Why I'd Put an 18-Year-Old in Your Lobby Before Another Nurse Resets a Portal Password

By Jill Steeley, former FQHC CEO and host of The Community Health Collective podcast

I'm Jill Steeley. I ran a Federally Qualified Health Center in Helena, Montana, where I inherited an $800,000 deficit and turned it around. Now I coach health center CEOs and run the FQHC CEO Connect Bootcamp with Steve Weinman. This post comes from Episode 46 of my podcast - and from a conversation with my 18-year-old son about his job at Lowe's.

In this post:

• What a $17-an-hour Lowe's job taught me about patient portals

• Why "older patients won't use the technology" is mostly a limiting belief

• Why I'd hire an 18-year-old for this role instead of reassigning a nurse

• The one thing a Bootcamp member taught me you have to fix first

• Why I give up on phone-only scheduling - and why your patients do too

My son is 18. He's a cashier at Lowe's and makes $17 an hour. I asked him what he actually spends his shift doing, and he said, "Mom, mostly I stand by the self-checkouts and help people get through them."

That's the whole job. A barcode won't scan. A gift card gets declined. Someone just doesn't want to do it alone. And there's my son - friendly, patient, completely comfortable with the machine - walking them through it.

Lowe's didn't install self-checkout and hope for the best. They put a person next to it. Most health centers launched a patient portal, handed out a flyer, and hoped for the best.

Do older patients really refuse to use patient portals and check-in kiosks?

Some do. Far fewer than we think.

This is the objection I hear most, in the Bootcamp and on coaching calls: "Older patients don't like the technology." "People don't know how to use the iPad." "The kiosk just slows everyone down."

Here's my take. Part of that is true, and a lot of it is our own limiting belief. Nearly every appointment I go to as a patient now hands me an iPad or a kiosk at check-in. I tap a few buttons and check myself in. The patients we serve are living in that same world - at the pharmacy, at the bank, at Lowe's.

So give your patients more credit. And for the ones who really do struggle, the answer isn't to skip the technology. It's to put a friendly human next to it.

Who is handling portal problems in your health center right now?

Probably someone you're paying too much to do it.

A patient calls: "I got a text with a link, I made a password, and now it's locked." Or they can't find their lab results. Or they want to schedule online and can't figure out how. Or they want to know why they got a portal invitation at all.

That call lands on the front desk - who's also checking in the patient standing in front of them - or on an MA, or on a nurse because it got routed to the clinical line. And they walk the patient through it, step by step, over the phone.

None of that requires a license. In my time-management framework, it's a $10 task. When your most expensive people spend their day on $10 tasks, you pay twice - in wages, and again in burnout. Nobody went to nursing school to reset passwords.

Nobody decided this on purpose, either. You launched a portal, or online scheduling, or online bill pay, and the incoming calls landed wherever there was a phone and a person.

Why would I hire an 18-year-old instead of retraining existing staff?

This is the judgment call at the heart of the episode.

I've been telling Bootcamp members for a while that the portal is one of the best ways to cut administrative burden - and that someone should own it as a "technology integrator." The mistake I see is making it one more duty for an already-stretched front desk or nurse. Then it's the first thing to drop on a busy day.

So I'd make it a job. One young, tech-fluent person - 18, 19, 22 - whose only job is getting patients onto the portal and using it. I call it the Self-Checkout Hire. Here's why young:

1. Technology doesn't scare them. They set up their grandparents' phones. That makes them patient with the people tech does scare. They don't get flustered - they say, "Oh yeah, here, let me show you."

2. It's the first rung on your career ladder. Today they're helping with the portal. In a year, maybe they're your next medical assistant or dental assistant. In five years, maybe a nurse. In rural communities especially, growing your own is one of the best workforce strategies you have.

3. The rate matches the task. At $17 an hour full time, that's about $35,000 in wages, or roughly $44,000 with taxes and benefits (adjust for your market). Compare that with the licensed and front-desk hours currently going to portal help, and it's not new money - it's moving the work to the right person at the right rate.

What does a Self-Checkout Hire actually do all day?

Five jobs:

1. Greet and enroll. No patient leaves without a working portal login - tested on their own phone. Not a flyer. Not a QR code.

2. Teach the portal during dead time. In the lobby or the exam room before the provider comes in: "Want me to show you how to book your next visit? Request a refill? Send your provider a message?" The patient does it themselves, so next time they know how.

3. Be the help desk. Password resets and "where are my lab results?" get handled in person instead of bouncing around your phone lines.

4. Speed up check-in. Walk patients through digital intake so the front desk isn't typing forms by hand while the line grows.

5. Track the numbers. Report portal activations and self-scheduling every week.

Why does online scheduling matter so much for community health centers now?

Because I'm a patient too, and I know what I do when it isn't there.

I book my appointments at the end of the day, when I finally sit down and look at next month. If I have to call during business hours, wait on hold, and play phone tag, I don't get it scheduled. I give up and move on.

I'm not unusual. That's the working mom who can't make a call during her shift, the adult son managing his dad's Medicare appointments, and the guy on a construction crew who doesn't get a break until 3.

For a long time, health centers got away with phone-only, business-hours scheduling - especially for patients who were low income, uninsured, or rural - because those patients felt like they had no choice. I call that the captive-patient myth.

It isn't true anymore. Urgent cares, retail clinics, and telehealth apps all let people book from the couch at 7:30 at night. And the patients with the most options - insured families, working adults, Medicare patients - are exactly the ones who keep your payer mix healthy. That payer mix is what lets you keep serving the patients who don't have insurance. No margin, no mission.

What problems does the Self-Checkout Hire solve?

1. Licensed staff doing $10 tasks. Nurses and MAs spend hours on tech support.

2. Portals nobody uses. A portal launched without help doesn't get used, so neither the patients nor the health center ever see the benefit.

3. Phones that never stop ringing. Every reset, reschedule, and "where are my results" becomes a call.

4. Front-desk bottlenecks. Forms typed by hand while the line grows.

5. Losing patients who have options. If booking only happens by phone during business hours, working patients go elsewhere.

What's the right order to make this work?

One of our Bootcamp members made a point in a session last cohort that changed how I teach this: you cannot turn on patient self-scheduling if your provider schedules aren't templated. If every schedule is a free-for-all - different visit lengths, block time everywhere, slots only the front desk knows how to work around - there's nothing for a patient to book into.

So the order is:

1. Clean up your templates first. Standard slot types, clear rules on who can block time, and some same-day slots held.

2. Make it a real job. Self-Checkout Hire, technology integrator - call it whatever you want, but give it one clear purpose.

3. Train them like front-desk staff. They'll see patient information on screens, so they get the same HIPAA training. Their scope is technology, never clinical advice.

4. Hire, then measure. Portal activations, self-scheduling, no-show rate (it may drop once reminders reach patients in the portal), lab results viewed in the portal, and inbound phone calls.

5. Use the numbers to keep the position. That data is your case for keeping this person on the team.

Where do I start?

With a tally, not a job posting.

Next week, pick one provider team. Every call they take that the portal could have handled - a password reset, a reschedule, a "where are my lab results" - gets one hash mark. That's it.

I'm betting the number surprises you, and surprises them. That number is your business case.

🎧 Listen to Episode 46 of The Community Health Collective for the full conversation.

We go deep on patient conveniences and retention inside the FQHC CEO Connect Bootcamp - Cohort 5 starts October 9 at www.fqhc-ceo.com. Or if you want to talk through what this could look like at your health center, schedule a call with me. You're not doing this alone.

- Jill Steeley, Steeley Strategic Solutions

About the Author

Jill Steeley is the host of the Community Health Collective Podcast and an executive coach to leaders across community health centers, FQHCs, and mission-driven healthcare organizations. After two decades inside the healthcare leadership world and close to 250 healthcare leaders coached and mentored, she helps healthcare executives build the leadership skills they were never formally taught - and helps full leadership teams shift culture together rather than one leader at a time.

Learn more at jillsteeley.com.