June 25, 2007

HIM Assessments: Helping Departments Achieve Their Goals
By Mary Anne Gates
For The Record
Vol. 19 No. 13 P. 16

A unit-wide assessment can help HIM departments run smoothly by improving operations and the bottom line.

Whether there is a need to correct a possible problem or a desire to transform a good HIM department into a cohesive, forward-thinking unit, an assessment can help secure departmental ideals, as well as the broader goals of the entire institution.

An assessment of an HIM department’s operation is done within the context of the larger organization, says Gwen Hughes, RHIA, CHP. Assessments are often requested by C-level staff, such as the CEO, chief financial officer, chief operating officer, or chief information services officer, she says.

Reasons to Perform an Assessment
Hughes, director of eHIM consulting for Care Communications, Inc., suggests the following reasons for an assessment:

• There is a perceived problem. Examples include unbilled accounts receivable is too high, and HIM is a potential contributor to the problem; physicians are complaining about transcription turnaround time; or the staff is unhappy, and turnover is too high.

• A strong HIM leader wants the fresh perspective of a colleague to further enhance HIM operations.

• The HIM director has resigned.

• Conversion to paperless processes from a predominately paper-based system is being considered.

• External assistance is needed to communicate a message and establish a sense of urgency.

• A further increase of an already high level of proficiency within the department is desired.

Other Assessment Drivers
According to Kathy Willis, sales executive for PHNS Inc., there are additional reasons an organization will request an assessment.

“The whole purpose for an HIM assessment is to implement best practices. [We want] to find out if the HIM department is following best practices. If they’re not, then hopefully there are opportunities that will arise as part of the assessment that will do one of two things: Normally, it either improves customer service, or it decreases the expenses,” says Willis.

“For example, you can have a very aggressive organization that is determined to implement best practices. They [hospital administration] may have a great impression of their current director and current management staff, but that team may have been there awhile, and they’re not sure if that team has been exposed to different opportunities,” she says.

Additional concerns driving an assessment include the desire to look at operations differently or confront perceived or real dissatisfaction.

“On one end of the spectrum, the facility may just be looking for a fresh set of eyes to come in and look at a department to see if there are areas for improvement. Or, on the other side of the spectrum, you can have dissatisfaction. Typically, either the hospital administrator or the senior management is getting complaints from physicians or other stakeholders,” says Willis.

A worst-case scenario may be a failed review that requires immediate and extensive attention to correct errors, omissions, or flaws within the HIM department. “It could be as bad as a failed Joint Commission review,” says Willis.

“There are many things that lead to an assessment. On the very best side, the very most positive side, it’s just a great organization trying to implement best practices,” adds Willis.

“Conversely, if there are a lot of unhappy people and some point to the HIM department as a possible source of the melancholy, senior hospital management staff will want to find out if there is something wrong,” she says.

Guiding HIM Leadership
When major events, such as a change in leadership, an experienced director seeking guidance because of an unusual circumstance, or someone working to assemble the best HIM department, occur that alter the function of an HIM department, an assessment can point to ways that will help make these transitions smoother.

For example, after a director resigns, an assessment can determine where the department should be led by an interim or new manager, says Hughes. An assessment can also be performed when a seasoned director wants input from other HIM experts.

“Perhaps she’s in a unique environment or on the cutting edge of our profession and needs someone to serve as a sounding board and coach,” says Hughes.

Further, says Hughes, help is available when someone has an eye focused on creating the best HIM department. “The right follow-up can help a pretty good department become the gold standard—the one all others measure performance against.”

Transitioning to New Processes
Besides leadership or other staffing issues, the HIM department and, by extension, the larger organization can benefit from an assessment when major workflow changes are being considered.

For example, a shift from a paper-dependent to paperless work model can be difficult and costly without a prior assessment. Transitioning to a paperless system can be accomplished more easily because an assessment of current practices provides an opportunity to design ways to move toward stated goals. An assessment helps with vision and planning to lead staff forward in a constructive way, says Hughes.

How In-depth?
The scope of an HIM assessment depends on why you’re brought in to do it, says Willis. “There may be concerns about individual areas of improvement. For example, the coding division is not meeting expectations, or customer response has not been positive. So, they want to dig a little bit into that area and find out what the situation is,” she says.

Sometimes, an assessment is financially driven. “They [administrators] feel the processes may have become antiquated, and there is an opportunity to implement best practices. And by doing a complete HIM assessment, they can dig into each of those areas and find opportunities for both service improvement and a financial or expense reduction,” says Willis.

Credentialed Consultants Respond
Experience, superior listening skills, and good coaching skills are some of the attributes consultants should have. “Generally speaking, consultants doing an assessment are usually credentialed RHIAs or RHITs,” says Hughes. “The credentials of the individuals doing the assessment should match the services being assessed.”

Furthermore, seasoned HIM professionals who have not only the technical knowledge and experience but are good listeners and coaches can conduct assessments, she says.

Conducting an Assessment
Initially, there is a lot of data gathering and interviewing. Consultants will look at documents and talk to people both inside and outside of the department. “A consultant is going to interview individual staff. They’re going to find out what they do and what their daily routine looks like,” says Willis.

Additionally, the consultant will examine a variety of other areas affecting the department. As part of the assessment, the consultant will create a workflow analysis, as well as review policy and procedures.

Consultants’ Questions
During the assessment, consultants will first look at the organization itself. Willis offers some questions consultants may ask during an assessment, including the following:

• How does the HIM department fit within the organization?

• To whom does the HIM staff report?

• Who do they serve?

• What are their roles?

• What committees do they serve on?

• What access do they have to software, educational materials, or programs?

• How does work flow through the department?

• Do employees have the tools they need?

• How are they oriented and trained?

• What are their responsibilities?

“Consultants are going to look at anything the staff does that affects their ability to perform for the organization,” says Willis.

Questions for Stakeholders
Besides the questions asked of HIM departmental leadership and staff, the consultant will have questions for others who interact with HIM professionals. The consultant will talk with physicians, hospital management, and other employees to gauge individual perceptions.

“There should be individual conversations with stakeholders throughout the organization to find out what they think about HIM,” says Willis. “All the stakeholders or users of the department have their own feedback.”

Willis says stakeholder questions may include the following:

• Are there areas that the stakeholders have not been happy with?

• Are there areas they are happy with?

• What are their opinions?

Finally, after all the information has been gathered, the consultant will create an assessment summary. Then, says Willis, the consultant will go back and verify the data.

Information Verification
After collecting the information, the consultant will ask questions to be sure she heard everything correctly. “There is a verification process and a lot of data gathering from various sources because some of that data can be skewed,” says Willis.

Once the information is verified, the consultant can make best practice recommendations and present them to the appropriate director or senior management staff at the hospital.

In some cases, the assessment is finished at this point. In other cases, says Willis, the facility will request the consultant put together a work plan and provide consulting services to implement many of the recommendations.

Assessment Cost and Return
The cost of an assessment can vary but is generally dependent on organizational need, says Willis.

The return, says Hughes, depends on the reason for the assessment, the level of performance, and the type of facility. “However, recommendations, if implemented, will usually result in at least $500,000 in cost-avoidance opportunities,” she says.

Hughes offers the following examples of returns on assessments:

• decreased unbilled accounts receivable as a result of streamlined HIM processes;

• decreased unbilled accounts receivable by shortening the bill drop from five days to three;

• reductions in staff turnover and the corresponding estimate of an $11,000 per person cost to recruit and train a new staff member;

• higher levels of physician (and their business) satisfaction due to improved cycle times and physician-friendly services; and

• higher levels of patient satisfaction (and patient referrals to hospital) secondary to reduced wait times for copies of records and patient-friendly services.

Examples of Positive Assessment Outcomes
In addition to positive returns on assessments, Hughes cites the following positive outcomes of HIM operational assessments:

• One client had an HIM director who didn’t provide his staff with opportunities for input about areas that had a huge impact on them. “We encouraged the director to work on certain leadership skills and to attend AHIMA’s Renaissance program. The director chose to make changes in his leadership style, and the result is his staff really likes working for him now.”

• At another site, “we helped leadership understand the challenges the HIM department’s physical structure necessitated and shared options for more efficient and effective processes. Leadership made physical changes to the department immediately that allowed for much more efficient processes and higher levels of customer and employee satisfaction.”

• At yet another site, “we helped leadership understand why HIM was overstaffed when benchmarked against other facilities of the same size. We helped them understand and implement actions to correct the fact that the HIM staff was overworked, performing duties that could and should be performed much more effectively in other departments.”

“In numerous sites, we’ve helped organizations implement much more efficient work product cycle times, allowing the organization to reduce substantially unbilled accounts receivable,” says Hughes.

“The highest functioning leaders in our profession often leverage the expertise of consultants to help their departments achieve excellent rather than good results. These high functioning leaders use consultants to provide a fresh perspective and help them lead their departments to even higher levels of performance,” adds Hughes.

— Mary Anne Gates is a medical writer based in the Chicago area.