Job fatigue touched every aspect of healthcare during the pandemic, with nearly one out of two nonclinical healthcare professionals experiencing feelings of burnout due to work overload, a recent study found. Levels of prolonged stress are so high, about one-third of nonclinical workers say they have considered leaving the profession because they cannot keep up with unrealistic demands for productivity and efficiency and the impact of these demands on well-being.
Now, as experts evaluate how to decrease stress for nonclinical healthcare professionals — from revenue cycle management (RCM) to patient access to healthcare IT — they must consider whether the remote and hybrid work models that emerged during the pandemic have staying power. They also must explore ways to keep remote employees engaged and productive while creating a sense of belonging — a key to retaining talent and maintaining well-being.
In this recent roundtable conducted by the Healthcare Financial Management Association (HFMA) and sponsored by CommerceHealthcare®, five healthcare leaders in RCM and patient access share their approach to workforce management in a remote and/or hybrid model and lessons learned along the way.
Q. What approach is your organization taking around remote or hybrid work for revenue cycle or patient access?
Robert Dewar, Chief Revenue Officer, Geisinger: I do have some people who work with patients in person, such as registrars in our emergency departments (EDs) and financial counselors who go to inpatient floors to meet with patients. However, other than those employees, we are virtually all remote on the revenue cycle side, and that encompasses nearly 1,000 people. Except for small numbers of people who really want to work in the office — and we still have the space to allow them to do that — we’re operating under a remote work model. And even those employees who work in the office will be encouraged to shift to remote work eventually.
Romina White, M.Ed, Vice President of Patient Services, Conifer Health Solutions: The majority of my patient services team is on site. We do have a good share of centralized services folks who are onshore remote and offshore remote, and we’re looking for opportunities to automate where we can to relieve pressure on some of our frontline staff, such as providing the ability for patients to input their own information digitally.
Sharon Kelley, Chair Revenue Cycle, Mayo Clinic: Mayo has a centralized revenue cycle process. We have approximately 2,200 employees, and with the exception of registration and financial counselors, 90% of our team is totally remote. Currently, our team is located in 43 states, while our organization provides services in four states.
Nicole Robinson, BS, MJ, MBA, CRCR, RHIA, Vice President Revenue Cycle, OSF HealthCare: We’re 100% hybrid in revenue cycle. We have mission partners who come into the office, and we have others who work at home, and it’s all by choice. We have never asked anyone to come back to the office unless it’s due to a progressive discipline or productivity issue. If mission partners choose to work at home, we allow that to continue. My role here is hybrid as well. I do tend to spend more time in the office just because that's what I'm used to doing, and I like that separation of work and home. In patient access, our team is on site. During COVID-19, we did get creative in this area, building in ways to do remote registration so our team would not have to go into patient rooms, especially in the ED or inpatient setting. But unfortunately, these staff members don’t really get the choice to do this work from home because of the nature of what they do. Our financial clearance team members come in once a week if they need to print things or if there is something happening on-site and they’d like to work in the office for a day. Our health information management team rotates in-office coverage. This manages their own functions and their own schedules, and that has worked really well for us.
Sue Martin, Senior Vice President and Director, Specialty Healthcare, CommerceHealthcare®: We’re 100% hybrid across our revenue cycle teams relating to sales, implementation, product, IT and support. Our local and expansion market team members target 2–3 days in the office per week. We, too, expanded our virtual teams across the country over the past couple of years. As mentioned by the members of the panel, their experiences are common across our client base. A hybrid workforce has brought about additional virtual meetings and communication versus prior to COVID where the majority of all client meetings took place onsite.
Q. How have you redesigned your workflows to account for remote or hybrid work?
White: One of the biggest challenges we face is, “How do we continue to keep up with our workforce’s needs?” This involves a lot of continued learning as well as challenging ourselves to find the right approaches to true employee engagement and relieving administrative stress for frontline staff. We’ve made moves to automate transactional pieces of our team’s interactions with patients, and we’re being really intentional about communication, looking for opportunities for leaders to take 15 minutes to touch base with our team one-on-one and putting out newsletters with callouts for employee rewards and recognition. We insist on “cameras on” during video calls to promote active participation and a sense of being part of a team. When leaders are on site, we ask that they clear a portion of their schedule to be on the floor, engaging with their teams. It’s block-and-tackle management: At a time when new employees might plan to be on the job for just six months to a year — which is not normal — we need to invest time in active engagement.
The pandemic also allowed us to recruit leaders from around the country, rather than our designated areas, and that opened up a plethora of talent. And I think the talent we brought in had extensive experience with metrics, such as how to hold remote people accountable from the perspective of performance. In addition, we looked for ways to maximize our use of our internal technologies, and analytics reporting, so we could ensure we were getting the performance we needed from our team.
Robinson: We have forced ourselves to finally go paperless. As an industry, we rely so much on printing and the signing of things in a physical environment. It was a huge adjustment to lean into electronic signatures and transfer of information. It’s also been a challenge to ensure we have the workflows and technology needed to share confidential information electronically rather than printing things out and carrying them around and getting authorization on paper. It has been hardest for our long-term employees to let go of their reliance on paper, but we’ve used change management tactics to navigate this transition with our team.
Kelley: I would say the redesign of workflows is coming more from the adoption of automation within revenue cycle. We’re in the process of implementing 25 bots this year. As we rely more heavily on automation, we’ve had to redesign workflows to allow our staff to focus on where they are most effective, complementing that new strategy.
Dewar: Our revenue cycle teams are still performing the same functions; they’re just tackling those functions in a different way. When it comes to managing productivity, our leaders provide guidance on ways to solve problems and overcome barriers through open chat lines and individual groups in the same way they used to provide this guidance in an office environment. The group’s setup has been much easier than I would have anticipated, and our employees’ willingness to adapt and change and still be responsible for getting things done has been extraordinary. Fortunately, our technology provides a number of tools that help us see what people are actually touching and producing, too. We’ve been able to maintain and even improve our performance despite not being in an office, and frankly, we’re still trying to determine why that has been the case so we can carry those learnings forward.
Martin: The panel provides valuable input to this question. As our teams migrated to remote/hybrid work, clients have dealt with challenges related to communication, employee engagement, work toward automation and best uses of technology. At CommerceHealthcare®, these top client priorities also hold true not only to our internal teams, but also how to deliver to our client base. We strive to deliver our healthcare solutions such as RemitConnect® (remittance processing), Health Services Financing (patient lending), Accounts Payable (AP) and PreferPay® (automated patient refunds) in the most automated fashion, along with maintaining a development roadmap to continue ease of use and streamlined workflows.
Q. Which of these three challenges — workforce shortages, turnover, or a competitive talent market — do you consider to be of the highest concern now?
Kelley: I'd say maintaining a competitive talent market is our biggest challenge. We’re moving very quickly on our transformation in a post-COVID environment, but we’re highly dependent on a team that stays together and is cohesive in that process.
Robinson: Workforce shortages are our greatest challenge, especially for entry-level positions. We just do not have the workforce we did pre-COVID in any of our markets.
White: We’ve had to re-engineer processes around the moment of recruiting so we can engage candidates differently. We ask candidates, “Are we first or second choice for you?” If we’re third on the candidate’s list, we’re not going to invest a lot of time in pursuing that candidate. We’re also expediting the recruiting process, because if you wait a second too long, that person might have already jumped to a new job. From there, we’re embarking on ways to onboard new employees more quickly and efficiently while giving them the tools for success and the feeling that they are a valued member of our team.
Dewar: For most of my staff in RCM, I do not feel like I’ve had extraordinary turnover. We’re in a rural area, and I’ve heard from colleagues in urban areas where that’s a bigger problem. Where I see challenges is in our ability to fill jobs that are more specialized and in high demand across industries, such as IT. When we lose people who have expertise in certain systems or in analytics to more lucrative positions outside healthcare that they can also perform remotely, that leaves a significant gap that is hard to fill in a competitive hiring environment.
Martin: While all of those challenges are certainly top of mind, we are finding the competitive talent market to be of the highest concern at this time. Mr. Dewar noted filling the jobs that are more specialized and in high demand, such as IT, are perfect examples. The talent is certainly specialized and requires extended onboarding for those who may have some form of healthcare exposure versus having solid revenue cycle experience, along with understanding the complexities of the regulations and requirements.
Q. What steps are you are taking to address employee satisfaction in a rapidly changing environment?
Martin: One of the greatest accomplishments achieved over the years is our investment in workplace culture. A driving force of what we do each day is to ensure we’re listening and recognizing our team members. A major request from our healthcare team members is to have leadership be more timely on the pace and communications related to decision making. We have adopted multiple forms of communication, such as town halls, newsletters, online communication boards and an enhancement of one-on-one sessions in order to meet the needs of the team. Getting out there, being visible virtually or in-person, is a great way for all of us to connect and communicate with one another.
White: We are continuously evolving our approach to employee engagement because even when an employee is very good at working remotely, that doesn’t mean they don’t miss being part of an in-house team sometimes. A few months ago, we hit a goal that we knew was going to be very hard to achieve, and I recorded a video of me blowing up a confetti cannon. We’ve got to do better as leaders of remote workforces in engaging our people, and part of that is hardwiring creative ways of recognizing our employees for a job well done. Part of this involves understanding an employee’s love language: Do they need public accolades, or would they feel more appreciated by highlighting the value of their contributions in a one-to-one conversation? We also need to intentionally interact with new hires to build a sense of community from the start.
Robinson: Everybody is struggling with margin repair now across the industry. We’ve really tried to be flexible about schedules, trying to meet our business needs while still meeting the personal needs of our employees as well, and that’s helped us reduce turnover. Before COVID, we were very much an 8-to-5 organization in RCM. That’s not to say that our mission partners don’t feel the stress of long hours and being short-staffed, but based on the improvement shown in our last employee survey and the appreciation we see when we make rounds on the floor, I’m optimistic about the impact we’re making with our team.
Q. To what extent is your organization exploring automation to increase efficiency or productivity?
Dewar: We’re taking advantage of the technology that’s available to us. We’re also dipping our toes into the water when it comes to automating coding. We’re starting with ED and radiology and then moving out to other specialties. Coding is an area where we have trouble finding coders and maintaining a full bench, so that’s a perfect place to be flirting with and adopting technologies that will help us do more work without more bodies.
Robinson: This summer, we plan to roll out self-registration in our EDs, where the patient will receive an email link to complete their own registration if they meet certain criteria. It’s an approach that will not be appropriate for every population, but it could help give us better coverage and provide administrative relief for our employees, some of whom are covering longer shifts in the ED space. It’s an opportunity for staff to focus on work that is more professionally fulfilling. There are some operational challenges to rolling out a new process such as this, but we believe it will definitely be a good solution.
White: For staff, automation is a little scary unless you do it in the right way. That means looking for opportunities that free up a person to do more of the types of activities that make them successful. What are the types of tasks that could be automated to help an employee focus on the work they say they never have time to do, but want to? That’s what we consider when we evaluate automation: How can it not only improve patient satisfaction, but also help our employees feel more empowered?
Dewar: The message I share with staff is, automation is coming, and we need to take advantage of what’s there, but it’s not likely to result in wholesale layoffs. Rather, it’s a tool that will allow us to right-size our organization as we go along.
All in all, there’s no right answer yet when it comes to how we manage remote teams and get work done. I don’t feel as though anyone has a perfect answer when it comes to remote management. It’s going to be an ongoing process for all of us. The more we can evaluate new tools, like automation, and get to a certain level of confidence in applying them to our work, the more agile we will become, and the better able we’ll be to solve business problems without putting more pressure on staff.
The public health emergency resulting from the COVID-19 pandemic may be over, but the effects — including on nonclinical professionals’ administrative workload and their willingness to continue carrying this burden — are likely to linger. Now is the time to consider new approaches to nonclinical workforce management that mitigate tendencies for staff to feel overworked and burned out while improving productivity and professional satisfaction.
HFMA Roundtable Participants:
Sue Martin, Senior Vice President and Director, Specialty Healthcare, CommerceHealthcare®
Robert Dewar, Chief Revenue Officer, Geisinger
Sharon Kelley, Chair Revenue Cycle, Mayo Clinic
Nicole Robinson, BS, MJ, MBA, CRCR, RHIA, Vice President Revenue Cycle, OSF HealthCare
Romina White, M.Ed, Vice President of Patient Services, Conifer Health Solutions
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