Re-Engineering the HIM Department
By Kathy Mair, RHIT, CPHQ
What can you expect to find in the HIM department that you have just become the Director of HIM or as a consultant hired to re-engineer the department? How do you prepare to address your findings? Get ready for the experience of a lifetime, and know that no two experiences will be the same.
When you get started with your re-engineering project, make sure that you understand what the hospital's expectations are for the HIM Department. Listen to leadership's concerns about what they believe is not working in the department. BE SURE TO KEEP AN OPEN MIND. Remember that some of the items identified as not being correct may be perceived that way because people are not getting what they want when they want it and don't understand health information management (HIM) procedures and guidelines that we have to follow (ex: coding guidelines).
You will want to do a very thorough assessment of each area in the department as you begin to evaluate the needs of the department. You need to know the delinquent chart count (currently and previously); suspension process; unbilled accounts pending due to HIM (# days for bill hold per hospital standard); all backlogs and volume; staffing (number of FTEs); hours/days of operation; transcription volume (in-house/outsourced), transcription system; and coding system (number of coders (in and outpatient, full and part-time) and what encoder do they use. You will want to talk with the staff; in doing so, you will probably find that most have been trained by their fellow employees. Ask if the department has productivity standards for each job function. Get a copy of the monthly statistics for the hospital showing discharges for all services. Be very observant and listen as you do your assessment and you will start getting a “feel” for the department and staff, and some of the areas needing improvement will be easily identifiable. I usually do a three to four day assessment depending on the size of the hospital. If I am the Interim Director I also do the assessment because the information that I identify will help me reengineer as I conduct the day-to-day operations.
In addition to the assessment you need to obtain the following information to begin your project: copy of the medical staff bylaws, hospital rules and regulations (make sure you get the copy under which the hospital is currently operating); state law applicable to HIM; policy/procedure manual (most recent date of revision); job descriptions/competencies (last date revised), HIPAA guidelines for the department and previous JCAHO results (date of next survey).
Now you've done your assessment, reviewed your reading material and are saying to yourself, “What have I gotten myself into this time?” Now the work begins and you begin to develop your action plan. Prioritize your findings and outline how you intend to address each item. You need to spend time with each member of the staff involved in the procedure you are working on to determine their knowledge of why they are doing a procedure, who trained them, what is the workflow of their procedure and how it impacts the rest of the department. For example, if you are evaluating the process for the census, you need a step by step process of receiving the discharges, checking them off the ADT, pulling the old chart, creating a new chart, determining where it goes next in the department, timeframes for completing the process and problems that they encounter. This is a very time consuming process but a very necessary part of the re-engineering process. It will help determine the training the staff needs and also identify workflow issues. The more times you touch a chart the less productive you are. In your workflow re-design you need to remember to develop policies/procedures that allow the staff to work smarter not harder. For example, when addressing elimination of the backlogsyou need to develop a procedure that will prevent the backlog from occurring again (e.g., for loose reports, you might assign each person (ex: transcription clerks and coding clerks) in the department a section of terminal digit files to file loose reports daily, thereby, not accumulating a backlog. In addition, you will assign responsibility for the staff, and you can determine who is not keeping up with their filing daily.
It will seem “slow going” in the beginning, and it will be slow because you are trying to change policies/procedures, staff thinking, and other departments, medical staff and administration's ideas about what/how HIM should be functioning. Be prepared to hear over and over again “we've always done it this way”, “we tried it before and it didn't work”, “I don't know why we have to change, we're doing OK”, and “they need to try and work in this department and see how they like it”.
This is a long process and you have to have patience, determination, and will power. Know the HIM regulations from JCAHO, the hospital, state and federal agencies. Be sure that your changes are all HIPAA compliant. You need to get the staff involved as much as possible in re-designing policies/procedures for the department as this gives them a sense of ownership. I like to describe the process as “getting to a corner and trying to round the corner (a lot of starts and stops headed to the corner) before we make it around the corner”. As you are involved in the process you are going to have days that you feel as though you are making no progress and the staff is never going to get it, but one day you are going to say “Hey, its working! We have started around the corner.”
At the end of the project there is no greater sense of satisfaction than being part of a team that has worked hard to re-engineer the HIM Department to provide services for the hospital, a department workflow that is smooth and consistent, an increase in morale in the department, increase in productivity, eliminate all backlogs, re-establish credibility for the HIM Department throughout the organization and medical staff, and be survey-ready at all times.
Yes, I am in the middle of a re-engineering an HIM Department and preparing them for JCAHO at the same time. This article describes the approach that I use for re-engineering an HIM Department. I'm sure there are many other ways that will also work. It can be a most exciting, rewarding, and frustrating experience, and I wouldn't trade it for the world.
If you have any questions, please contact me 830 372-0700.
Katherine (Kathy) Mair, is credentialed as an RHIT and CPHQ with over twenty-five years experience in HIM. She is the President/CEO of Cornerstone Healthcare Consultants, Inc. located in Seguin , Texas . Contact Kathy at: Kmair@cornerstonehealthconsult.com
