Centralization involves a PC on every desk
Different processes may serve customers best
Merging health care organizations can require health information management (HIM) professionals to coordinate facilities acting as separate entities or to centralize all services.
The latter is the challenge that Sue Malone, MA, MBA, RRA, of Clinical Information Consulting in Colorado Springs, CO, faced when she became medical records director after her organization went through a series of mergers. (For an example of how to coordinate facilities acting as separate entities, see story, p. 116.)
When Malone became director, the three hospitals in the system functioned separately. After the merger, however, management wanted to remove all duplication of services. That meant the organization would have only one of everything — one Medicare provider number, one department of radiology, and one departmental lab, for example.
Malone realized she would need support above and below to complete such a task. This support included:
• financial support to create and to buy needed information systems;
• information systems support for help with automation;
• administrative support;
• support from team members.
"You have to have moral support from your boss," Malone adds. "You cannot make [sweeping] changes at all the campuses and expect them to work unless you have a dedicated management team that is committed to the vision of what you are trying to accomplish."
She began putting together her team, which isn’t always easy right after a merger. "You have to have a team that will pull together in the same direction," Malone says. "Keeping existing employees on the team is important, if they are willing, for they bring a lot of history and knowledge that you don’t want to lose."
Once her team had solidified, it began developing a vision and purpose. Malone knew that part of the organization’s vision was to be highly centralized.
The same — or different?
Malone’s team held regular meetings with all the managers from the different units in the hospitals. While wrestling with the problems involved in the consolidation, the team developed several principles. One was to cut costs and streamline processes. This included:
• Eliminate unnecessary procedures. For example, the team stopped one hospital’s inefficient practice of tagging nurses’ notes.
• Simplify.
• Automate. "You have to have that automation piece in a multicampus environment," she says.
When Malone began in her position, medical records were virtually all on paper. Four years later, the team had automated every medical record function in the department. "We went from having about eight terminals on all campuses combined to having a PC on every desk," she says. "Anyone could look at chart tracking on the PC and know what charts were complete."
Another principle the team chose was to adopt pragmatism over idealism — to do what works. "I think medical records people in particular have a tendency to want to have everything the same," Malone says. "It doesn’t always work."
The team decided to centralize some functions, such as placing transcription in an outside department and centralizing the off-site medical records "warehouse." The team also created a single medical record number for every patient.
"The patient had one chart although it might be in multiple volumes that could be located at any one of the three campuses depending on where the patient was seen," Malone explains. To help patients move between facilities, a transportation service was established. "We had shuttle services going between the hospitals all the time."
In addition, the team standardized virtually all of the forms the hospitals used. "It was easy to standardize them because of the contrasts between the forms from each hospital. We were able to see who had the best practice because we had the internal benchmarking."
The team did decide to keep some processes different. "We would often have discussions about making a particular change in the organization and a member of the team would say, This is what’s going to happen if we do that in our hospital,’" Malone says. "Very often we would make an exception for that hospital. The other two hospitals would do the task the same, but the third would be different."
An example is the electronic chart tracking system. In two of the hospitals, the location of the charts was keyed into the tracking system.
Doctors in the psychiatric department of the third hospital argued that the psychiatry records rarely left the hospital and that it took more time to use the electronic system than it did to use their system.
The team let them use their tracking system since it worked well for them. If the charts left the hospital, however, their location had to be entered into the electronic system.
"We asked ourselves with every issue, How much sameness and how much differentness should be allowed and why?’" Malone asks.
The pertinent question was how to best serve the customers. "We had a different makeup of customers at each hospital, and sometimes decentralization worked better." The team also thought about centralizing the correspondence functions but decided it wouldn’t improve efficiency and left them separate.
For several years, Malone and her team made significant progress in the coordination of the three campuses. "We cut costs unbelievably and improved performance by many-fold," Malone says.
Subsequent mergers were not as successful, however. Loss of any of the key support elements — financial, information systems, administrative, or team — can and did hurt successful implementation of continuing initiatives.
Still, she enjoyed the experience of getting results when the time was right. She advises other HIM personnel who are meeting the challenge of consolidating services to evaluate their resources and build on their strengths. "Don’t try to make it look like the hospital across town or featured in the latest magazine," she says.
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