactorintermsof avoiding counterproductive behaviorintheworkplace.Toclarify,anindividualneedstoknowtheexpectationsoftheirdailytasksin order to feel productive and motivated each day.

In our Patient Access department, we have personnel that are responsible

for collecting data from patients and inputting it into the hospitals health information system. The data that they enter is monitored for accuracy. Every month, we measure each employee’s accuracy and those with the highest throughout the organizationarepresentedwithmovieticketsorgiftcards.

This type of incentive contributes tomotivationandjobsatisfaction.Positiveofferingssuchasthisdemonstratetheorganization’sappreciation for its personnel and help create an ethical environment.

In conclusion, in order for organizationstoperpetuateanenvironment that is ethical and honest, they should continue to empower personnel with the resources and education necessary for development and enhancement ofskills.Inreturn,theymaybeable to avoid or reduce intentional unethical behavior that can have a negative impact on the values and missionoftheorganizationand its reputation.

Resources

Goleman,D.(1998).Working With Emotional Intelligence.NewYork:BantemBooks.

Motowidlo,S.J.(2003).Jobperformance. Handbook of psychology: Industrial and organizational psychology,12,39-53.Hoboken,NJ:JohnWiley&Sons.

TheEthicalMind.(2007,March).Harvard Business Review,5(3),51-56.

Maria Romeo, CHAM, began her

career in healthcare

in 1992 as a patient

accounts

representative. She

was recently cited by the NYC Council for

her commitment to women’s health in the

community. She currently serves as the

assistant director of Financial Services at

Staten Island University Hospital. She is

also a member of the National Association

of Healthcare Access Management

(NAHAM) and Healthcare Financial

Management Association (HFMA).

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Improve Productivity: Identify Your Staff’s Motivating FactorsBy Diane Ciotta

It is human nature to try to motivate another person from the same basis as one’s own perspective. However, being motivated is aninternaleffortandthereforearguably cannot be instilled in someone else; rather, it must be self-induced.Awell-knownathleticapparel company’s logo simplifi es theactof“justdoingit”andthiswouldbeawholedifferentworldifeveryonejustdid.Unfortunately,when it comes to managing employees,motivationisnotaone-size-fits-allconcept.

Differentpeoplearemotivatedfordifferentreasonsbothpersonallyand professionally. Particularly where employer/employee interactions are concerned, understanding an associate’s individual motivating factor can enhance coaching opportunities and improve productivity while reducing turnover. Common motivation factors include:

Compensation“Showmethemoney!”Th isphraseis often heard at casinos around the world, but is also often the mindset of an employee that has

What’s in it for me? This common phrase exemplifies the reality of how people are primarily focused on the things that matter most to them. This is well depicted in the story of a young car salesman who enthusiastically shared with his 75-year-old female prospect the feature of how the new model SUV’s spare tire bin was designed to double as a beer cooler; perfect for tailgating!

a purely fi nancial perspective on employment opportunities. Th is is especially common amongst people incommission-basedpositions.A professional that is motivated by money is less concerned about title,perks,orevenrecognition.Instead,theyoperatefroma“putitinmypaycheck”mentality.Th eirphilosophy is that if they can’t cash it, it has no real value. Th is employeeisusuallyself-motivatedand as a result, often does not need a lot of coaxing to perform. Th ey respondbesttocashreward-basedspiffsandbonuses,whichcanbeofferedasadditionalincentives.

AdvancementA26-year-oldcollegegraduatewasconvincedthathewasmakingthe right decision to turn down a positionwithawell-establishedcorporationofferinghimasalary$15,000/yearmorethanthestart-up venture group that was also interested in him. His decision was based on his theory that it’s not justaboutthemoney.Hisdesiretolearn and grow in his new position withthestart-upoutweighedtheincome potential of the corporation. An employee that is motivated

in this way genuinely thrives on the concept of moving up the corporateladder.Offeringconstantreinforcement of advancement opportunities and highlighting examples of internal promotions are excellent ways to maintain a high level of motivation for this associate.

RecognitionOurculturehastrainedustofocuson fi rst place. Is it the sense of accomplishment or the bragging rights? Perhaps a little of both! Mostcontendersjustaren’tasexcited about the silver medal or

Particularly where employer/

employee interactions are

concerned, understanding

an associate’s individual

motivating factor can enhance

coaching opportunities and

improve productivity while

reducing turnover.

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beingtherunner-up.Sadly,infact,second place has been referred to as“thefirstloser.”Despitesociety’sperspective, for some people, simply receivingaccoladesfortheeffortofajobwelldoneatanylevelistheirmotivatingfactor.Recognitionbuildsself-esteemandconfidencewhile setting a positive example for others.Intheworkplace,aphotoonawall,adesignatedparkingspotor a shout out at the department meeting can mean more than a bonus to the employee motivated by recognition and usually doesn’t impact the company budget.

SecurityThewell-knowndefinitionofinsanity is to do the same thing overandoverandexpectadifferentresult.Ontheotherhand,doingthe same responsibilities over and over with a consistent result isconsideredjobsecurity.There’sanoldjokeabouta40-year-veteran accountant who would starteverydaybylookinginhistopright-handdeskdrawer.Afterhis retirement, his associates were

anxioustoseejustwhatitwasthathepeakedatdaily.Uponlooking,they found an old index card that read:“creditsontheleft...debitsontheright.”Inthecaseofthesecurityseekingemployee,minimalchange implies safety and increases motivation. When assured often that their position is valuable and necessaryforthelong-termvisionof the company; it reinforces a comfort level and encourages maximumeffort.

Personal SatisfactionIf the dream is big enough, the facts don’t count. An aspiration, apersonalobjectiveoraself-established goal is the greatest encouragement to the employee that is more motivated by personal satisfaction than money, advancement, recognition or security. It is common for this employee to be willing to commit to activities that are beyond the callofdutyinanefforttomovecloser to fruition of their own desireandnotforany“at-a-boys”from the boss. In coaching this

team member, gain a respectful understanding of their personal agendaandoffersupporttofocuson what is necessary to accomplish thoseindividualobjectiveswhich will simultaneously attain professional goals.

Identifying one’s own motivating factor can be the trigger to hitting agoal.Recognizingwhatmotivatesothers will have a positive impact on the process of building good relationshipsbothattheofficeandat home.

Diane Ciotta is the founder of The Keynote Effect, where she presents a passionate message of accountability and

encourages activities to conquer complacency. As a professional speaker with more than 20 years of sales training experience, she is also co-author of the book, “Pushing to the Front,” with Brian Tracy. For more information, please visit www.thekeynoteeffect.com or email di@thekeynoteeffect.com.

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Eight ‘Be-Attitudes’ of Holding People AccountableBy Bob Whipple, MBA, CPLP

A frequent refrain of top managers is “we need to do a better job of holding people accountable.” Accountability seems to be the mantra for organizational get-well programs these days. One can agree with this in part, and yet there is an aspect of accountability that feels like a cop-out.

Th ekeytoleadershipistocreateanenvironment whereby people do the best they can because they want to doit.Whenemployeesknowitisclearly in their best interest to give theirmaximumdiscretionaryefforttotheorganization,managersdon’thavetocrackthewhipasoften.Imagineworkinginanenvironmentwhere people do the right things not because they are expected, but because it is in their best interest. In that atmosphere, holding people accountable would nearly always be a positive occurrence rather than negative. How refreshing!

It is the actions, attitudes and intentionsofleaders,nottherankandfile,thatmaketheenvironmentof either reinforcement or punishment the habitual medication for individual performance issues. Let’sexamineeightattitudesorbehaviors of leaders that can foster a culture where holding people accountable is a precursor to a feeling of celebration instead of a sentence to the dungeon.

1.Be Clear About Your Expectations. It happens every day.Th ebosssays,“Youdidnotfi le the documents correctly by client;youtotallymessedup.”

Th en,theassistantsays,“Younever told me to fi le them by client, so I used my initiative and fi led them by date because that is what they taught us in recordretention.”Holdingpeopleaccountable when the instructions arevagueislikescoldinganuntethered horse for wandering offthepathtoeatgrass.

2.Be Sure of Your Facts. A manager learned this painful lesson early in his career. He gave his administrative assistant a letter to type for a customer. When he gotitback,theletterwasfullofobvious errors. He immediately held her accountable for the sloppyworkandcalledherintoaconferenceroomtoletherknow

of his disappointment. When he told her about the errors, she said,“Wellifyouhadtakenthetime to notice the initials on the bottom of the letter, you would haveseenthatIfarmedthatworkout to Alice because I was busy with other things. I did not type thatletter.”Gulp.Th emanagertriedtocoverwith,“Iamglad,becauseyourworkisusuallyhigherqualitythanthat,”butthe irrevocable damage had been done. If you are going to accuse someoneofsloppywork,makesure it was done by that person.

3. Be Timely. If there is an issue with performance vs. stated expectations, bring the matter up immediately. If you wait a couple days before trying tobringuptheissue,itjusttends to cloud and confuse the person who did not meet expectations.Ifabosssays,“Youdid not answer the phone in the properwaylastweek,”howisthe employee supposed to even remember the incident?

4. Be Kind. Always apply the golden rule liberally. If you had alapseinperformance,justifiedor not, how would you want to

One caveat: Gracious

behavior cannot be faked,

so be sure you are calm and

have dealt with your own

emotions before speaking to

the employee.

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get the information? Keep in mind that some people are more defensive than others, so ifyoulikeyourfeedback“straightfromtheshoulder,”toneitdownwhen dealing with a particularly sensitive individual.

5.Be Consistent. If you are a sticklerforcertainbehaviors,makesureyouconsistentlyapplythe discipline. Coming down hard on employee for being late forworkcanseemunfairifyouhabitually let another employee waltzin45minutesafterthestartof the shift. Always avoid the appearance of playing favorites. Recognizethat,asahumanbeing,youdohavedifferencesin your attitudes toward people. However, when holding people accountable, you must apply the same standards across the board.

6.Be Discrete. Embarrassing a person in public will create a blackmarkthatwillliveforalong time. If there is an issue of performance, share the matter with the individual privately and in a way that upholds the dignity of the person. This issue also refers to the golden rule.

7. Be Gracious.Forgivingapersonwho has failed to deliver on expectations is sometimes a way to set up better performance in the future. Get help for individuals who need training or behavior modification. A leader needs to be mindful of his or her personal contribution to the problem through past actions,likenotdealingwithaproblem when it is small. If the current infraction is a habitual problem or one born out of laziness,greedorrevenge,thenstronger measures are needed. People cannot be allowed to continually fail to meet expectations. The corrective measures will be based on the severity and longevity of the problem.Onecaveat:Graciousbehaviorcannotbefaked,sobesure you are calm and have dealt with your own emotions before speakingtotheemployee.

8.Be Balanced. This is an incredibly important concept. There is nothing written on a stone tablet that says all forms of accountability must be negative. In fact, most people love it when someone holds them accountable

for all the wonderful things they have done along the way. If we view accountability as both a positive and a corrective concept, then we can remove much of the stigma associated with the word. When we hear a top manager say,“Weneedtoholdourpeopleaccountable,”itmeansnegativefeedbackinmostcases.Thisisaneasy thing to change by simply modifyingourpatternoffeedback.

Holding people accountable is a great concept if it is used in a consistent,kind,andthoughtfulway.Trychangingthenotionofaccountabilityinyourworkareatoincorporatetheeight“be-attitudes”above, and you will see a significant improvement in your culture.

Bob Whipple is CEO of Leadergrow, Inc. He is author of the following books: The Trust Factor: Advanced Leadership

for Professionals, Understanding E-Body Language: Building Trust Online and Leading with Trust is Like Sailing Downwind. He can be reached at bwhipple@leadergrow.com or through his website leadergrow.com.

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Advocacy Update

22

It goes without saying that NAHAM continuestofocuseffortsonpatientidentity integrity. And it can be acknowledgedthatbecauseofitspotential for impacting quality of care and patient safety, patient identitymanagementisalong-standing challenge in the healthcare organization,provideroffice, or anywhere patient databases are collected.

TheNAHAMGovernmentRelationsCommittee is driving the NAHAM focus on the importance of patient identity integrity, primarily through ourworkwiththeHealthcareInformation and Management Systems Society (HIMSS) Patient IdentityIntegrity(PIIntegrity)WorkGroup.Inlate2009,thissameworkgroup released a white paper, simply titled“PatientIdentityIntegrity,”whichspoketothecomplexissuesof the title. It documented the critical issues of ensuring identity integrity, namely the accurate identification of the patient and the linkingofallrelatedinformationto that individual within and across systems in healthcare entities. The PI IntegrityWorkGroupsubsequentlyparticipated in the development of the HIMSSPIIToolkit,whichmaybefound, along with the white paper, on the HIMSS website at www.himss.org/asp/topics_Piitoolkit.asp.

Work Group Focuses on Patient Identity Integrity ChallengesBy Frank Moore

Thetoolkitwasdesignedtoserveasa central resource for information on PI Integrity to enhance the industry’s understanding of patient identity integrity and the many issues involved in reliably—and safely—matching patient identity across systems. It is divided into seven sections: security safeguards, modelinterfaceprotocols,keyperformance indicators, model data practices, model monitoring reports, executive level training, and literature reviews. The sections reflected the critical areas identified bythe2009whitepaper.Theworkgroup will continue to add tools as they become available.

TheworkgroupisnowaddressingPI Integrity from the specific perspective of Healthcare Information Exchanges (HIEs), requiredundertheAffordableCare Act. The diverse nature of the participants and business models of HIEs present unique challenges. As adverse as potential effectsfromdataerrorsarewithin a single provider’s local system, the implications are even more widespread and potentially impactful to larger populations of patients as the number of HIEs grows. What are the unique issues facing HIEs? What practices, policies and procedures can be

established to address these issues andreducetheriskoranewsetofdata errors?

These and other questions will be addressed in a supplemental white paper, complementing the group’spreviouswork.Thepaperisexpected to identify the unique PI Integrity challenges for the HIE and its participants, rather than the original white paper’s focus on the challenge for the single entity provider. It is hoped that developing a common understanding and discussing strategies will help guide HIEstoeffectivelyandefficientlymanage the PI Integrity challenge.

Ledbyitschair,NancyFarrington,CHAM, EMPI Administrator, MainLineHealthSystem,NAHAM’s Government RelationsCommittee“HIMSSSubcommittee”isparticipatingwith a specific eye on ensuring thatPatientAccessisrecognizedand addressed. Its particular role is to provide additional insight and recommendations related to data capture/data integrity in an HIE environment. What are the data elements that would be associated with positive patient identification?

Members of the subcommittee will address such specific lines of inquiry, including:

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Advocacy Update

1.Whatistheimplicationofunknowngender?

2.Wherearegenerationaltitlesplaced in a patient’s name?

3.Howisa“Doe”treated?

4. What are the clinical implications of the source of thelegalname?(Forexample,what if the insurance card name differsfromthenameinabloodbank?)

5.Whohasaccesstoeditdatainaddition to entering data?

6.Howdoweensurethatregistrars fully understand what dataisauto-filledandwhatdataneeds validation?

7. What are our strategies regarding patient validation that appears to be without “reflection?”

8.Howdoweensureproperknowledgeofhowdatatravels?

Oureffortsandsolutionswillbepracticalinnature,speakingtothereal-timechallengesofPatientAccessprofessionals.Forexample,recognizedinthisprofession,aswellasindependently,weknowthatidentifiers that are not naturally “permanent”donothavelong-termreliability—identifierssuchas“name”and“address.”Thoseidentifiersthathave a natural permanence, such as “birthplace,”canberecommended.Othermore“permanent”identifiersorthose that may contribute to reliability mayinclude“mother’smaidenname”and“father’sname.”And,withagrowing population with names that are traditional to Spanish or Asian cultures and countries, an awareness of traditional naming conventions will be important. We should also thinkoutsidethebox—thenameofthe elementary or high school one attended does not change (while we haveacknowledgedthataddressesandzipcodescanandwillchange).

A2008Randreport,issuedpriorto passage of healthcare reform, speaksspecificallytotheUniquePatient Identifier (UPI). While ourworklooksspecificallyatPI Integrity within the context of HIEs, the undercurrents and history of the public policy debate remains. Congress first directed the Department of HHS to adopt standards providing for a UPI for individuals, employers, and healthplansaspartofits1996Health Insurance Portability and Accountability Act, and then placed a prohibition on HHS from using funds on developing such standards. Potential approaches for positive patient identity are knowntoincludeUPI,avoluntarypatient identifier, biometrics, algorithmic matching, among others.Randconcludedthatbroadadoption of a UPI should enhance the U.S. healthcare system and thata“hybrid”approach,usingboth statistical matching and a UPI, would be necessary in the shortterm.Butimportantlytotheongoingdebate,Randconcludedthat security and privacy could be strengthened with a UPI. Privacy and patient safety, equally important in the public policy debate, must overtimefindameanstoco-exist.

In the meantime, NAHAM’s contributions to the PI Integrity WorkGroupmovespositivelytowards solutions that can find application in HIEs today.

Frank Moore is NAHAM’s Government Relations Senior Director, based in Washington, DC.

Membership Spotlight

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24

From Poultry Processing to Patient Access Services: Jeff Brossard Successfully Managed Extreme Adversity By Dennis Coyle

The ability to adapt to adversity is critical in the business world. It can—and often does—determine whether a personissuccessfulornot.Tenyearsago,JeffBrossardwasanexperiencedITprofessionalinruralArkansasandfound himself on the unfavorable end ofalayoff.Hisoptionswerelimitedbut that didn’t stop him.

“Theonlyoptionsforemploymentinthis community were the hospital or apoultryprocessingplant,”hesaid.“Ioptedforhealthcare…Itookanentry-levelpositionintheadmittingdepartment, and as they say, the rest ishistory.”

Brossard,CHAM,joinedthehealthcare industry and is now the Patient Access director at Mercy Hospital Springfield, Springfield, Mo., and incoming president of National Association of Healthcare Access Management (NAHAM). His areas of expertise are emergency departmentregistration,pre-registration, insurance verification, customer service, and regulatory requirements.

Injustadecade,BrossardhasmadehismarkinthePatientAccess and is a past vice president andpresidentoftheArkansas

Association of Healthcare Access Management(ARKHAM,NAHAM’sArkansasaffiliate).

Turning Adversity to Opportunities Facingadversityisrarelyapleasantexperience, but—if managed appropriately—itcanyieldamazing,life-changingresults.Brossardfacedextraordinary challenges late in his ITcareer.Hefacedthemhead-onand found a rewarding career in PatientAccessServices.BrossardtooktimeoutofhisbusyscheduletotalktoNAHAM’sAccess Management Journal.Here,Brossardreflectson

the lighter side of Jeff BrossardWhen not at the Mercy Hospital Springfield, Springfield, Mo., Jeff Brossard finds time to relax and enjoy the lighter things in life.

Brossard’s hobbies include reading, singing, camping, and traveling. His favorite books are “The Left Behind” series by Tim LaHaye and Jerry B. Jenkins. Movies that he cannot get enough of are “The Ten Commandments” and “Titanic.”

And if Brossard could meet one person (dead or alive) it would be King David.

“I have always felt a connection with him in Bible stories,” he said. “I would just really like to know him and find out why I feel such a connection…”

NAHEM’s incoming president reflects on his career and encourages other NAHAM members to get involved.

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Member Spotlight

hiscareerchoices,offersadvicetoyoung professionals in Patient Access Services and even speculates how the Patient Access Services profession willchangeinthenext10years.

How did you find your way to the Patient Access Services profession? JB: I found my way into healthcare quite by accident. Healthcare is my secondcareer.Ispent20yearsininformation technology, specifically systemsimplementations.TheITworld is quite volatile, and in most caseswhencontractsend,layoffsoccur.IhadmovedtoruralArkansastobeclosertomyagingin-laws,when I found myself involved inalayoff.Theonlyoptionsforemployment in this community were the hospital or a poultry processing plant.Ioptedforhealthcare…Itookanentry-levelpositionintheadmitting department, and as they say, the rest is history.

And then how were you introduced to NAHAM? JB: The person who originally hired me,PeggyBranscum,wasveryactive

inARKHAM.Sheinvitedmetobecomeactiveinthelocalaffiliate.InmyinvolvementwithARKHAM,I met Maxine Wilson and Holly Hiryak.Wilsoninvolvedmeintheregional activities and proctored my CHAMcertificationexam.Hiryakeventually invited me to become a part of the National Certification Commission. I have continued to be actively involved ever since.

As NAHAM’s incoming president, what do you hope to accomplish during your term? JB: My hope—the same as any other incoming president—is to continueleveragingtheorganizationastherecognizedleadingresourcefor managing successful Patient Access Services. The sign of a strong organizationistheabilitytocontinuewith forward momentum, in spite ofchangingleadership.Forsomanyyears,thisorganizationhashadtremendous leadership, both from astaffperspectiveandavolunteerboardperspective.Thatfactmakesthetransitionintoofficeaseamlessone. I really do not see this as an

opportunity to individually shine. Rather,Iseethisasanopportunityforourorganizationtoshine.

You worked your way up the NAHAM volunteer ladder; how would you encourage others to get involved with NAHAM? JB: I recommend starting at the local or regional level. As a past regional delegate, I learned there are so many volunteer needs at thelocalaffiliatelevel.Sometimesthe thought of getting involved inanationalorganizationisabitdaunting. However, starting with a local group of peers can be a springboard into the national level.

I see with changes in

healthcare and regulations,

the increased need to

emphasize point-of-service

collections and the need

to be more creative in

our approach to up front

collections.

In regards Mercy Hospital Springfield, how would you describe the work environment?JB: In many ways, I would say that theworkenvironmentinMercyisnotunlikeanyothersinthisever changing world of healthcare. However, I will have to say, there is a culture at Mercy that I have never seen anywhere else. There truly is a“MercyExperience”bothforourpatients and visitors, as well as our

Acc

ess

Man

agem

ent

Jou

rnal

26

co-workers.Inspiteofthehecticschedules and constant changes associated with healthcare, the faith-basedvaluesshinethrough.Isoughtoutthisorganization,andIcannot see myself any place else.

Do you have any big undertakings or projects planned in the near future? JB: We have recently completed a four-yearprocessofimplementingasystem-wideelectronicmedicalrecord(EMR)systemthroughoutallofour30hospitals.Th athasbeenachallengingundertaking.With that under our belts, I believe we deserve some time to relax. However, this is healthcare.

It may not be in the very near future, but I believe that the transition from the International Classifi cation of Diseases(ICD)-9thRevisiontoICD-10willhaveahugeimpactonhealthcare and on Patient Access Services. I also see with changes in healthcare and regulations, theincreasedneedtoemphasizepoint-of-servicecollectionsand

the need to be more creative in our approach to up front collections.

Given your experience, how have you seen the profession change in the last fi ve to 10 years? JB:Idon’tevenknowthatIcanput into words how this profession haschanged.Fromthedaysofblue cards to the current era of fully electronic health records, this profession has been in the middle of it all. Consistently, Patient Accessprofessionalsareaskedtodomoreandknowmore.Th edaysofsimplyworkingasadataentryclerkarelonggone.Today,PatientAccessprofessionalsaremulti-talented.Responsibilitiesincludefinancialcounseling, customer service, confl ict resolution, insurance expertise and much more.

How do you see it changing in the next fi ve or 10 years? JB: I see the changes continuing at an ever increasing pace. Technologyisgoingtocontinueto play a huge part in Patient Access Services. I see the challenge

of balancing the personal touch offace-to-faceserviceswiththeefficiencyofcentralizedprocessingandevenself-servicekiosks.Th echallenge in this is to not lose the personal touch.

What advice do you have for new professionals entering the Patient Access Services fi eld? JB:Beflexible.Don’tbeafraidtocontinue learning and trying new things. I believe that in this fi eld, as with every aspect of life, one is either moving forward (growing) or oneisfallingbackward.Th ereisnosuch thing as status quo.

Dennis Coyle, a newspaper and trade writer with nearly 15 years of experience, has been a nonprofi t

trade publication editor since 2003. He joined the National Association of Healthcare Access Management (NAHAM) in 2012 as the association’s associate editorial manager.

Access Management JournalThe Official Journal of the National Association of Healthcare Access Management Volume 36, Number 1

Access Management Journal Discussion Guide For members of the National Association of Healthcare Access Management and their staff

The Access Management Journal helps to enhance the overall performance of NAHAM members and their staff teams. Its articles reach professionals engaged in Patient Access Services in healthcare delivery. Each issue of the Journal has a supplemental discussion guide to raise awareness and provoke conversation around the issues, concepts and critical objectives of Patient Access Services departments. Each discussion guide includes thought-provoking questions to help members better explore the Journal’s content with their staff teams and discuss the articles’ pertinence to their organization and profession as a whole.

The NAHAM GR Committee Stands Strong for MembersThe NAHAM Government Relations (GR) Committee is working on several different projects and presented two case studies related to The Joint Commission (TJC) Toolkit. By Brenda Sauer, RN, MA, CHAM, and Michael F. Sciarabba, MPH, CHAM

What recommendations are stated within the Advocate Illinois Masonic Medical Center case study to help prepare for TJC survey?

How did the New York Presbyterian Hospital use each Friday morning to implement patient safety and organizational readiness programs?

How does your organization plan to use the soon-to-be-released TJC and CMS toolkits?

Change Management: What is It and Why is It Needed?Implementing change within an organization is not easy, and large-scale changes with a considerable size and scope—such as a process redesign—must be justified. Sizeable transformation initiatives often fail due to poor planning and a lack of understanding about how the change will affect the organization. By John Woerly, MSA, RHIA, CHAM, FHAM

What are the formal and practical definitions of change management? Name the four critical success factors for process redesign related to change management and

communication. What are some of the ways to define a change landscape? Has your organization successfully implemented large-scale change in the past? In retrospect, what aspects of

the process would you change?

Job Satisfaction Creates an Ethical Mind-SetHoward Gardner provided research and evidence on ethical development known as the Multiple Intelligence Theory (MI). The theory provides insight on how the ethical mind is developed, information critical to understanding how ethics can deteriorate. By Maria Romeo, CHAM

What is Howard Gardner’s Multiple Intelligence Theory? Why is the behavior of leadership tied to ethical mind-sets of employees? How did the author’s Patient Access department boost employees’ performance and job satisfaction?

Discussion Guide Discussion Guide Submit an article to the Access Management Journal today!Authors earn 3.0 contact hours per published article. To view issues of the Journal online, visit www.naham.org.

Take the Next Step in Your Career

Apply now to take the cHAA and cHAM exams in 2010!NAHAM’s certification exams are being offered

again in July and October. Don’t miss the

opportunity to finish the year strong and take

charge of your future.

Visit www.naham.org/certification for more information.

Access Management JournalThe Official Journal of the National Association of Healthcare Access Management Volume 36, Number 1

Access Management Journal Discussion Guide For members of the National Association of Healthcare Access Management and their staff

The Access Management Journal helps to enhance the overall performance of NAHAM members and their staff teams. Its articles reach professionals engaged in Patient Access Services in healthcare delivery. Each issue of the Journal has a supplemental discussion guide to raise awareness and provoke conversation around the issues, concepts and critical objectives of Patient Access Services departments. Each discussion guide includes thought-provoking questions to help members better explore the Journal’s content with their staff teams and discuss the articles’ pertinence to their organization and profession as a whole.

The NAHAM GR Committee Stands Strong for MembersThe NAHAM Government Relations (GR) Committee is working on several different projects and presented two case studies related to The Joint Commission (TJC) Toolkit. By Brenda Sauer, RN, MA, CHAM, and Michael F. Sciarabba, MPH, CHAM

What recommendations are stated within the Advocate Illinois Masonic Medical Center case study to help prepare for TJC survey?

How did the New York Presbyterian Hospital use each Friday morning to implement patient safety and organizational readiness programs?

How does your organization plan to use the soon-to-be-released TJC and CMS toolkits?

Change Management: What is It and Why is It Needed?Implementing change within an organization is not easy, and large-scale changes with a considerable size and scope—such as a process redesign—must be justified. Sizeable transformation initiatives often fail due to poor planning and a lack of understanding about how the change will affect the organization. By John Woerly, MSA, RHIA, CHAM, FHAM

What are the formal and practical definitions of change management? Name the four critical success factors for process redesign related to change management and

communication. What are some of the ways to define a change landscape? Has your organization successfully implemented large-scale change in the past? In retrospect, what aspects of

the process would you change?

Job Satisfaction Creates an Ethical Mind-SetHoward Gardner provided research and evidence on ethical development known as the Multiple Intelligence Theory (MI). The theory provides insight on how the ethical mind is developed, information critical to understanding how ethics can deteriorate. By Maria Romeo, CHAM

What is Howard Gardner’s Multiple Intelligence Theory? Why is the behavior of leadership tied to ethical mind-sets of employees? How did the author’s Patient Access department boost employees’ performance and job satisfaction?

Discussion Guide Discussion Guide Submit an article to the Access Management Journal today!Authors earn 3.0 contact hours per published article. To view issues of the Journal online, visit www.naham.org.

Access Management JournalThe Official Journal of the National Association of Healthcare Access Management Volume 36, Number 1

Access Management Journal Discussion Guide For members of the National Association of Healthcare Access Management and their staff

The Access Management Journal helps to enhance the overall performance of NAHAM members and their staff teams. Its articles reach professionals engaged in Patient Access Services in healthcare delivery. Each issue of the Journal has a supplemental discussion guide to raise awareness and provoke conversation around the issues, concepts and critical objectives of Patient Access Services departments. Each discussion guide includes thought-provoking questions to help members better explore the Journal’s content with their staff teams and discuss the articles’ pertinence to their organization and profession as a whole.

The NAHAM GR Committee Stands Strong for MembersThe NAHAM Government Relations (GR) Committee is working on several different projects and presented two case studies related to The Joint Commission (TJC) Toolkit. By Brenda Sauer, RN, MA, CHAM, and Michael F. Sciarabba, MPH, CHAM

What recommendations are stated within the Advocate Illinois Masonic Medical Center case study to help prepare for TJC survey?

How did the New York Presbyterian Hospital use each Friday morning to implement patient safety and organizational readiness programs?

How does your organization plan to use the soon-to-be-released TJC and CMS toolkits?

Change Management: What is It and Why is It Needed?Implementing change within an organization is not easy, and large-scale changes with a considerable size and scope—such as a process redesign—must be justified. Sizeable transformation initiatives often fail due to poor planning and a lack of understanding about how the change will affect the organization. By John Woerly, MSA, RHIA, CHAM, FHAM

What are the formal and practical definitions of change management? Name the four critical success factors for process redesign related to change management and

communication. What are some of the ways to define a change landscape? Has your organization successfully implemented large-scale change in the past? In retrospect, what aspects of

the process would you change?

Job Satisfaction Creates an Ethical Mind-SetHoward Gardner provided research and evidence on ethical development known as the Multiple Intelligence Theory (MI). The theory provides insight on how the ethical mind is developed, information critical to understanding how ethics can deteriorate. By Maria Romeo, CHAM

What is Howard Gardner’s Multiple Intelligence Theory? Why is the behavior of leadership tied to ethical mind-sets of employees? How did the author’s Patient Access department boost employees’ performance and job satisfaction?

Discussion Guide Discussion Guide Submit an article to the Access Management Journal today!Authors earn 3.0 contact hours per published article. To view issues of the Journal online, visit www.naham.org.

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