MEDICAL RECORD AVAILABILITY UNIT PROJECT

Final Report

IOE 481: Special Projects in Hospital Systems

Dr. Richard Coffey

Winter 1995

Deborah Kiecha

Patrick Pruksapong

Edwin Robbins

Yeeling Wu

EXECUTIVE SUMMARY

This report details a study of a unit of the University of Michigan Medical Center’s Medical InformationServices (MIS) department. The Record Availability Unit (RAU) of the MIS department is responsible forlocating lost patient records. The two goals of the project were to:

• Develop a work standard by which to evaluate the RAU employees• Identify the root causes of lost records

The project consisted of two parts: a self-study and a direct observation study. The self-study was used totrack the search paths of the RAU employees and to assess where lost records were most frequently found.The direct observation study was used to determine the percentage of time spent each day on search and non-search tasks.

The studies generated the following results:• A work standard of seven records found per day per employee with an average of 48 minutes spent on

each successful search. This rate does not include vacation, sick or personal time.• Identification of the MIS area as the source of 60% of lost records with the following breakdown:

- Main File: 33%- Medical Record Data Quality (MRDQ): 16%• Return-to-File (RTF): 11%

• An average of two locations searched for each record found with 12.5% of searches remainingunresolved.

• A breakdown of the RAU workday as follows:- 72% time spent on search activities- 28% time spent on non-search activities

• Identification of several root causes of lost records, including:- Misfiles and files not signed into Main File and MRDQ- Clinics and inpatient floors failing to update the MRL system after receiving and/or

returning records- Failure to promptly return discharged patients’ records to Main File- Records retained outside of MIS for extended periods of time without proper notification- Inconsistent definition of a “lost” record.

• Identification of issues concerning working conditions, including:- need for an additional computer terminal- insufficient lighting in RAU office and Main File room

Suggested actions that follow from the recommendations are:• Refining and enforcing current MIS policies on the use of the RAU• Establishing a Main File goal of reducing search requests.• Storing deceased patients’ records in a separate area• Developing and submitting a proposal to the Program and Operations Analysis department for further

study of Main File room operations.• Installing an additional computer at the desk of Employee 2.• Increasing lighting to recommended levels in the RAU office and Main File room• Instituting a formal employee recognition program for the entire MIS department. Components of the

program could include:- written recognition of individual employees to be filed in employee files- an annual awards banquet- awards for individuals, work teams, and units

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TABLE OF CONTENTS

1.0 Introduction and Background 41.1 Abbreviations used in this report 41.2 Acknowledgments 5

2.0 Current Situation 53.0 Approach and Methodology 7

3.1 Project definition 73.2 System familiarity 73.3 Data collection 7

3.3.1 Self-study 73.3.2 Direct observation study 83.3.3 Historical data 8

3.4 Data analysis 83.5 Recommendations 9

4.0 Findings and Conclusions 94.1 Work standards 94.2 External factors 11

4.2.1 Root causes 134.3 Working conditions 14

5.0 Alternatives and Hypotheses 155.1 Reducing workload/problems 15

5.1.1 Refinement and enforcement of current MIS policies on the use of the RAU 155.1.2 Establishment of a Main File goal of reducing search requests 155.1.3 Job rotation between the Main File room and the RAU 155.1.4 Removal of Records of Deceased Patients 155.1.5 Inactive purges 155.1.6 Further study of Main File room 15

5.2 Improving Working Conditions 165.2.1 Personal voice mail/pagers for the RAU 165.2.2 The addition of another RAU computer terminal 165.2.3 Improved lighting in both the Main File room and the RAU office 165.2.4 RAU/Main File room employee recognition 16

6.0 Recommendations 166.1 Reducing problems/workload 16

6.1.1 Refinement and enforcement of current MIS policies on the use of the RAU 166.1.2 Establishment of a Main File goal of reducing search requests 176.1.3 Removal of Deceased Patients’ Records 176.1.4 Further study of Main File room 18

6.2 Improving working conditions 186.2.1 Addition of another computer terminal 186.2.2 Improved lighting 186.2.3 Employee recognition 18

7.0 Action Plan 18APPENDIX A

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(_tO Introduction and Background

The University of Michigan Medical Center (UMMC) is a health care facility that acceptspatients from all over the world. The medical center averages more than 500,000 visits peryear, which translates into more than 500,000 accesses to patients’ medical records.Medical Information Services (MIS) is the department of the hospital that is directlyresponsible for storing these records and providing them to requesters as needed.

As with any large organization that has many records circulating in and out of the system,the hospital’s Medical Information Services department occasionally experiences delays inlocating and delivering records, or in some cases, cannot locate records. These problemscan inconvenience doctors and patients, and result in lower efficiency of the hospital’soperation as a whole.

Medical Information Services has established the Record Availability Unit (RAU) to aid inthe operation of the department. This unit is mainly responsible for locating records thatcannot be found in routine searches. Currently, the unit is lacking a clear work standard bywhich employees can measure their performance. Working conditions must also beaddressed, since heavy workloads are leading to employee stress and frustration.

The main purpose of this study is to evaluate the current system and environment of theRAU and to try to establish a clear standard by which the unit’s productivity can be judged.

L .‘his standard is to be expressed as the number of records retrieved per worker per unit oftime. The study also seeks to locate problems or bottlenecks in the record search systemand to provide the client with recommendations for improving the system, therebyimproving the unit’s working conditions.

This study will focus primarily on the RAU, but given that the activities of this unit affectthe medical center’s various areas, this report will attempt to identify possible problemareas outside the unit as well.

1.1 Abbreviations used in this report

This report uses the following abbreviations:UMMC University of Michigan Medical CenterMIS Medical Information ServicesRAU Record Availability UnitMRDQ Medical Record Data QualityMRL Medical Record LocatorPW Patient WaitingRTF Return To FileFE Full Time Equivalent

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1.2 Acknowledgments

The project team appreciates the support and assistance received from Irma Wright, LucilleGagarin, Shirley Percy, and the RAU throughout the course of the project.

2.0 Current Situation

The Record Availability Unit is located on the basement one level (B 1) of the UMMC’sTaubman Center with hours of operation from 6:00am to 4:30pm, Monday through Friday.The unit consists of four full-time equivalent staff (FTE) whose areas of responsibilityinclude: Record Availability, Coding Documentation, Confidential Names, and StatisticalFile Maintenance. Definitions of these areas are given below:

• “Record Availability” includes locating lost or missing records or parts of records,reconstructing records as deemed necessary, and requesting and assembling recordsfrom secondary storage.

• “Confidential Names” involves processing requests for confidential names in caseswhen patients are to remain anonymous during hospital visits.

• “Statistical File Maintenance” involves providing the supervisor with statisticalinformation on problem researchlresolved and secondary storage requests.

Record Availability is the primary area of responsibility of the RAU. Requests for lost ormissing records can be made to the RAU in two ways — data tracking sheets andtelephone calls. Data tracking sheets are used by Main File and MRDQ to request recordsearches while clinics and doctors primarily use telephone calls. These sheets are receivedin a single “in” basket and are processed by RAU employees in the order received whileeach telephone request is processed by the RAU employee that answers the telephone andreceives the request.

Table 1 and Figure 1 display historical statistics concerning the number of requestsprocessed. The numbers in the table represent the total requests for missing records theRAU received each month in 1994, the number of records resolved or found, and numberof records unresolved or not found. The RAU received an average of 768 requests permonth in 1994.

5

However, there was an abrupt decrease in the total number of requests in September, 1994.The average number of requests for January through August was 841, but the average forSeptember through December was 623. This decrease was the direct result of proceduralchanges in Main File. The procedural change in Main File was the assignment of seniorfile clerks to supervise each file section. The senior file clerks review all data trackingsheets from Main File before they can be sent to the RAU.

Table 1: Monthly Resolved and Unresolved Records Searches for 1994

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Resolved Unresolved TotalRequests

Jan.-94 845 36 881Feb.-94 772 44 816Mar.-94 669 61 730Apr.-94 538 41 579May-94 613 49 662Jun.-94 922 75 997Jul.-94 955 65 1020Aug.-94 973 72 1045Sept.-94 559 56 615Oct.-94 576 73 649Nov.-94 547 89 636Dec.-94 504 87 591Average 706 62 768

Figure 1: Monthly Search Requests in 1994

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3.0 Approach and Methodology

The project team used a five-step approach to the project. Steps included:• defining the project and problem• understanding the system• collecting data• analyzing data• developing recommendations

3.1 Project definition

The team worked with the client to define the following two project goals:• Develop a work standard by which to evaluate the RAU employees• Identify the root causes of problem records

3.2 System familiarityPrior to data collection, the project team spent time interviewing and directly observing theactivities of the RAU employees. Each team member followed a designated RAUemployee through her tasks for a minimum of two hours in order to understand the natureof the tasks being performed.

3.3 Data collection

Data collection was done in three parts: self-study, direct observation, and historical dataanalysis. The self-study method was used to determine the frequency with which problemrecords were found at various locations. It was also used to determine whether or notoptimal search techniques could be developed and standardized.

The direct observation study was used to determine the percentage of time each RAUemployee spent on search and non-search tasks. Historical data was used to determine theaverage number of records each RAU employee found in a day. The direct observation andhistorical data were then used in combination to determine work standards for eachemployee, both in terms of records found per day and average search time per recordfound.

3.3.1 Self-study

A self-study was used to assess the frequency of problem records and their origins aswell as evaluate the RAU team’s search methods. In this study, the RAU employeeswere given data tracking sheets to record details of each record search they performed.A sample data tracking sheet is included in Appendix A. A total of 200 data sheetswere collected between February 21 and March 17. During this four week period, oneemployee was on sick leave for three weeks while another was conducting training forone week. However, since search paths are independent of workload, this variation instaffing was expected to have no effect on the self-study data.

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3.3.2 Direct observation study

A direct observation study was used to determine the distribution of search and non-search tasks in each employee’s work day. The project team members observed RAUemployees in one to two hour blocks distributed throughout a forty-hour work week.The distribution of these observation times is given in Appendix A, along with asample data collection sheet. The project team attempted to cover all days and times inthe week, missing only employee lunch breaks. The team members recorded start andend times for record searches as well as other tasks. The start time for a search activitywas defined to be the time the employee picked up a data tracking sheet or received aphone request. The end time for a search activity was defined as the time the RAUemployee began a non-search activity.

Like the self-study, this study was conducted between February 21 and March 17during which time one employee was on sick leave for three weeks and another wasconducting training for one week. This staffing variation would be expected to have aneffect on the data collected since the other employees were taking over some of thenon-search tasks of the absent employees. This would result in a greater percentage oftime spent on non-search tasks than usual. However, since non-search tasks comprise arelatively small percentage of each employee’s day, the effect is minimal.

3.3.3 Historical data

Previously collected data tracking sheets were used to determine the average number ofrecords found per day for each of the four RAU employees. Data from October,November, and December of 1994 were used. Note that data were not available forEmployee 3 for the month of December. Her work standard was therefore based ontwo months of historical data. Table 2 gives the sample size for each employee.

Table 2: Number of Historical Data Points for Each RAU EmployeeEmployee Employee 1 Employee 2 Employee 3 Employee 4No. of Data 52 41 17* 53Points (daysworked OctDec)*OctNov only

3.4 Data analysis

Analysis of the data was done in two sections. In the first section, the time study andhistorical data were used to develop work standards for each of the RAU employees. Thetime study data were used to assess the average percentage of time employees spent onrecord searches. The historical data were used to determine the average number of recordsfound per day for each employee. These two numbers were then used to calculate theaverage time per successful record search for each employee. The calculations areillustrated below:

8

minutes/day on search tasksminutes/record found =

records found/dayThe second section of the data analysis dealt with the evaluation of upstream sources ofproblem records. The self-study data sheets were used to determine where problem recordswere most frequently found, the distribution of the number of locations searched for eachrecord, and the relationship between the two. The data were also used to compare thenumber of locations searched for problem records found inside and outside the MISdepartment.

3.5 Recommendations

Once data analysis was complete, alternative solutions were generated and evaluated. Ofthese, the most feasible and effective suggestions were selected and presented asrecommendations. A course of action based on these recommendations was alsodeveloped.

4.0 Findings and Conclusions

Findings and conclusions fall into three categories: work standards, external factorsaffecting RAU workload, and working conditions.

4.1 Work standards

Historical and time study data were used to calculate work rates for each of the RAUemployees. Table 3 gives these figures, both in terms of number of records found per dayand average time per record found. Assumptions made in these calculations include:

4’ %4’’

• Employees work at 100% capacity. -• Time period of study was representative of normal conditions.• Search requests were distributed equally among the RAU employees regardless of

problem difficulty.

Table 3: Work standards for each employeeRecords Found Distribution of Time MinutesfDay

Employee Per Day Per Month %Search %Non- Minutes - Minutes - Total Mm/RecordAverage Average Search Search Non- minutes/day Found

SearchEmployeel 7 122 52% 48% 250 230 480 35Employee2 7 86 76% 24% 364 116 480 50Employee3 5 48 79% 21% 378 102 480 77Employee4 9 166 83% 17% 397 83 480 42Average 7 106 72% 28% 347 133 480 48

The results seem to indicate that the effectiveness of Employee 3 falls short of the groupaverage. However, this employee has the longest tenure of the group and is considered tohave the greatest expertise. The low averages for Employee 3 therefore possibly result

9

from inaccurate reporting of historical data. The employee may not have reported allrecords found for each of the months used in the analysis. An uneven distribution of thehistorical data for this employee across each month supports this assumption. Forexample, historical data indicate that this employee found few or no records on most daysand had a few days in which she found an unusually large number of records.

Several factors affecting this work standard were identified and should be considered whenusing the standard for evaluating or improving employee effectiveness.

Factor Effect on Work StandardEmployee experience Workers with greater experience may have

better idea where to begin search. May alsohave contacts in departments to help speedup search process.

Other tasks Employees with other task responsibilitiesdo not spend as much time on search tasks,and therefore may not retrieve as manyrecords per day.

Accuracy of historical data Some employees may not have completedthe data tracking sheets for all searches theyperformed. This would result in anunderestimated figure for the number ofrecords found per day. This may explainthe low averages for Employee 3.

Overcrowded Main File room The closely packed records in Main File. slow the search function since not all

records are easily visible or accessible.This also affects the accuracy of the searchsince records may be overlooked,particularly those stacked on top of theshelves.

Lighting Poor lighting in Main File and the RAUoffice can also hinder the search process;again, not all records and recordinformation are visible.

The project team did not observe any significant variability in demand or employee workrates throughout the work day or week. In general, employees did appear to be more activeon Mondays and more relaxed on Friday afternoons, but the differences in work rates werenot readily discernible.

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4.2 External factors

Two important observations stem from the self study data:• 49% of lost records are found in Main File and MRDQ, both areas within the MIS

department.• 73% of lost records are found by searching in one or two locations, independent of the

location found. This suggests that the definition of a “lost” record is not consistentthroughout the medical center.

Figure 2 shows the frequency with which lost records were found in various locations.Sixty percent of the missing record problems can be traced directly to the MedicalInformation Services area (Main File, MRDQ, and RTF).

Figure 2: Percentage of Records Found Per Location

The Main File room presents two issues: records that were never signed in and records thatwere signed in but misfiled. Of the 54 records found in Main File, two thirds were misfiledand one third were never signed in. Records found in MRDQ were generally not signed inor were signed in but left unfiled.

There are two external problems that occur with less frequency but consume a great deal ofsearch time. Twenty eight percent of records found are located at the last MRL andRequester locations. This indicates that clinics are not returning records to Main File andthat requesters may not be thoroughly searching their own areas before submitting searchrequests to the RAU.

OtherRequester 3%

CinicIFIoor9%

Last MRL19%

Main File33%

11%

11

The last two locations listed, RTF and Clinic/Floor, represent records that were essentiallymisplaced or forgotten about. When a patient is discharged from one of the hospital floors,his/her record is supposed to remain on the floor for 3 days. Many times, these get put onshelves, in drawers, left in conference rooms, or just in general forgotten about.

Figure 3 and represents the frequency with which records were found on the first search,second search, etc. Fifty percent of all records found were located in one search andtwenty percent were located in two searches. Statistics for the data shown in Figure 3 aregiven in Table 4.

Figure 3: Number of Locations Searched

>63%

312%

153%

Table 4: Statistics for locations searchedaverage 2maximum 10minimum 1standard deviation 1.41total resolved 173total days 10

Figure 4 breaks the data down into internal, external, and unresolved searches. Theunresolved category shows the highest number of searches on average. Since these cases

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Direct observation of the record search process revealed that root causes of lost recordsinclude:• Misfiles and files not signed into Main File and MRDQ• Clinics and inpatient floors neglecting to update the MRL system after receiving

and/or returning records• Failure to promptly return discharged patients’ records to Main File• Records retained outside of MIS for extended periods of time without proper

notification

It is important to note that a lack of consistency in the definition of lost recordsthroughout the medical center leads to search requests that could be resolved byrequesters without the involvement of the RAU.

are all unresolved, this number can be thought of as the average number of locations theRAU employees tried before they gave up and started a new search. Intuitively, one wouldexpect that the internal searches would take less time than the external ones. As far asabsolute time spent on each record, this may be the case, due to the extra distance thatnormally has to be covered on an external vs. internal search. However, the number ofsearches the RAU employees needed to find a record in their own unit did not vary muchwith the number of searches needed to find a records somewhere else in the hospital.

Figure 4: Internal, External, and Unresolved Searches

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4.3 Working conditions

Direct observation of the working conditions led to several conclusions about both theavailability of equipment and ergonomics of the working environment.

• Inadequate number of computers• Occasional time with no employee available to answer phones• Insufficient lighting

Currently, four RAU employees share three computer terminals, adding wait time to searchtasks if all four employees are performing searches.

Because the RAU employees frequently leave the office to search for records or performother tasks, there are occasionally times when no one is present to answer the phones.Customer dissatisfaction may result, particularly when records are needed immediately andno one is present to processes requests. Investigation into customer perception of this areacan help determine whether or not this is a problem.

Light readings were taken in the RAU office and the Main File room and compared againststandard ergonomic charts to determine the adequacy of the lighting in both rooms. Theresults are given in Table 5. A recommended level of 750 lux for simple office work isused here for comparison (Fundamentals of Industrial Ergonomics, Pulat, 1992), butrecommended levels can be obtained from other sources and should be consulted forconfirmation. These figures are provided to motivate further research into lighting levels.

Table 5: Light readings in RAU and Main FileLocation Light reading (lux) Percentage of

recommended levelRAU Office Center of office 300 40%

Directly under desk light 653 87%By computer with desk 612 82%light on (average of 2readings)

Main File Room Center of File room 505 67%In aisle of filing shelves - 226 30%at eye level (average of 3readings)In aisle of filing shelves - 122 19%near floor (average of 3readings)

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5.0 Alternatives and Hypotheses

All alternatives/hypotheses considered were directed toward improving working conditionsand/or reducing the number of problems handled by the RAU. All discarded options werethe result of infeasibility as so deemed by management staff and the observations of theproject team.

5.1 Reducing workloadlproblems

5.1.1 Refinement and enforcement of current MIS policies on the use of the RAUA clear definition of a lost record has not been established throughout the medicalcenter. Consequently, many requests for record searches could be eliminated byestablishing guidelines for determining whether or not a record is lost. Because overfifty percent of lost records can be located by searching in a single location, theelimination of these requests to the RAU can lead to workload reduction.

5.1.2 Establishment of a Main File goal of reducing search requestsThe establishment of a Main File goal to reduce the number of search requests fromthis area to the RAU would get the Main File area involved in locating those recordsthat are currently being found in Main File. This would allow the RAU to concentrateof searching for records outside of the MIS department.

5.1.3 Job rotation between the Main File room and the RAUThis was designed to give Main File room employees an appreciation for the difficultyof RAU work and, again, prevent misfiled records by having Main File roomemployees locate all misfiled records.

5.1.4 Removal of Records of Deceased PatientsThis can be done in two ways: 1) periodic purges of deceased patients’ records and 2)alternative storage for deceased patients’ records (with subsequent purging), creatingmore Main File room space (reduced expansion pressure) and increasing searchefficiency by decreasing the number of records stored in Main File and increasing theamount of space per record.

5.1.5 Inactive purges

This would have a similar effect on the workload as that of the death purges. Bothwould have the added effect of improving working conditions by reducing thecrowding of records and making it easier to locate and remove records.

5.1.6 Further study of Main File roomSince the project team did not have adequate time to thoroughly study the Main Fileroom, it appears that further study is needed in order to fully assess and reduce thenumber of lost records originating in this area. Goals of additional study would include

• Reducing the number of misfiles and search requests originating in Main File.

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• Reducing crowding of files and assessing the impact on reducing misfiles andspeeding up search time.

5.2 Improving Working Conditions

5.2.1 Personal voice mail/pagers for the RAUThis option would prevent incoming calls from being missed due to RAU employeesbeing out of the office at the same time. Voice mail would allow customers to leavemessages in the event that all four RAU employees are out of the office. Used as ananswering service, this option would also allow RAU employees to concentrate on theirtasks without being interrupted by phone calls for non-PW searches. The use of pagerswould reduce travel time by allowing RAU employees to perform multiple searcheswithout returning to the office between searches and would eliminate the need to waitin the office for return phone calls. Further study into the receptiveness of customers tothese ideas would need to be done prior to implementation.

5.2.2 The addition of another R4U computer terminalAddition of a computer terminal at the desk of Employee 2 would reduce RAUemployee idle time by allowing all four employees full access to a computer at any timethroughout the working day.

5.2.3 Improved lighting in both the Main File room and the RAU officeThe addition of another light source or an increase in bulb wattage would bring thelight levels in these areas up to recommended levels and improve search efficiency.

5.2.4 RAUIMain File room employee recognitionThis would increase the productivity of both areas by boosting employee morale andrelieves some of the stress associated with the nature of the work being done.

6.0 Recommendations

Of the ten previously discussed alternatives/hypotheses, the project team recommendsseven: refinement and enforcement of MIS policy, establishment of a Main File room goalof reducing the number of requests to the RAU, removal of deceased patients’ records,further study the Main File room, the addition of another RAU computer, increasedlighting, and institution of a formal employee recognition program. These fit into twocategories: improving current working conditions and reducing problems/workload.

6.1 Reducing problems/workload

6.1.1 Refinement and enforcement of current MIS policies on the use of the RAUThe number of search requests could be reduced if clinics and floors were assignedresponsibility for exhaustively searching their areas and checking the last MRL beforesubmitting search requests. The RAU would then be responsible for handling onlythose requests that require greater time, effort, and expertise.

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6.1.2 Establishment of a Main File goal of reducing search requestsEstablishing a goal of reducing the number of search requests would allow the RAU toconcentrate of external record searches by assigning Main File room employees theresponsibility of searching for lost records in their areas. A monitoring system could beused to track the number of lost records found in each filing area with the goal ofreducing this number for each area. Such a system would encourage thoroughsearching of each file area prior to submission of search requests to the RAU.

Figure 5 illustrates the impact of reducing the number of search requests from the MainFile room on RAU time. For example, a 20% reduction in the number of requestswould result in a savings of 32 hours of RAU time per month.

FigureS: Impact of Reducing the Number of Search Requests From Main File

6.1.3 Removal of Deceased Patients’ RecordsThis recommendation can be a great savings to the department in terms of storagespace and time spent searching. As previously stated, this can be accomplished in oneof two methods: regular purging and alternative storage (with subsequent purging afterobtaining approval from the Medical Record Workgroup). In either method there willbe a significant amount of increased shelf space, relieving at least part of the pressureto expand current file space. However, it may be observed that the second method ismore of a cost savings than the first, since records of deceased patients will already beisolated for removal, whereas with the first method, there will be an investment inlocating records that were filed in the Main File room. Again, with either of thesemethods, the advances that can be made towards increasing the allotted space per

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record will increase search efficiency by allowing records to be more easily moved andby improving the ergonomics of record movement. Currently RAU employees areeasily subjected to conditions such as carpel tunnel syndrome, the direct result ofpositioning their hands in awkward positions in order to remove crammed records.Eliminating even part of this problem can improve search efficiency and reduce thenumber of misfiled records, examples of both the effects of improved workingconditions and problem reduction.

6.1.4 Further study of Main File room

Finally, the project team recommends further study/analysis of Main File roomoperations with the intent of reducing the number of lost records stemming from thearea.

6.2 Improving working conditions

6.2.1 Addition of another computer terminalOne way to immediately improve working conditions is to add another computer to theRAU office. This will not only make the jobs of RAU employees easier, but it willalso reduce Unit idle time and thereby increase the percentage of time spent searching.It was brought to the project team’s attention that the department has approved theproposal of a fourth computer, particularly since the RAU office change, but the teamwould like to emphasize the importance of this matter.

6.2.2 Improved lighting

It has been shown that the lighting levels in both the RAU office and the Main Fileroom do not meet recommended ergonomic levels. Therefore, it is therecommendation of the project team that either more light sources be added or the bulbwattage be increased. This may increase search efficiency and reduce the potential foremployee eye injury.

6.2.3 Employee recognition

The project team is aware of the attempts currently being made to establish anemployee recognition program within the department and would like to outline thebenefits of such a program. First, any regular written or verbal recognition of employeeefforts can promote job pride and, subsequently, further effort. Through personalinterviews, the project team was informed of the basic need for recognition that existswithin the department.

7.0 Action Plan

Suggested actions that follow from the recommendations are:• Refining and enforcing current MIS policies on the use of the RAU• Establishing a Main File goal of reducing search requests.• Storing deceased patients’ records in a separate area

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• Developing and submitting a proposal to the Program and Operations Analysisdepartment for further study of Main File room operations.

• Installing an additional computer at the desk of Employee 2.• Increasing lighting to recommended levels in the RAU office and Main File room• Instituting a formal employee recognition program for the entire MIS department.

Components of the program could include:- written recognition of individual employees to be filed in employee files- an annual awards banquet- awards for individuals, work teams, and units

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APPENDIX A

UNIVERSITY OF MICHIGAN MEDICAL CENTERMEDICAL INFORMATION SERVICES

RECORD AVAILABILITY TEAM

IRMA MICKI KAREN MICHELLE ROSIE

SUPPLEMENTAL RECORD TRACKING SHEET

NOTE: Fill out this top section ONLY if no Record Tracking Request Sheet accompanied the search request.

Date of Request:

_________________________________

Time of Request:

Patient Name:

_____________________________

IPT / PW / STAT I ER

Registration Number:

_____________________________Requester

MRL:

________________________________

Last MRL Location:

_____________________________

Transfer Date:

__________________________________

Resolution Date:

______________________________

Found in:

_____________________________________

NOTE: Fill out this section and attach to the Record Tracking Request Sheet.

Date of Request:

_________________________________

Time of Request:

Registration Number:

___________________________

A. Search PathPlease indicate sequence of search (i.e. where you searched first, second, etc. until you found the record).

1. o File o MRDQ o Coding o Other.

2. o File o MRDQ o Coding 0

3. o File o MRDQ o Coding 0 Other

4. 0 File o MRDQ o Coding 0 Other

5. o File o MRDQ 0 Coding 0 Other

B. CauseIf known, please state the reason the record could not initially be found.

C. Additional comments

Distribution of Direct Observation Times

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tfl

oor

swee

psP

arts

Inac

tive

Pur

geS

econ

dary

Sto

rage

II

II

II

II

II

II

II

III

I

II

II

II

Com

men

ts/O

bser

vati

ons:

II

II_

_I