Productivity measures prove cost-effectiveness
Is your HIM department pulling its own weight?
Managed care organizations want you to give them more data, physicians want you to finish their charts faster, and patients want their questions answered now. And since your department is fully automated, hospital administrators want you to hire fewer staff and spend less money. Sound familiar?
Demands on health information management departments are coming fast and furious at a time when cost-cutting pressures are leaning hard on nonrevenue producing areas. One way to prove your department is pulling its own weight and to motivate staff to improve quality and efficiency is to measure your productivity.
"We measure most of the work that’s done in the department for justification of budget and to prove that we’re running a good department," says Nancy Fricke, ART, RRA, director of health information services at St. Luke’s Regional Medical Center in Boise, ID. "If reimbursement is slow and people say this department is not doing something right, we can prove they’re wrong. We’ve really felt a need to monitor for budget, for performance improvement, and for employee evaluations."
Fricke’s department measures such work as lines of transcription, turnaround time per type of report, coding, clerical duties, and release of information. High standards have been set based on previous experience at St. Luke’s and peer hospitals. The department also measures quality through coding audits and computer quality data checks. Focus studies are done on particular problems to determine the cause, such as a trend of a certain employee making the same mistake or not providing information in a timely manner.
Fricke graphs all the areas she measures and shares the information quarterly with employees, managers, the administration, and the performance improvement department. If any areas need work, Fricke develops an action plan. "It helps employees know where they are and what the expectation is from management and employee standpoints," she says. "They know at all times where they stand, and if they need improvement, we can work on it immediately."
Details, details
Similar standards are set for the medical records department at St. Mary of Nazareth Hospital Center in Chicago, says Salme Drunga, RRA, director of medical records. Coding of inpatient charts is expected to be completed within two days of discharge and analysis of the charts within five days. Charts should be pulled within 24 hours. Transcription should be finished in 24 hours for some reports, 48 hours for others. Reports are done on a weekly basis, and coding is assessed daily to make sure nothing gets out of hand.
Drunga has developed a table of various productivity statistics number of charts pulled, dictated reports, information requests and turnaround time, and number of doctors who come to complete charts that are updated monthly and posted in the department. "By seeing those turnaround times, hopefully it will motivate them to work faster, she says." Drunga also plans to use the posted statistics to stimulate discussion on how to solve problems as a group.
Besides using statistics internally, St. Mary subscribes to the Facility and Activity Center Tracking service provided by the Center for Health Care Industry Performance Studies (CHIPS), based in Columbus, OH. About 210 hospitals send quarterly updated statistics on facilitywide indicators to CHIPS for benchmarking. Each quarter, hospitals that fall in the top 25% for a certain department are named best practice hospitals. St. Mary is a recent best practice hospital for medical records.
Big picture approach
At Memorial Medical Center of West Michigan in Ludington also a recent CHIPS best practice hospital for medical records the medical records department prefers to measure productivity in broad strokes rather than fine lines. Tom Cressy, RRA, director of the medical records department and interim director of the quality resource management department, says he thinks that measuring broad categories, such as how much backlog exists, is more productive than measuring such specifics as lines of transcription.
Every morning, Cressy checks the department’s coding and transcription backlog and posts a spreadsheet that shows the backlog for every day of the month and the average for the month and for the prior 18 months. Staff take ownership of the work and can plan their days accordingly after seeing how much needs to be done. And checking productivity data every day allows the department to catch problems as they arise, Cressy says.
"I review the numbers and decide that maybe it’s a Dairy Queen day," Cressy says. "Someone will run out for Dairy Queen or doughnuts if one area is having a particularly good or particularly bad day. I try to use motivators and look at the positives."
Before Cressy came to his job a year and a half ago, the hospital’s CHIPS data were dismal, showing backlogs, high overtime, and heavy use of transcription services. Cressy points to the daily productivity posting, software upgrades, and improved morale as factors in getting to best practice status. "The fact that morale is up is as tangible an output measurement for me as the number of things done in a day. I don’t micromanage the employees. I spend more time looking at how we can improve and how the staff can participate in improving than getting bogged down in non-productive counting."
Nancy Fricke, ART, RRA, Director of Health Information Services, St. Luke’s Regional Medical Center, 190 E. Bannock St., Boise, ID 83712. Telephone: (208) 381-2173.
Salme Drunga, RRA, Director of Medical Records, St. Mary of Nazareth Hospital Center, 2233 W. Division, Chicago, IL 60622. Telephone: (312) 770-2289.
Tom Cressy, RRA, Director of Medical Records Department, Memorial Medical Center of West Michigan, 1 Atkinson Dr., Ludington, MI 49431. Telephone: (616) 845-2318.
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