LEADERSHIP
Stephanie T. Wells
Rebecca Bravender
improving employee engagement
in the revenue cycle
AT A GLANCE
>> In 2014, leaders at Ochsner Health System in
Jefferson, La., began an effort to increase employee
engagement.
>> Professional services such as the revenue cycle
presented a unique challenge, as employees work in
various locations, away from patients, and are
therefore somewhat separated from the mission of
the health system.
>> Giving employees an opportunity to share their
concerns and ideas with leaders, and vice versa,
helped bring team members into the fold and
increased their engagement systemwide.
36 October 2016 healthcare financial management
Numerous studies have linked employee engagement to business
outcomes, but a recent Avatar Solutions survey shows that only 29to 38percent
of employees in the healthcare industry are fully engaged in their work. Thus, as
Ochsner Health System in Jefferson, La., began working to identify strategies to
compete in a value-based environment, its leaders recognized that increasing
engagement was critical to improving revenue cycle performance.
Ochsners revenue cycle is centralized for both hospital and professional services
and covers functions such as scheduling, preregistration, registration, medical
coverage assistance, health information management, hospital and professional
coding, data governance, and others. Many team members, such as those in
registration and professional coding, are spread throughout the system even
though they report through the revenue cycle leadership. This structure, with
centralized reporting but decentralized work sites, can present challenges with
employee engagement. In addition, many team members have limited or no
interaction with patients, which can lessen their connection to Ochsners mission
and vision.
Knowing the challenges as well as the value of an engaged workforce, Ochsner
made revenue cycle employee engagement a primary focus starting in October
2014. Ochsner Health System employees are surveyed each year to measure
engagement across the system. Actively engaged employees have an emotional
commitment to the organization. The 2014survey measuring employee engage-
ment found that 36.3percent of revenue cycle team members at Ochsner
were actively engaged. The 2015survey indicated an increase in employees
who were actively engaged, to 50percent. This share represents a significant
improvement over a 2012survey, in which only 28.4percent of employees were
found to be actively engaged.
The impact on performance metrics has been equally
impressive:
>> Voluntary turnover decreased from 2014to 2015,
dropping 4.54percentage points to 7.4percent.
>> Gross days in accounts receivable (A/R) improved
by 8.16percent.
>> Net days in A/R improved by 12.24percent.
>> A/R aged over 90days improved by 16.27percent.
>> Administrative adjustments as a percentage of net
patient revenue improved by 14.02percent.
>> Point of service collections as a percentage of net
patient revenue improved by 35.45percent.
>> Cash collections exceeded goal at 101percent of
target.
In its work toward those improvements, Ochsner
completed research that identified five areas where
engagement could improve: mission/strategy, job fit,
leadership, recognition, and career development.
As a system, Ochsner worked to improve employee
engagement by strengthening the connection
between team members and leadership via rounding,
a monthly process in which team members have an
opportunity to meet with leaders. This connection
allows employees to have a voice and a venue in which
to discuss areas of focus and processes that they
would like to see changed and improved. Additionally,
health system-level power of one meetings for team
members were implemented to better communicate
Ochsners mission and values. In these large
meetings, the CEO and senior leadership present
results and strategy directly to more than 1,000em-
ployees, connecting employees to Ochsners plans as
a health system and its focus on patients. A system
playbook was developed to assist in translating
Ochsners plan to wini.e., how the organization
intends to fulfill its stated missionto a level that can
be understood by employees at every level. Power of
one bulletin boards were introduced to ensure that
all team members are updated regularly and
communication is flowing to all levels.
The revenue cycle team has had great success with
the initiatives, relying heavily on system leaders to
connect with their teams to identify the key engage-
ment areas most meaningful to them. From there, the
The system implemented pre-hire
job shadowing in most departments
to ensure that team members know
the aspects of the job before accepting
the position.
system developed strategies by division and
then by team.
Mission/Values
As a nonclinical function within the health system, the
revenue cycle lacked a connection to the mission and
strategy of the organization. To effectively communi-
cate to the entire division, Ochsner implemented
power of one meetings at the divisional level,
focusing specifically on revenue cycle strategy and
responsibilities. These meetings bring team members
from across the revenue cycle functions together
(approximately 100employees at a time) for
networking and to connect to the overall goals of the
division. Team members see presentations on the
Ochsner Playbook and the various functions within
the division, as well as a patient story via video. These
steps help to show team members how their function
affects the overall cycle as well as the overall results of
the organization. The meetings also feature presenta-
tions and exercises on a teambuilding topic (such
as different personalities and how to interact
between them).
Job Fit
Job fit is critical to employee engagement given
employees desire to feel that they are able to
contribute and do the things they do best. At Ochsner,
the initial focus in its employee engagement initiative
was on its newest team members. The system
implemented pre-hire job shadowing in most
departments to ensure that team members know the
aspects of the job before accepting the position. New
hires have the opportunity to speak with the leader-
ship team at meet-and-greet events regarding their
on-boarding process, the position workload and tasks
versus expectations, and what areas should be
improved. In the revenue cycle division, a training
hfma.org October 2016 37
leadership
course is being developed to give current employees
an opportunity to explore the work that goes on in all
areas of the department.
Leadership
Revenue cycle leaders are held accountable to
implement all systemwide leadership initiatives, but
efforts were made at the division level as well. For
example, offline sessions have been implemented to
pull in a cross-section of team members for meetings
with senior leadership about what is working well and
what needs to be improved. These sessions have
helped deliver on Ochsners open door promise and hand-written thank you notes and systemwide
have identified improvements for teams and for the
division.
Department report-outs including project status
updates are performed monthly to all leadership to
ensure that the entire division is aware of obstacles
being faced, accomplishments achieved, and the
priorities for the coming quarter.
The revenue cycle department has embraced the
systemwide focus on lean methodology to ensure
that waste is eliminated. Having team members
participate in finding solutions helps them understand
the meaning of their work and assists with removing
the frustrations of non-value-added tasks that they
face daily.
Career Development
In an era of industrywide financial constraints,
hospitals and health systems must find ways to invest
in their employees and leaders to improve as a system.
To advance such efforts, Ochsner has taken the
following steps:
>> Implemented the Revenue Cycle Leadership Acad-
emy, a course that spans approximately 18months
with live courses, online courses, projects, and
presentations
>> Implemented revenue cycle training, a one-day
course to assist in educating team members about
all functions within the revenue cycle
>> Implemented team huddles to ensure that all mem-
bers know where the results stand and the focus
areas that require attention
>> Implemented a revenue cycle fellowship designed
to impart a vast amount of information in a short
38 October 2016 healthcare financial management
amount of time about a financial and operational
cycle that gets more complex every day
>> Offered a knowledge base self-assessment, where
applicable, to aid in career development conversa-
tions and plans
>> Supported external conferences and learning
where appropriate
Recognition
Recognition has long been a systemwide area of focus
for Ochsner Health System. The revenue cycle
division has adopted the system initiatives such as
recognition awards. In addition, the division now has a
larger focus on celebrating positive results and
laudable performances through employee apprecia-
tion events. Getting input from the team regarding
what was important to them led to the implementation
of Jean-uary (a time period when meeting certain
performance metrics earns employees casual dress
days). Gratitude walls were also put in place (large
swaths of butcher block paper where team members
can publicly write thank you notes to colleagues who
assisted them in some manner).
Lessons Learned
Moving to a metrics-based performance manage-
ment system where each leader is measured and
rewarded based on his or her teams engagement
scores accelerated Ochsners success with these
initiatives. Initially, leaders were concerned that
engagement was not fully in their control. However, a
focus on department-level action planning and the
information received in rounding helped them to
recognize that more was in their control than they
previously thought.
The system also learned that theres no one approach
that will garner results by itself. Listening to employ-
ees to understand what the engagement drivers mean
to them is a critical part of the process.
Stephanie T. Wells is system vice president of revenue cycle/
HIM, at Oshsner Health System, New Orleans, and a member
of HFMAs Louisiana Chapter (stwells@ochsner.org).
Rebecca Bravender, MBA, SPHR, is HR business partner,
Ochsner Health System, New Orleans (Rebecca.
Bravender@ochsner.org).
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