New Rev Cycle Leaders: Don't Swoop into 'Fix-It' Mode Until You've Taken These 3 Steps

Taking steps to shore up trust, communication, and training before making changes will provide leaders a strong foundation upon which to build improvement initiatives. 

When coming into a new leadership role, it's easy for senior revenue cycle leaders to want to jump into action and immediately start trying to correct processes, systems, and workflows.

"A lot of us are eager fixers in the revenue cycle," says Sarah Ginnetti, associate vice president of revenue cycle at UConn Health.

But Ginnetti didn't start trying to fix things right away when she came into her role at UConn in March 2021 after spending nearly 19 years in the revenue cycle at other hospitals in Connecticut. Instead, she asked a lot of questions. And she listened.

Revenue cycle elders "want to get our hands on things, and we want to try to start fixing," she says. "But it's really essential to listen to the folks that are in place."

Only then can new leaders learn about current processes, hear what team members' pain points are, and understand what barriers they're facing.

Such leadership skills will be increasingly important as job turnover skyrockets from the "Great Resignation" and as baby boomers continue to retire. Ginnetti has already faced both staffing situations in her new role, with two directors moving on from the organization and other revenue cycle employees taking advantage of Connecticut's state pension system and opting for retirement.

1. Listen before trying to fix things

In the 10-plus months Ginnetti has been in her new role, she's certainly put new initiatives in place, from improving how the system's claims management logic is set up to taking steps to improve the patient estimate process.

But before Ginnetti started "fixing," she did something else first: Listened, asked questions, and built rapport with the staff.

For example, she advises "spending your first 90 days just listening and not doing much else."

"The first step is to build trust with the team members that are already there. I think that's key," she says. Only then will leaders understand what systems and processes employees are working with and why.

In addition, doing a lot of listening helps leaders build goodwill with team members.

"Then as you start moving your own initiatives forward, they're much more willing to buy into what you're doing and really be a part of it," she says.

2. Ask questions to get to the 'why'

Ginnetti also says that asking a lot of questions is a key element of her leadership style.

"I'm very curious about seeing firsthand what's happening under the hood," she says. And despite her senior leadership role, "I do sometimes dig down into the layers of the work."

Not only does digging into the layers allow Ginnetti stay in touch with and understand the day-to-day work, but it also enables her to ask additional questions about the processes and steps that employees use to complete tasks and identify places for improvement.

For example, if she notices employees are using a lot of workarounds or taking excessive steps to complete certain tasks, she asks the crucial question: Why?

Sometimes she discovers that team members simply have never been shown another way to do something or that no one has ever asked about their process, so they've never had the opportunity to make a positive change.

"I really try to encourage my team members and my leaders to always be thinking critically, asking 'Why' over and over again," she says.

And in asking why, there's one answer Ginnetti will not accept: "Because we've always done that way."

"That may be true. But that doesn't tell me why we're doing it," she says. "I have always come at the work with a lot of curiosity. And I try to cultivate that same curiosity among my team members so that they will adopt a similar mindset if they don't already have it. I believe it becomes an essential steppingstone in terms of how you make progress."

3. Help staff develop their skills

Effective leadership also means helping staff develop their skills, which is why Ginnetti has spent some of her first year partnering with UConn Health's vice president of finance to stand up an institutional membership through HFMA, which they're working on now.

By offering some industry developed, standardized education—they plan to roll out the program later this year—Ginnetti hopes to provide a broader foundation of knowledge among the revenue cycle staff and create a more formalized process for ongoing training, since learning the revenue cycle can be "like learning another language."

Doing so will "help educate our staff about all of the nuts and bolts of revenue cycle that sometimes we expect people to just learn through osmosis," she says.

She also plans to set up some customer service training and coaching with the staff.

"The customer service element of the revenue cycle is so critical, and I think it's often the overlooked part of the patient experience," she says.

Taking these steps to shore up trust, communication, and training before swooping into fix-it mode will provide leaders a strong foundation upon which to build improvement initiatives.

"I'm optimistic that we're now stabilizing the leadership team here for the road ahead," she says, "so that we can start moving some of our objectives forward."