To treat customers well, treat your workers better
HIS customer ratings parallel job satisfaction
Six years after the Austin Clinic and St. Olaf Hospital merged to become the Austin Medical Center and part of the Rochester, MN-based Mayo Clinic system, anyone could see that the medical records operation needed major repairs.
The 1989 merger threw two record keeping systems in with a full range of ambulatory services dispersed among five regional locations. Today, the medical center provides a comprehensive range of inpatient, outpatient, chemical dependency, mental health, and home health services.
The records department received 90 calls a day from providers asking for patient charts, many of the 90 were repeat requests. Job duties were fuzzy as the staff constantly moved from crisis to crisis. The records staff responsible for sorting all that out earned paychecks just one grade higher than entry level. With a 28% staff turnover rate compounding the chaos, it was clear to Mary Shaw, director of business support services, in what is now the health information services (HIS) department, that employee morale was the first order of business.
Shaw notes, "We didn't even take time to conduct a physician survey before we started re-engineering medical records. "We knew what we needed to do."
The process began in 1995 when a filing team leader/supervisor, Jill Brockberg, was hired. "People wanted to do a good job, but there wasn't the ability here to do it," she recalls.
After Brockberg came on board, it took only a few days to create a "filing team plan" to guide the process.
"We looked at the technical work expected of our staff and realized it was time to raise the salaries one grade level," Shaw explains.
Computer literacy is but one example of the skill levels required of records staff. Another expectation, Shaw notes, is "a vast knowledge of medical specialties that a filing professional needs to know to place documents accurately and appropriately into the charts so the doctors can find them." Here are the other steps in the medical center's information systems repair:
· Staff up.
Today, 18.7 full time equivalents (FTE), divided among 22 people, cover the department 6:00 a.m. through 11:00 p.m. seven days a week. Contrary to what happens in many mergers, this is an increase of 6.1 FTEs since re-engineering began. A fresh look at the ebb and flow of activity changed the distribution of work and personnel.
Graphing and comparing staff coverage with peak activity times for chart retrieval and filing led to more staff coverage from 6:00 a.m. to 6:30 a.m. to prepare for the 10:00 a.m. clinics. They shifted duties during the slow evening hours so workers could quickly pull charts for emergency department walk-ins and clean up work from that day while preparing for the next.
"You might save a dollar when you understaff your filing function, but the savings are just on paper," Brockberg contends, "and it's going to cost you two dollars in filing mistakes and lost charts and wait times. It's a false saving when you have a patient in the waiting room for a long time and all they need is a B-12 shot, but you can't find the chart."
· Enhance communication.
An intranet interface now expedites computerized communication between HIS and each regional health care service site.
· Scrap outdated job descriptions.
After analyzing the filing functions, Austin Medical redesigned jobs. New ones include Brockberg's present position as liaison between records and clinical staff. She's the main contact nurses and physicians call when they have complaints about patient record turnaround or misfiled documents within a chart.
Other key functions include a courier service that circulates twice a day picking up and delivering records among the clinic's regional sites. The filing receptionist - a new position - takes calls for charts and handles walk-in requests. Routing calls to one person cuts the volume 28% a day.
Everyone is responsible for one part of the filing process, promoting job ownership opportunities for each employee. By 11:00 p.m., when the department closes, the filing is done. On an average day, this includes pulling 800 charts and filing 800 to 1,200 loose papers.
· Train for customer satisfaction.
HIS uses Mayo's internal customer service training program which they adapt to their customer relations with providers. Monthly meetings offer skill-building techniques. And, "If there's a failure in our process, like we fail to pull or send a chart for a patient's appointment," Shaw says, "the staff has a mechanism for retracing their steps and dialoguing ways to prevent a recurrence."
· Create worker friendly job spaces.
As the clinic grew, records staff fought with overcrowded filing cabinets. Charts were damaged from being shoved into ever-shrinking spaces. Employees juggled stacks of paper to clear surfaces for chart assembly, and there was no room for the receptionistdesk. In addition to expanded square footage, the filing team has additional counters plus work spaces with ergonomically designed equipment. To prevent repetitive motion injuries, there are electric staplers, electric three-hole punches, and headsets for the phones. The facelift cost $62,700.
Today, charts are up and out of HIS within 15 minutes when a patient is waiting. Compared with the earlier two-hour-plus wait translates into an 87% drop. "Stat requests are out of here in minutes," Brockberg says. (For a picture of the providers' response to the HIS improvements, see the charts, "Physicians Filing Area Survey Results" and "Nurses Filing Area Survey Results," p. 81.)
"But what I'm proudest of are the employee satisfaction ratings," Brockberg notes. (See chart "Employee Filing Area Survey Results," at left.) Ratings have soared and staff turnover dropped 20% to its present 8% low.
Shaw is exploring measures to quantify HIS staff productivity. She is identifying benchmarking partners as well as appropriate instruments from professional associations of information service professionals.
To celebrate its accomplishments to date, HIS recently held an open house. In attendance were the mayor of Austin and the clinic's management staff. At that event, the department's old name of medical records officially changed to HIS.
From Day One of its re-engineering project, Shaw notes, the department established strong communication links with its internal customers in nursing, medical, and the other clinical departments. The ties have guided the ongoing discussions for future improvements. Currently, they're defining the terminology for chart requests. For example, they're hashing out what constitutes "stat" (emergency) compared to "patient waiting."
Also in the works are plans for bar coding records. The group is also designing standard patient information templates as they prepare for a transition to electronic records. As they continue their work, Shaw explains, they stick with the credo that got them where they are today, "Begin with the end in mind."
[For further information on integrating medical records functions and personnel, contact:
· Mary Shaw, or Jill Brockberg, HIS Department, Austin Medical Center, 1000 First Drive, NW, Austin, MN 55912. Telephone: (507) 433-7351. Fax: (507) 434-1447. E-mail, Mary Shaw: [email protected]; Jill Brockberg: [email protected].]
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