Every business wants its employees to follow policy.  But when employees don’t understand why certain policies exist, enforcement can bring risk of unintended consequences. This medical office front desk scenario offers a great lesson about what can go wrong when employees don’t understand the intent behind policy. Further, it’s a reminder that when outcomes matter, a higher-level review process can provide a long-reaching benefit for situations that fall outside the norm.

Imagine a patient checks in for a diagnostic test.  As is common, the patient is asked for a photo ID and insurance card. 

How many of you have been to a business and watched as a front desk employee scans your driver’s license? Countless people hand official IDs over and passively allow a scan without asking a single question about why taking a copy is necessary…forget asking about where it’s kept, or who has access to it.  Has the practice of scanning our official IDs become so commonplace that the purpose has become irrelevant? Sometimes there IS a legitimate business need. But more often than not an image of your driver’s license (or other official ID) is done sheerly for operational convenience. And while it’s true that certain entities are regulated and have safeguards for data protection (HIPAA, anyone?), it’s also true that identity thieves work in just about every industry…and frankly, they don’t much care about the law.

Back to the patient check-in for a minute. The patient asks why this diagnostic business needs to keep a copy of the only photo ID he has- his driver’s license.  He asks if they can verify his identity without them keeping a copy of his ID. The front-desk employee responds doubtfully, mumbling vaguely about how it’s an insurance requirement. The patient says there’s no problem showing the ID but prefers not to have a copy retained- unless there’s a legitimate business need.  The employee responds with a forceful statement that scanning is “just our policy.” The conversation ultimately ends with “If you won’t let us scan a copy of your ID, we can’t do the scheduled (medically necessary, prior authorized) diagnostic test.  The patient leaves, ID in hand, with no diagnostic test done that day.

In a discussion about this scenario, an administrator pointed out, rightfully so, that as a private business an office has the right to refuse service to anyone who doesn’t comply with their policies.  If the patient really needed the test that badly, he or she would have followed the policy and allowed the employee to scan the driver’s license.  All true, yes…but is that the hill a business really wants to die on, I asked? If the reason for the policy was operational convenience (in this scenario, it was) then retaining a copy of someone’s ID wasn’t an actual need for administering a diagnostic test.  It sounded as if verification was the end goal, necessary to provide service and guarantee correct billing.  So was there a way that could be done (there was) without retaining a copy of a person’s driver’s license? While the refusal of a scan might justify denial of service, what risk was a business taking with that decision? Looking past what the policy said, the larger issue was the one behind it: desired outcomes in patient care.  If the scenario was a refusal to perform a car repair, for example, or a spa treatment…a denial of service might be inconvenient. It might leave leave a customer with a bad impression of the business, and risk some negative online reviews.  But in this scenario, let’s consider what service was refused: a diagnostic test.  One that needed advance scheduling and prior authorization.  I’m going to go out on a limb here and guess the test was necessary for that patient to get a diagnosis. The business refused to provide it, citing policy that served operational convenience…and sending the patient back to square one.  Scheduling and obtaining prior authorization for certain diagnostic tests can take time. Starting the process again from the beginning only served to delay to the patient’s goal: diagnosis. What value was placed on the patient outcome? In exploring the scenario further, two vital issues came to light: first, policy should generally be able to stand up to challenges by demonstrating  legitimate business purpose.  And finally, front desk employees are often the front line of your business.  Train them on the meaning of the actions they take, and offer them support for when challenges occur.  Those actions can be critical to both perceptions and outcomes.