Restructuring builds teams, fills staffing gaps
Proper training is the key
When staff levels are shrinking, something has to change. But a Houston health care facility turned severe staffing cutbacks into a plus when teams were used to rebuild the staff in a critical administrative department.
Downsizing at the M.D. Anderson Cancer Center cut staff levels in half over three years in the health information management (HIM) department at the University of Texas outpatient-oriented hospital, forcing it to re-engineer itself beginning in the spring of 1996. Rather than keep the traditional staffing structure, the HIM department developed a team approach that works, says Lydia Washington, RRA, director of health information management.
"We’re always looking for better ways to do things," she says. "We were organized like a lot of HIM departments, with a lot of people doing everything."
The changes started with an analysis, she adds. "We looked at all the processes in the department and picked out the key ones, then we structured the teams along those lines," Washington adds.
The teams work in tandem, Washington says. "As a result, we have no filing backlogs in medical records, and we have no loose reports waiting to be filed." Before the changes, the filing backlog often amounted to 30-40 ft. of paper each month.
Each team responsible for filing
One reason for the speedy filing is that each team has besides its primary responsibility responsibility for file maintenance, Washington says. Returned records are placed in staging areas along each aisle in the filing room, and the various teams are responsible for filing and maintaining records in certain aisles. This includes filing the records, filing loose reports, repairing records, and even purging them. "They’re responsible for everything related to file maintenance [in their assigned aisle], the whole nine yards," Washington explains. (For an overview of the teams, see department organizational chart, p. 118.)
About 35 of the department’s 86 people are involved in this process. "Our record retrievable rate is running about 96% for the first clinic appointments of the day, and the loose report problem is nonexistent," she adds.
The key to success for changing to a team approach is training, Washington says. Before the new system was inaugurated, the staff underwent extensive training for about a month.
People and positions appropriately matched
There were three comprehensive training modules that involved both classroom work and hands-on training, all done during regular business hours. The training concluded with employee assessments to determine each person’s strengths and weaknesses. Team assignments were based on those evaluations. The goal was to, whenever possible, place people in positions where they showed the greatest strength. Time was built into the process for retraining, if needed, Washington says.
Typically, in retraining situations, "You have people reacting along the whole continuum [of emotions]," says Christine O’Shea-Roper, who recently left her job as team development program manager at the hospital.
"Some are very enthusiastic and are excited about it. These will be your informal leaders, and you need people like that. There also will be some people resistant, who may not want to work that closely with people, or who do not want to be that interdependent, or who just want to do their own thing and don’t want to be accountable to anyone else," O’Shea-Roper says.
For underachievers, peer pressure is often the best method of getting them on the right track. (For additional details on teamwork challenges, see related story, p. 119.)
So far, the changes have been well received by the M.D. Anderson staff, Washington says. If you talked with them, I think 90% would say they like it. It’s an evolutionary process, and it’s still evolving."
The results are even more impressive considering the HIM staff has undergone a drastic reduction, from 173 workers about three years ago to the current 86. The cutbacks have extended beyond the front lines; the former four levels of management have been whittled down to two.
Part of the change involves giving the staff the responsibility and authority to solve problems, she adds. The changeover is now moving into the stage in which workers will set specific goals for their teams rather than relying on those handed down by supervisors. "We’re trying to self-empower them so that they can proceed on their own without a supervisor overseeing them," says Washington.
That empowerment has required some retraining for the managers as well, she says. The management staff, which has experienced similar cutbacks, did its team building education this summer and the process is still going on, Washington says.
For example, one of the next steps will be involving all the teams in doing quality improvement projects. The managers are also learning to let go of some responsibilities such as selecting new team members. The teams will take over some of that work.
Washington says managers are working on becoming leaders rather than people who tell others what to do next.
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