BKT Task 3 Quality and Performance Management and Methods Case Study

7/27/2019 BKT Task 3 Quality and Performance Management and Methods Case Study

http://slidepdf.com/reader/full/bkt-task-3-quality-and-performance-management-and-methods-case-study 1/5

Quality and Performance Management and Methods Case Study

As director of a health information management (HIM) department, Linda knew she wouldhave occasional problems with staff performance or personalities, but it seemed that lately

there was tension in the department. She was trying to decide if the problems wereoccurring due to staffing, processes within the department, or the recent growth of the

organization.

Her organization, Clearwater Orthopedics, had recently purchased another physician groupand expanded its staff by 20 more orthopedic surgeons, bringing the total number of

medical staff to 50. She had heard from administrators at the last managers‟ meeting that

the addition was clearly a coup for the organization because the doctors were prominent inthe community for being up-to-date in surgical techniques. One of them, Dr. Haas, was

known for his teaching of continuing education courses to medical staff and his work with

athletes around the state. It was not unusual for injured athletes to travel hundreds of milesto have their ligament reconstructions or shoulder arthroscopies performed by Dr. Haasbecause his patients‟ recovery rates after surgery were quick and successful. Coaches and

parents loved him.

Regardless, Linda saw stress in the HIM department increasing and expected it wouldcontinue unless she identified the issues quickly. Over the last six months, she had been

having difficulty retaining entry-level staff. These were the employees who most often hadnever worked in a professional environment and seemed to have the most personalproblems. They also received the lowest hourly wage, although the medical benefits were

good.

Linda would move through the recruitment and hiring process, which took valuable time,only for the employees to decide a month or two into the job that a regular eight-to-five

job, five days a week, was not for them. Linda tried not to be cynical. She reminded herself that some of her best employees today started at that level and worked themselves upthrough the ranks or went on for education to attain credentials in HIM. She smiled to

herself as she remembered her first job, answering phones in a medical office for a friend of her dad‟s. Those were the good old days—no stress!

She hardly had time to train newly hired staff due to the organizational growth and endless

meetings and planning. With government regulations changing continuously, it wasimportant that all staff members be aware of regulatory changes. After all, the physicians‟

group depended on her department to know all the latest regulations and convey that

information to the medical staff.

Nearly 40% of their patient base was workmen‟ s compensation claims, and her staff needed

to have knowledge of all of those regulations as well. They also needed to maintain good

relationships with insurance companies, case managers, and attorneys.

Linda would usually direct a new staff member to spend a week with the front deskemployee, Sally, for training, to learn those responsibilities, and that method used to work.

They seemed busier now up in front, and with the turnover, Linda knew staff in the backwere unhappy. Often her long-time staff found themselves pulled away from their coding

responsibilities to help up front with phones and patients coming in to pick up documents.

She wished she could establish a policy against accepting walk-in requests for medicalrecords, but when she had spoken a few months ago to Dr. Blumenthal, the medical director

and founder of Clearwater Orthopedics, he would not hear of it. “We are here to serve thepatient,” he said adamantly. “Customer satisfaction is our focus.” She liked working for him,



but felt his ideas were sometimes outdated. Did he not realize that his organization had

grown to 50 physicians? The clinic was no longer composed of the three partners who

started working together 20 years ago.

As she walked into the HIM department at 7:45 that morning, she was met by two of herlong-time employees, Marge and Tina, who jumped up from their desks. Out of the corner

of her eye she saw Sally speaking on the phone, sounding professional, while standing up tohelp an elderly patient who was approaching the front window. “Sally handles that front

desk like a pro,” thought Linda. “What would we do without her?”

Marge and Tina trailed into Linda‟s office after her. As Linda took off her coat and set down

her briefcase, she turned to them. “Go on,” she said. “You both look like you are ready toburst.” Marge jumped in at the chance, “Carrie called in again sick today. That makes three

times in the past two weeks. How can we get any of our work done in the back when we

have to keep helping Sally up front with patients coming to pick up their records or thoseblasted phones that never stop ringing? Carrie‟s useless to us. I wish she would just get itover with and quit. If another lawyer‟ s office calls today saying they need a medical record

for tomorrow, I will scream! I am two days behind in my coding and you know that is not

like me, Linda; I am a good employee and I am never late with my work for you. Plus Dr.

Garcia‟s nurse just called and said he does not understand why I am suggesting codingadjustments on his last operative report. (I told his nurse about the new guidelines for that

one surgery.) Please, you call her back. She is always so snippy with me!”

Marge stopped to take a breath, and before Linda could speak, Tina jumped in. “Linda, you

know I love it here and I love working for this practice,” she said, “but they are expecting us

to do the same good work for more doctors and more patients with the same amount of staff —two up front, the two of us in back, and you—and I do not know how you are doing itwith everything else that is on your plate. You know I appreciate how much you help with

the case management problems and these insurance companies and their complaints. Iswear they think we can get everything done quickly for them, but they do not understand.Poor Sally takes the bulk of their complaints, and that girl who quit last month—what was

her name? Irene?—well, it is a good thing she left because Sally had three differentinsurance companies call and say the medical records they asked for were incomplete, andthey were pretty mad about it and are going to tell the doctors about these problems.”

Linda felt her heart drop. She, too, liked working for Clearwater Orthopedics and knew mostof the physicians on a first-name basis. The last thing she wanted was for them to think she

did not know how to run her department. Linda told Marge and Tina she appreciated them

and all their hard work. “We know you do,” Marge said. “But something has to change,Linda. My friend over in the HIM department at Trinity Health gets paid much more than Ido and has been calling me every time they have an opening. It‟s getting pretty tempting!”

Linda took a breath. She could not lose her staff. Sally, Marge, and Tina worked so welltogether. It was just that the practice seemed to be growing faster than they could control.

They needed more staff, and she needed time to train them. She needed to hire the rightpeople who would stay with the practice. She felt a headache coming on and checked her

watch: 8:15 a.m. The day had hardly started.

She had an 8:30 a.m. monthly report and brainstorm session with the physician leaders.

She could not be late for that. She asked Marge and Tina to excuse her until she returned inan hour. As she passed Sally at the front window, she saw three people waiting for help.

Sally continued to smile and acknowledged the people in line. Linda scribbled a note for



Sally, which said, “Let‟s meet today at lunch—my treat.” Sally glanced down, read the note,

and nodded yes to Linda as her hand reached for the ringing phone.

Four hours later, Sally and Linda sat in a quiet corner of a nearby coffee shop. “Tell me

about how you are handling things these days,” Linda said to Sally. “And I want you to tellme what you really think.” Linda knew that Sally was by nature an optimist, but she also

knew that holding stress inside was not healthy. “Things are OK,” Sally said. “It just seemsthat we are really busy lately, and it is hard to keep everyone happy, you know?” Sally tried

to smile, but her eyes became teary. “I really like my job, Linda, but the last couple of months it seems like I have no help. Sometimes the people you hire are just so much more

work for me that I would rather work alone.”

Linda found herself feeling guilty when she heard that, but knew she had to remain

objective if she was going to get the problems fixed. “Sally, tell me specifically what some

of the problems have been. If you can give me examples of what is going wrong, that willhelp me to identify exactly what we need.” Linda took notes in a notebook while Sallyspoke.

An hour and a half later, Linda sat in her office looking at the pages of handwritten notes

from her lunch meeting with Sally. Her own lunch, still uneaten, sat next to her computer.Her stomach was churning as she read through the list of problems Sally had been quiet

about for the past few months. When asked why she had not brought these issues to Linda,Sally replied “I did not want to bother you because I know how busy you are. I thought Icould handle them on my own.”

As much as she appreciated Sally‟s work ethic, Linda knew she had important issues toaddress right now. She began to type up her notes to have a legible recording of hermeeting with Sally. She knew she would use this information to support her requests to

administration. Linda started with the following:

Problems with release of information (ROI):

ROI turnaround time: Current policy calls for a 24-hour turnaround time on requests torelease information and documentation to patients or other requestors. Sally hadinformed Linda that the policy was not being followed. “Linda, we could do this if I had

good help at the front desk, and if we had some type of rule that we really stuck to,” Sally had said. “We get far too many requests from patients or family members who

walk up to our window and say, „My doctor sent me down for my records. I‟m going for a

second opinion and I need the records now.‟ When I explain that we have a 24-hourtime window because it takes time to organize the record and make copies, they usuallyget mad. Sometimes they live 50 or 60 miles away and do not want to come back, or

they start to question me as to why the doctor told them they could get the record right

away. Then I look like I do not know what I am doing.”

Mistakes with released information: Linda had asked Sally about the three charts Tinahad mentioned—the charts in which Irene, who had quit, did not include all the

information for the requestor. “Oh, that was a mess,” Sally had said. “It happenedwithin about a two-week time period, and it was with three different insurance

companies. Two of the three problems were with patients of Dr. Garcia. He does all

those spine procedures—you know who I am talking about—and his nurse, well, sheneeds lessons in stress management or something! The bottom line is, I took care of

everything, and Irene said she was sorry and forgot what she was supposed to includein the documents. I felt bad in a way because I know I should have given her a better



orientation, but we have been so busy that it is hard to have the time to explain every

little thing over and over. She quit a week later, so it did not matter. Besides, she was

always texting her boyfriend when I was not sitting right next to her. No loss with herleaving.” Linda made a note to herself to follow up with Dr. Garcia‟s nurse and with the

three insurance companies.

Unauthorized release of information: Sally had a problem with that just last week. Carriewas covering the lunch hour for Sally and went to the window to respond to a walk-up

patient. The woman gave her husband‟s name and said she was there to pick up his

medical records. Carrie checked the list of documents for pick-up that day but did notsee his name. She asked the woman to wait, as the documents were not ready. Thewoman was pleasant about it, and Carrie made copies of his record. The woman chatted

with Carrie as she made the copies and was soon on her way, after signing a sheet

verifying that she had picked up the record. When Sally returned from lunch, Carriementioned what had happened. “Did you ask her for some type of identification?” Sally

asked. “No. She said she was his wife and she signed her name. Isn‟t that enough?”

Carrie asked. Sally explained that the woman should have provided some type of proof that she was his wife, and Carrie could have called up to the physician‟s office to verify

the request. Usually the patient would come down or the physician‟ s nurse would call inmost of these workmen‟s compensation cases. Sally did not have a good feeling about

this, and when she called the physician‟ s office, they said there was no reason for thepatient to request a copy of his record since he was just getting started in treatment and

may be having surgery. He had a case manager, and, if anything, she would have

called. An hour later the case manager called and told Sally that her client phoned herand was extremely mad. He asked why someone had given his medical record to his

wife. They were going through a divorce and she was looking for more money in thesettlement. Knowing that he was injured while on the job, she wanted to get a share of

any money he may be receiving in a lawsuit. Sally apologized to the case manager

profusely but knew that Carrie had made a big mistake with that one. “I was going totell you about it,” Sally had said to Linda at lunch. “But the case manager called meback a couple of hours later and said they had it all straightened out.”

Linda started another column: “Talk with Carrie About,” and wrote absenteeism, verbal warning, and release of information. She also wrote HR policy as a reminder to herself.

Linda added a few more notes to her list. Sally had told her about the patient who moved

out of state and requested three times that his medical record be sent to his new physician.Sally said he sounded more frustrated than anything else. “What kind of customer service is

that? We should have had that out to his physician weeks ago. He signed all the formsbefore he moved. I do not know where it fell through the cracks,” she said.

Before their lunch had ended, Sally said to Linda, “Well, at least I have one piece of good

news for you.” Linda asked what that might be; she really needed to hear some good news. “Dr. Haas came down yesterday morning and said his wife is a new patient with Dr.

Blumenthal. He asked to see her medical record because he wanted to make sure Dr.Blumenthal is being aggressive enough in his treatment.” Linda stared blankly at Sally,afraid to ask what happened. “What did you do?”

“I gave him my biggest smile and told him that unless I had his wife‟s signature on an

authorization form, I could not release any of her medical information to him. I told him Iwas sure he would understand. He looked a little surprised, then smiled back and said, ‟Of course,‟ and turned and went back to the elevator. Lucky for us, Carrie was not at the front

window for that one!” Linda laughed out loud. Yes, that was good news.



Coming back to the task at hand, Linda began to write lists to herself as reminders. The ROI

problems were a big quality issue, but she needed physician backing to allow her to enforceexisting policies. She would check with some of her colleagues at other facilities and see

how they were handling the ROI process. It was such a basic task, but it seemed like, at herorganization, it was out of control. Linda needed to gather some data first to make

comparisons with other organizations. She wanted to have objective data to take to Dr.Blumenthal and the physician group before she made her proposals.

There was also the issue of staffing. Morale was slowly dropping among her three star

employees, and she did not want to lose them. Their team needed reinforcements. The

department was going to need another full-time coder; 20 new physicians was a significantaddition to their coding load. She needed to find some comparison data for productivity

standards and also for revenues generated to show how the investment in another staff

member would generate reimbursement more quickly.

The other issue she wanted to address immediately was staff training. Linda could see

where she as a supervisor had fallen short of her responsibilities in appropriate training. She

wanted to promote a real commitment to her staff towards their professional development.

Linda would check into professional development activities when she spoke with hercolleagues. It was always good to see what others were doing and to make those

comparisons.

Linda thought about what Dr. Blumenthal had said about customer satisfaction. She thought

not only about patients and their families but also about the many case managers,

insurance companies, attorney‟s offices, and even the physician group. All of these werecustomers to the HIM department, and she and her staff had a responsibility to serve all of them. She had to find a balance between customer service and enforcing policy to manage

the process more effectively.

She also knew she needed to do some physician training on HIPAA requirements, reminding

staff that HIPAA applied to everyone. With all the new physicians joining the practice, thiswould be a good idea.

Documents

BKT Task 3 Quality and Performance Management and Methods Case Study