This Document Contains Chapters 1 to 7 Chapter 1 Introduction to the Health Information Management Profession and the Health Care Environment Learning Objectives After completing this chapter, the learner should be able to: 1. Identify the major components in a definition of management. 2. Relate management to Health Information Management (HIM). 3. Provide ideas for maintaining knowledge of health care trends. 4. Outline how the HIM career field has evolved over the years. 5. Explain how data and the resulting information are used in health care organizations today. 6. Discuss advocacy and its role in the effective use of health care information. 7. Define a health information consultant’s role in alternative delivery settings. 8. List two unique health information needs facing home health care organizations. 9. Give three areas of expertise that HIM professionals offer the home health care setting. 10. Describe several advantages that a computer-based patient record system can offer HIM managers and their customers in the future. 11. Apply the resources that an HIM professional may use for change management. Key Terms Administrative Data Aggregate data American Health Information Management Association (AHIMA) Broker Change management Consultant Demographic data Effectiveness Efficacy Efficiency Effort Electronic health record (EHR) External data Health data Health Insurance Portability and Accountability Act (HIPAA) Internal data Longitudinal patient record Management Matrix organizational structure Paradigm shift Patient-focused centers Resources Strategic planning Lecture Notes I. Introduction A. Common beliefs about management B. Define management 1. Planning 2. Leading 3. Organizing 4. Controlling II. Customers of managers in health care A. Patients B. Families C. Health care team D. Physicians E. Office staff F. Risk managers G. Utilization review H. Performance improvement III. HIM professionals serve as brokers A. Information demands of others B. New career opportunities to broker information IV. Use of resources A. Efficiency B. Effectiveness C. Efficacy D. Effort V. Overview of managing health information A. Evolution of the HIM career field B. HIPAA C. IT D. Evolving roles VI. Unique management features A. Variety of tasks in the HIM field B. Information management in health care VII. Definition of health care organization A. Health care professionals work together with standards and guidelines B. Expanding roles have created additional opportunities outside of traditional hospital setting VIII. Delegation of responsibility A. Board of directors B. CEO C. Managers IX. Health care facilities and information needs A. Clinical decision making B. Electronic health records (EHR) C. Data elements D. Types of data 1. Administrative 2. Aggregate 3. Demographic 4. External 5. Health 6. Internal X. Health care data quality and security A. Reliability B. Secure from corruption or modification C. Routine backup D. Privacy and security E. Database management F. Integrity XI. Health care data analysis A. Acquiring data B. Collecting data C. Evaluating data D. Processing data E. Transforming data into information F. Incomplete/missing data G. Data–information–knowledge continuum XII. Advocacy XIII. Types of health care facilities A. Acute care B. Ambulatory C. Skilled care D. Home health E. Government agencies XIV. Change management Teaching Strategies This chapter introduces the concept of management as it is pertinent to the health care environment. It will be helpful for students to hear real-life examples, either from the experience of the instructor or from guest lecturers. Videos may be developed with brief guest lectures from HIM professionals working in a variety of both traditional and nontraditional health care settings in order to demonstrate the diversity of tasks and positions that may be held by HIM professionals. Answers to Critical Thinking Exercises 1. Explain why HIM managers of the future can increasingly describe themselves as health information brokers. HIM professionals are responsible for protecting and disseminating information to and from a variety of entities. 2. List three methods HIM professionals can use to keep their knowledge current, and discuss the benefits of each. Answers may vary, but some may include attendance at meetings, reading journal articles, attending teleconference seminars, and networking. 3. Contrast the terms efficiency and effectiveness in the framework of health information management. Effectiveness is the degree to which stated outcomes are attained, such as coding health records without errors. Efficiency may be viewed in terms of the number of charts accurately coded within a specified period of time. 4. Describe several major management skills that will be needed by HIM brokers of the future. Answers may vary, but may include (not limited to) desire for career-long continuing education, knowledge of regulatory and accreditation standards, technical competence, and flexibility. 5. Offer three ways an affiliated acute care organization differs from a freestanding ambulatory care organization and three ways in which they are similar. Differing aspects may include (but are not limited to) employment status of providers, tax ID status, and contracts with insurance providers. Similarities may include (but are not limited to) types of patients seen, types of providers, and skills needed by professionals. Answers to Application of Theory Exercises 1. Reflect on the evolution of the HIM career field into the current industry practices and outline your predictions of what further evolution of the career field may involve over the next 10–20 years. Answers will vary based on student opinion. The HIM career field has evolved from traditional record-keeping to encompass data analytics, interoperability, and cybersecurity. In the next 10–20 years, I predict further integration of AI and telehealth, along with an increased focus on health data privacy and ethical considerations. 2. Choose one of the ambulatory care settings and discuss present and future opportunities for HIM professionals in this setting. Answers may vary according to setting, and future opportunities are always evolving and changing. In outpatient clinics, HIM professionals have key roles today in managing EHRs, coding for billing, and improving quality metrics. Future opportunities include managing telehealth data, leveraging data analytics for patient outcomes, and enhancing interoperability across health systems. Overall, the digital transformation in healthcare presents expanding roles for HIM in outpatient settings. Suggested Responses to Case Study 1. You are the director of HIM at a 400-bed acute care hospital. One of the responsibilities of your position is to oversee the management of health record completion. As you review monthly reports, you notice that the incomplete and delinquent rates have been steadily increasing and are reaching the maximum limit designated in the institution bylaws. You realize that you must do something to impact change in this trend. Develop three creative methods of addressing the problem that you may present at the next Health Record Management Committee meeting for approval as a new process. Answers will vary since this is looking for creative methods, but students may come up with ideas about getting physicians to complete their records, such as rewards or fines and other penalties. Chapter 2 Management Theories for an Integrated Management Model Learning Objectives After completing this chapter, the learner should be able to: 1. Define and describe the universal process approach to management. 2. Define and describe the five traditional management functions. 3. Explain how the operational approach to management applies to HIM professionals. 4. Explain how the behavioral approach to management applies to HIM professionals. 5. Explain how the systems approach to management applies to HIM professionals. 6. Describe how other approaches to management apply to HIM professionals. Key Terms Closed systems Contingency approach Controlling Empowerment External environment Gantt chart Human relations approach Human resources approach Integrated model of management Internal environment Leading Open system Operational approach Organizing Participative management Peter Principle Planning Process approach Quantitative approach Scientific approach Stakeholder Systems approach Universal process approach to management Lecture Notes I. Introduction A. Foundation of scientific management B. Integrated model of management II. General management theories A. Paradigm shift B. Universal process approach 1. All organizations are guided by the same general rational management processes 2. All organizations are not equal C. Henri Fayol’s five traditional management functions 1. Planning 2. Directing 3. Organizing 4. Controlling 5. Leading D. Henri Fayol’s 14 principles of management 1. Division of work 2. Authority 3. Discipline 4. Unity of command 5. Unity of direction 6. Subordinator of individual interests to the general interest 7. Remuneration 8. Centralization 9. Scalar chain 10. Order 11. Equity 12. Stability and tenure of personnel 13. Initiative 14. Esprit de corps III. Scientific approach A. Frederick Taylor 1. Management is a science based on laws and rules and secures maximum prosperity for both employer and employee 2. Operational approach 3. Initiative and incentive 4. Four foci of management a. Develop standardized work processes based on scientific study of each process involved b. Systematically select, train, and develop each employee rather than making them learn processes and tasks on their own c. Provide supervision and guidance for each worker in order to ensure that the processes are completed appropriately d. Divide work equally with managers applying scientific management principles to assist in planning work, while workers perform assigned tasks and are appropriately rewarded B. Frank and Lilian Gilbreth 1. Reduction of wasted steps to reduce cost C. Henry Gantt 1. Gantt chart 2. Minimum wage IV. Human resources and human relations approaches A. Human relations 1. Emphasis on shift to concern for employee satisfaction 2. Human systems B. Edward Deming 1. Quality improvement 2. Plan-do-check-act (PDCA) cycle C. Walter Shewart 1. Focus on outcomes D. Peter Drucker 1. Father of modern management 2. Focus on motivation of employees E. Abraham Maslow 1. Hierarchy of five human needs 2. Development of organizations where employees could meet their needs and develop full potential V. Quantitative approach A. Application of statistical models, information models, and computer simulations VI. Process approach A. Harold Koontz 1. Planning 2. Organizing 3. Leading 4. Controlling VII. Systems approach A. Ludwig von Bertalanffy 1. General systems theory 2. Systems of any kind consist of many components that must work in a cooperative manner to accomplish the purpose of the system as a whole B. Closed system C. Open system D. Stakeholder E. Peter Principle 1. Employees will advance to their highest level of competency, and then be promoted to their level of incompetence, where they will remain VIII. Contingency management approach A. Participative management B. Internal environment C. External environment D. Empowerment Teaching Strategies Traditional and contemporary management theories should be applied to real-world examples from the health care environment. Answers to Critical Thinking Exercises 1. Choose one major management theory and explain its value by building an integrated model of management. Responses will be individual. One major management theory is the Systems Theory, which views organizations as interrelated components working together. Its value lies in promoting holistic thinking, enabling managers to understand how changes in one area affect the entire system. By integrating this model, managers can enhance communication, improve resource allocation, and foster adaptability, leading to more effective decision-making and organizational resilience. Overall, Systems Theory encourages a proactive approach to managing complexity in today's dynamic business environment. 2. Give four typical stakeholders who offer input to managing a health care organization. Answers will vary, but may include the following: • Physicians • Nurses • Ancillary department employees • HIM professionals • Business office • Quality and performance improvement staff • Patients • Community members • Vendors • Third-party payers 3. Explain why health care organizations are considered open systems under the systems approach to management. Health care systems are dynamic systems that interact with and are influenced by their environment. 4. How does a participative management style fit into the contingency approach to management? Managers must be able to make appropriate decisions for circumstances demanding immediate answers with no time to ask for employee participation in the decision-making process to solve a problem. 5. Discuss the role mentors can play in teaching both management theory and practice. Mentors can share their real-world experiences and apply them to the different management theories. Answers to Application of Theory Exercises 1. Compare and contrast the management theories presented in this chapter. Learners may provide brief summaries of the similarities and differences noted between each of the theories as they are presented in the chapter. 2. Interview an HIM professional to find out examples of situations encountered in the workplace, along with a management style most effective for each. Answers will vary based on professional interview responses. An HIM professional shared a situation where rapid changes in healthcare regulations required swift adaptation; a transformational management style was most effective, as it encouraged team innovation and engagement. In contrast, during a data breach incident, a more directive management style was used to ensure clear communication and immediate action, minimizing risks and restoring security. 3. Develop a Gantt chart for planning steps involved in writing a research paper. Answers will vary based on steps followed by individual learners. To develop a Gantt chart for writing a research paper, key steps include selecting a topic, conducting research, outlining, drafting, revising, and finalizing the paper, each assigned specific timeframes. Visualizing these tasks on a timeline helps manage deadlines and ensures a structured approach to completing the project. Suggested Responses to Case Study You are new to the position of vice president of HIM for a large chain of health care facilities. As you have assessed the current situations in the HIM departments at each facility, you have met with the HIM directors, all of whom do not believe that AHIMA Vision 2016 presents realistic goals for any of their employees because they feel their employees have reached their greatest potential and believe that they will not be successful if they try to pursue any kind of additional training or promotion. Describe how you would address this situation. Answers will vary since this may involve some creativity. One approach may be to break down Vision 2016 and provide practical applications. Chapter 3 The Art of Decision Making and Problem Solving Learning Objectives After completing this chapter, the learner should be able to: 1. Explain differences between strategic planning decisions and day-to-day problem-solving decisions. 2. Describe problem seekers and ways they manage differently than problem avoiders. 3. Outline the steps in the decision-making process. 4. Differentiate conditions for certainty, risk, and uncertainty. 5. Describe the pressures facing decision makers in satisficing rather than using total rationality. 6. Illustrate well-structured problems and contrast these with ill-structured problems. 7. Explain how to create programmed decision-making tools for teams and contrast these with nonprogrammed decision-making methods. 8. Identify advantages and disadvantages of team decision making. Key Terms Certainty Continuous quality improvement Creativity Decision-making process Electronic meeting Moderator Nonprogrammed decision Problem avoider Problem seeker Problem-solving process Programmed decision Rational model in decision making Risk Rule Uncertainty Lecture Notes I. Introduction II. Decision making in planning and daily problems A. Problem-solving process B. Problem seekers C. Problem avoiders III. Decision-making process A. Define the real problem, after awareness of the symptoms B. Set criteria for making the decision while analyzing available information C. Generate relevant alternative solutions to the problem D. Analyze and evaluate these alternatives E. Select the best alternative for a solution F. Implement the chosen alternative G. Monitor and evaluate the decision’s effectiveness IV. Rationality in decision making A. Maximize every choice in decision making B. Satisficing decision V. Contingency approach to decision making A. Routine/programmed decisions B. Nonprogrammed decisions VI. Team approach to decision making A. Reach out to the team B. Other teams may be assigned C. Multidisciplinary teams allow for mutual understanding of challenges and opportunities D. Moderator VII. Electronic meeting Teaching Strategies Real-world examples from the health care industry should be provided to reinforce the theories introduced in this chapter. Divide the class into teams and provide a simulated problem for each team to solve. Have the teams share their problem-solving experience with the class, examining obstacles and successes that they encountered in the problem-solving process. Answers to Critical Thinking Exercises 1. Why can the group decision-making process be both efficient and effective? Groups can benefit from diversity of opinion, which will bring the problem into focus. A wider range of alternatives results from diversity of ideas (two heads are better than one), bringing increased opportunity for creative problem solving. 2. Give three reasons why top management in a health care organization would encourage department managers to document a wide range of programmed decisions for their staff. Documentation for programmed decisions can save time by eliminating the need for employees to interrupt the manager with questions about the same topic repeatedly. 3. Interpret the meaning of the phrase satisficing decision and then describe a decision you have made recently that aligns with its assumptions. This is a decision that may not be the best approach, but may be most feasible considering circumstances. Examples will vary for individual learners. A satisficing decision refers to choosing an option that meets acceptable criteria rather than seeking the optimal solution, often due to constraints like time or resources. Recently, I needed to select a new software tool for project management. Instead of researching every possible option, I quickly evaluated a few tools based on key features and user reviews, settling on one that met my essential needs without exhaustive analysis. 4. Consider the steps of the decision-making process; identify one step, if any, that is more important than the others. Defend your answer. Answers will vary based on learner experiences. Identifying the problem is arguably the most crucial step in the decision-making process, as a clear understanding of the issue lays the foundation for effective solutions. If the problem is mis defined, subsequent steps may lead to ineffective or misguided outcomes. 5. Discuss the value of encouraging group members to share differing ideas as they explore alternative solutions to a problem. Individual experiences provide diverse backgrounds for differing ideas that allow a broader range of alternative solutions to a problem that expand the possibilities for a selected solution. 6. State reasons why managers may not routinely anticipate difficulties before they become problems. Answers may vary. Some may include that managers are not continuously aware of the status of all areas of a department to be able to identify potential problems. 7. Compare the use of rules and policies in managerial action; explain the difference between these tools. While a rule is a statement that sets parameters, a policy may be based on one or more rules. Answers to Application of Theory Exercises 1. You are the director of an HIM department. Having recently moved to the EHR, plus eliminated the old paper records through a combination of scanning and microfilm, your department has newly available space from the room previously used for paper record filing. You are considering a remodel of your department. Apply the seven steps outlined in Figure 3-1 to decisions involved. This will involve some creativity by the learner, so answers may vary. The seven steps to consider are: 1. Define the real problem after awareness of the symptoms. 2. Set criteria for making the decision while analyzing available information. 3. Generate relevant alternative solutions to the problem. 4. Analyze and evaluate these alternatives. 5. Select the best alternative for a solution. 6. Implement the chosen alternative. 7. Monitor and evaluate the decision’s effectiveness. 2. Explain the rationale for avoiding a difficult decision, hoping the problem will go away. Discuss advantages or disadvantages for tackling the problem immediately. Individuals may avoid tackling problems because they feel overworked, under pressure, or have time constraints. Addressing problems in a timely manner can help stop the growth of a problem before it gets out of control. Utilizing a team approach can also generate creative and varied solutions to a difficult decision. 3. Think of several decisions you have made in the past week. Describe the conscious steps you took in the process of reaching the final decision for each. Answers will be personalized based on individual experience. In choosing a book to read, I identified my interest in a specific genre, researched popular titles, evaluated reviews, and selected one that appealed to me. For planning my weekend, I considered my schedule, researched local events, weighed my options, and decided to attend a concert that fit my interests and availability. Suggested Responses to Case Study Complaints have come to the department manager regarding timeliness of requests for patient information and a decision must be made. Three months ago, Community Hospital opened a 24-hour urgent care center 10 miles away in a rapidly growing community. Kent Jones, the health information services manager, took part in the planning that included the use of a combined record and one patient identification number. The decision was made to use electronic sharing of patient records between the facilities; however, at present, it is necessary to fax some portions of the record upon request. In the past month, Kent has received four complaints from the urgent care center that records were not faxed in a timely manner. There are 26 employees in health information services. Three full-time employees care for record activity during the day, with one employee devoted to record activity during the evening shift, when a team leader and four other employees are usually in the department. During the 11 P.M. to 7 A.M. shift, one employee cares for the department and picks up the discharged records from the patient care units. This time away from the department averages 1 hour. Adding additional employees is not an option, since there is a hiring freeze in place. Kent envisions an increase in the requests for record information as the patient load at the urgent care center increases and realizes the assumption of his management team that this activity could be absorbed without adjusting work schedules was in error. Prepare to assist Kent in solving this problem using the steps outlined in this chapter. Answers will vary and should follow the steps of the decision-making process: 1. Define the real problem after awareness of the symptoms. 2. Set criteria for making the decision while analyzing available information. 3. Generate relevant alternative solutions to the problem. 4. Analyze and evaluate these alternatives. 5. Select the best alternative for a solution. 6. Implement the chosen alternative. 7. Monitor and evaluate the decision’s effectiveness. Chapter 4 Planning in the Health Care Setting Learning Objectives After completing this chapter, the learner should be able to: 1. Define the management function of planning. 2. Apply time management techniques in situations encountered by HIM professionals. 3. Explain differences between formal and informal planning. 4. Distinguish between strategic and operational planning. 5. Describe contingency planning and its advantages in health care management. 6. Define organizational vision and its role in the mission statement. 7. Explain how departmental objectives flow from organizational mission statement, goals, and objectives. 8. Identify the four components of SWOT analysis and describe the steps in analyzing the environment. 9. Outline major steps in the planning process. 10. Define transitional planning. 11. Describe use of a business plan. Key Terms Business plan Entrepreneur Informal planning Intrapreneur Mission statement Response time Span of control SWOT analysis Time management Transitional planning Vision Lecture Notes I. Introduction II. Time management A. Planners and calendars B. Priority ranking 1. Important, but not urgent 2. Important and urgent 3. Not important, not urgent 4. Nor important, but urgent III. Defining planning A. Informal planning B. Formal planning IV. Strategic planning A. Strategic management B. Strategic decision making C. Strategic goals D. Strategic communications E. Mission statement F. SWOT analysis 1. Strengths 2. Weaknesses 3. Opportunities 4. Threats V. Transitional planning A. Assessing the environment B. Transitional plan creation C. Implementation plan creation VI. Developing a business plan within the organization Teaching Strategies Provide real-world examples of both formal and informal planning that you have done. Identify obstacles and how they were overcome. Answers to Critical Thinking Exercises 1. Explain how an organizations mission statement, strategic plan, and overall objectives relate to one another. The mission statement is the strategy that transforms long-range objectives into action and reality. 2. Give examples for using informal planning in a managers daily activities, then explain when formal planning would be more appropriate. Informal planning might include daily to-do lists or spontaneous team meetings to address immediate issues. Formal planning is more appropriate for long-term projects or strategic initiatives that require thorough analysis and structured documentation. 3. Describe the major steps in strategic planning and document reasons why each step is important. The most important step is to start with a review of the mission statement. Objectives are developed from the mission, and plans are formed based on the objectives. Additional responses may vary. 4. Define the terms objectives and goals; then discuss their importance in strategic planning. Objectives and goals are developed to support the mission statement. 5. Describe the steps in a SWOT analysis. Give examples that show the value of SWOT analysis in strategic planning. Strengths, weaknesses, opportunities, and threats are identified in a SWOT analysis. Examples will vary. 6. Describe your nonverbal and verbal responses to the HIM manager who says, “Plan? I seldom have time to plan. I live from day to day just attempting survival.” Responses will vary based on student opinions. I would nod empathetically to acknowledge their feelings and say, "I understand that daily demands can be overwhelming; however, even small planning steps can help reduce that pressure over time." This response combines supportive nonverbal cues with a constructive verbal suggestion. 7. What are the components of a detailed business plan? 1. Executive summary (manager’s or team’s summary) 2. Mission statement: planned accomplishments and goals 3. Description of the business or project 4. Target market, sales, or service market penetration 5. Financial plan and projected budget 6. Evaluation plan Answers to Application of Theory Exercises 1. Make a list of activities that you did yesterday. Identify items in the list according to the priority that they were when you completed them. Should any of the activities been ranked as a higher or lower priority than as they actually were completed? Create a list of activities that you need to do tomorrow and assign priority ranking to each. At the end of the day, review the list to evaluate how well you adhered to your plan. Analyze your findings to determine what you could have done differently or how you plan to do things differently when planning in the future. Responses will vary based on learner experiences. Yesterday's activities included attending meetings (high priority), responding to emails (medium priority), and organizing my workspace (low priority). For tomorrow, I'll prioritize client calls (high), project deadlines (medium), and personal errands (low); at day’s end, I'll assess my adherence and adjust priorities based on what emerged as urgent. 2. Your management team is giving priority to automating chart tracking during strategic planning meetings. Write out possible major objectives the team members should consider as they prepare for a presentation to top management. The team could use the SWOT format—strengths, weaknesses, opportunities, threats—to outline the aspects of their proposal and to show that they had done due diligence in researching the system. Suggested Responses to Case Study Jackie and Sandra began a long-term-care consulting firm 5 years ago in a retirement region. They now have six employees: two RHIAs and four RHITs. They now have consulting contracts with 35 long-term-care facilities and have developed a reputation for excellence. During a meeting with the employees, Jackie and Sandra commended them for the effort each had contributed to the success of the firm. In planning for the future, Jackie and Sandra then asked the employees to share with them ideas on expanding the business by revising the vision. One option they had discussed and now shared was that of expanding their geographic region into another state. This would mean actively marketing to long-term-care facilities beyond their present region and hiring additional staff. Bryan said he had been listening to employee conversations at a nearby hospital and learned that there was a need for additional home health care personnel and resources in the region. Hospital utilization management staff expressed concern with the difficulty of referring patients promptly to home health care firms. Bryan thought developing and managing home health care as a separate cost center would fill this market niche and offer challenges to each of them. Ann shared an experience she had at one of the nursing homes. Two physicians were telling her how difficult it was to hire knowledgeable office staff and retain them. Ann suggested expanding their business into physician offices. She felt they had the expertise to manage practice offices and train competent staff. Ann further stated that when she mentioned this need to a physical therapist who recently joined a group of fellow therapists in opening an office, her friend responded that such a service would be welcomed by them also. Then he related the difficulty they were having finding competent office managers. Jackie, Sandra, and their staff have three options to consider as they undertake strategic planning: 1. Develop a SWOT analysis for this consulting firm. Responses may vary, but could include the following: Strengths—credentialed professionals Weaknesses—difficulty finding competent office managers Opportunities—expanding into another state Threats—difficulty referring patient promptly to home health firms and difficulty hiring and retaining staff 2. Make assumptions regarding the region and factors that relate to each of the three options. Assumptions will vary due to learner perceptions. 1. Option A: Urban Development Focuses on metropolitan areas with high population density and strong economic growth potential. 2. Option B: Agricultural Expansion Targets rural regions with fertile land, access to water resources, and government support for farming. 3. Option C: Renewable Energy Projects Concentrates on areas rich in natural resources (like wind and solar), driven by incentives and rising energy demand. 3. Choose one of the options and prepare a business plan for the firm. Responses will vary, as this will require some creativity. Business Plan for Green Future Energy: We will develop solar and wind farms in resource-rich regions, targeting utilities and corporations seeking sustainable energy. Our goal is to achieve a 15% ROI within five years while reducing carbon emissions by 100,000 tons annually. Funding will come from equity investments and grants, with projected revenues reaching $10 million by year five. Through strategic partnerships and robust marketing, we aim to lead in renewable energy solutions. Chapter 5 Planning in Health Care: Operational Plans and Tools for Planning Learning Objectives After completing this chapter, the learner should be able to: 1. Describe the scope of operational planning. 2. State the advantages of including team members in planning. 3. Identify major factors in planning operational objectives. 4. Outline major ingredients of the MBO system. 5. Give several advantages for using Gantt charts and PERT networks. Key Terms Management by objectives Performance evaluation and review technique (PERT Network) Results management Section/team managers Lecture Notes I. Introduction II. Preparing operational objectives III. Planning objectives with the management by objectives system A. Revising policies and procedures in the planning process B. Implementing and monitoring the plan IV. Tools and techniques to assist in managerial planning A. PERT network B. Gantt chart C. Mathematical models as planning tools 1. Break-even analysis 2. Queueing theory 3. Probability theory 4. Linear programming Teaching Strategies Provide real-life examples of how the different approaches work with practical applications. Have students complete a Gantt chart for a project they are working on. Answers to Critical Thinking Exercises 1. Describe differences between a top-down approach to creating objectives versus a bottom-up approach. A top-down approach involves the manager providing directions to a subordinate in a one-way communication, while bottom-up includes provision of feedback from the subordinate to the manager. 2. Discuss potential conflicts between objectives being planned by financial services and those planned by HIM department managers in a large hospital. Financial services may not be aware of the importance of some of the HIM-specific rules and regulations that could limit or drive activities by HIM staff. 3. Develop a Gantt chart for one of your class projects. Answers will be personalized by student. For my class project on environmental sustainability, the Gantt chart includes phases like research (Week 1), outline creation (Week 2), drafting (Weeks 3-4), and final revisions (Week 5). Each phase is assigned specific deadlines to ensure timely completion and effective progress tracking. 4. Explain why the critical path in a PERT network is so important. It is the most efficient approach to a project completion. The critical path in a PERT network identifies the longest sequence of dependent tasks that determines the project's minimum completion time. It is crucial because any delay in critical path tasks directly impacts the overall project timeline, helping managers prioritize resources effectively. 5. Give two examples where automation would lend valuable assistance in solving managerial problems. Answers will vary based on learner experiences. Automation can streamline data entry and reporting processes, reducing errors and saving time in financial management. Additionally, it can enhance customer service through chatbots, providing instant responses and freeing up staff for more complex inquiries. 6. How would you respond to the statement, “It is impossible to plan when we do not know what we are going to be doing next month.” Answers may vary but could imply the importance of being able to project into the future with plans into future months. 7. Explain the value of participative managerial concepts when coordinating a group effort. Participative managerial concepts are important with group work, as they encourage relatively equal participation from all members involved. 8. Think of the person to whom you were responsible in your last position. Give some operational planning activities you observed that manager doing. Responses will vary based on experiences. In my last position, the manager conducted regular team meetings to set weekly goals and track progress on projects. They also created detailed schedules to allocate resources effectively and ensure deadlines were met. Answers to Application of Theory Exercises 1. Compile a list of individual objectives that are operational in nature related to completing your education. Answers may vary but could include items such as completing homework, paying tuition, and attending classes. 2. Interview an HIM professional involved in planning a project. Document the tools being used in planning this project and in carrying it into implementation. Answers will vary based on interview responses. I spoke with an HIM professional who is planning a health records management project. They are using tools such as Gantt charts for timeline visualization, project management software (like Asana) for task assignments, and SWOT analysis for assessing project viability. For implementation, they rely on regular progress reports and communication platforms like Slack to ensure team collaboration and accountability. 3. Outline an operational plan for the transcription section of an HIM department. Plan may include completion of dictated reports and saving transcribed documents to appropriate records. Suggested Responses to Case Study The last Joint Commission report for Community Hospital was unfavorable with regard to employee ongoing education. Top executives admitted that they set other priorities and the managers concurred. Overall the report was very good and the managers were pleased but determined to focus on education during the coming year. With this mandate, upper-level management developed one corporate objective relating to education as the budget process for the coming year began. This corporate objective read: Corporate objective III: To educate health care professionals within the enterprise to meet the health care needs of society and to define 5-year plans to meet educational needs for the several professional groups. The corporate objectives were distributed and discussed at a meeting with middle managers. The responsibility for developing departmental objectives for the coming year was delegated to the managers. Community Hospital culture was participative in nature, and the flowchart in Figure 5-1 describes the communication process as the managers shared the vision with the teams and the team leaders empowered individual employees to offer suggestions. 1. Develop ongoing educational objectives for health information services to meet corporate objective III for the coming year. Answers will be individualized. 2. Develop ongoing educational objectives for the major teams in the department for the coming year. Answers will be individualized. 3. Choose two professional employees that you know and develop educational objectives for each of them for the coming year. Answers will be individualized. Chapter 6 Management of Financial Resources Learning Objectives After completing this chapter, the learner should be able to: 1. Outline HIM activities related to revenue cycle management. 2. Interpret coverage guidelines for insurance and government-funded payment systems. 3. Discuss the impact of HIM functions related to finance and accounting. 4. Explain the value of a budgeting process. 5. Contrast fixed budgeting versus variable budgeting. 6. Contrast incremental budgeting versus zero-based budgeting. 7. List the major factors for success in budgeting development. Key Terms Accounting Bottom-up budgeting process Capital budget Cash budget Charge capture Charge description master (CDM) Charge reconciliation Chargemaster Fixed budget Flex time Incremental budget Medicaid Medical necessity Medicare Medicare administrative contractor (MAC) Operating budget Recovery audit contractor (RAC) Revenue cycle Revenue cycle management Top-down budgeting process Variable budget Zero-based budgeting (ZBB) Lecture Notes I. Introduction II. Revenue cycle management A. Unbilled accounts B. Charge reconciliation 1. Charge capture 2. Charge description master (CDM) III. Insurance and government-funded payment systems A. Medicaid B. Medicare 1. Medicare administrative contractors C. Prospective payment systems D. Medical necessity E. Payment rejection F. Case-mix index G. Managing health care documentation IV. Finance and accounting principles A. Managing financial data and information B. Basic accounting functions addressed by HIM professionals 1. Balance sheet V. The budgeting process A. Operating budget B. Capital budget C. Cash budget D. Bottom-up budgeting E. Top-down budgeting F. Future budgets for information/communication systems G. Fixed versus variable budgeting H. Incremental budgeting versus zero-based budgeting Teaching Strategies Discuss creative ideas for revenue cycle management and reduction of accounts receivable. Answers to Critical Thinking Exercises 1. Give several differences in the budget you would prepare for a consulting business plan and the budget an HIM department director would be creating in a hospital with 50 employees. A consulting business plan would include additional overhead costs for running a business, while a department plan would be more operational in nature. 2. List some items in a departmental budget that have flexibility, depending on patient activity. Staffing, revenue, supplies 3. Compare incremental and zero-based budgets. Incremental is a budget that allocates funds to departments for the new budget period based on allocations of the previous budget period. Zero-based budgeting is a budgeting system where each budget request requires justification in detail regardless of past allocation. 4. Identify items that should be considered for inclusion in an HIM department budget. Payroll, benefits, supplies, EHR maintenance Answers to Application of Theory Exercises 1. Your department is behind in completing the coding and billing for your hospital, how would you prioritize the work of your coders to maximize their efficiency? Coders should prioritize their work, focused on the greatest impact, which would include the largest dollar amount accounts and the longest admission accounts. 2. As the manager of the Health Information Management department you receive a copy of a letter of denial from ABC Insurance Company for patient Joseph Barker, date of birth October 10, 1938. On January 4 of this year, Mr. Barker was seen in the hospital emergency department for chest pain. In a review of the medical information, you discover that the information sent to the insurance company on the claim form is not correct and many departments that treated the patient did not send their information to the billing system. Write a letter of appeal to an insurance company for the denial of a claim for services. The letter should include patient identification, date of birth, service dates, and a statement that the correct information is being submitted. Suggested Responses to Case Study Based on the following information, create a proposed budget for year 2: • Recent merit pay increases (usually 0–5% provided annually) have resulted in the following salaries: • Two coders each at $15/hour • One coder at $14.50/hour • Lead coder salary, $50,000/year • Two release-of-information specialists each at $13/hour • Director salary, $75,000/year • Physician record assistant at $14/hour • Credentialing specialist salary, $37,000/year • Two data quality analyst salaries at $15/hour • Scanning clerk at $12/hour • Additional equipment was obtained in month 6 at a rental rate of $200/month. • The ability to fax records electronically will be available at the start of budget year 2. Budget Year 1 Actual Year 1 YTD 3rd Quarter Budget Year 2 Revenue Record release fee income $150,00 $125,000 150,000 Expenses Salaries (including overtime) $375,000 $300,000 425,120 Benefits $550,000 $425,000 550,000 Contracted audits $100,000 $50,000 100,000 Equipment rental $4,000 $3,200 6,400 Supplies $5,000 $4,500 5,000 Education $6000 $3000 6,000 Postage $2,000 $1,250 2,000 Chapter 7 Planning Policies and Procedures Learning Objectives After completing this chapter, the learner should be able to: 1. Explain the differences between rules and policies and how each relates to objectives. 2. Discuss the value of documenting procedures into manuals in the work environment. 3. Give several reasons for creating an open-mode environment for employees. 4. Outline guidelines for developing departmental rules and policies that will conform to organization-wide rules and policies. 5. Describe the steps for creating rules and policies to cover unique problems. 6. Identify the steps for successfully revising department procedures. 7. Defend managerial decisions that empower teams to revise their own procedures. 8. Give examples of alternative health care settings where HIM consultants need skills in writing policies and procedures. 9. Describe the main features of the narrative format for writing procedures. Key Terms Manual Open-mode environment Standing-use plan Lecture Notes I. Introduction II. Developing rules, policies, and procedures A. Policies B. Rules C. Procedures D. Manuals as tools E. Creative manual writing III. Writing policies and rules A. Sources of information B. Guidelines for writing rules and policies IV. Writing procedures A. Revising procedures B. Writing new procedures C. Format for procedures 1. Outline 2. Abbreviated narrative 3. Action verbs 4. Page numbering Teaching Strategies Provide examples of when a policy or procedure was useful in your career. Provide an example of when lack of policy or procedure could have benefitted from having documented guidelines. Answers to Critical Thinking Exercises 1. List several of your attributes that you feel have contributed to creative ideas in your past experiences. Compare these with attributes you feel contribute to your skills in explaining activities in written form. Answers will vary by individual. Attributes that have contributed to my creative ideas include open-mindedness, curiosity, and adaptability. In contrast, attributes that enhance my written communication skills include clarity, attention to detail, and organizational ability. Both sets of attributes foster effective problem-solving and articulate expression of ideas, but creativity thrives on exploration while writing demands structure. 2. List eight advantages managers have when they choose to document rules, policies, and procedures. 1. Encourage teamwork. 2. Promote clarity, consistency, and continuity of performance. 3. Provide excellent information for training programs. 4. Establish standards and expectations against which actual performance can be monitored. 5. Serve as a central database for adding, revising, or deleting rules, policies, or procedures. 6. Release managers, supervisors, and team leaders for departmental planning or other activities by saving time spent answering repetitive questions. 7. Serve as source documents for inspection by accrediting and licensing agencies. 8. Become working benchmark documents and thus serve as a warning signal for potential problems and quality improvement actions. 3. Give several examples where standing-use plans would be valuable for a consulting firm that contracts with long-term care facilities. Standing-use plans would be valuable for a consulting firm by providing emergency response protocols, standardized staff training programs, and consistent quality assurance guidelines. These plans ensure efficient operations and maintain high care standards across long-term care facilities. 4. Define policies and explain how policies differ from rules. Policies are guides that establish parameters for making decisions. A rule differs from a policy in that it is written as an explicit statement that tells managers what they ought to do officially or outlines what they should not do. 5. Outline four steps managers can take to enhance an open-mode environment for creative writing. 1. Provide a specific work space away from the demands of the daily routine. 2. Set specific time periods for using this space. 3. Eliminate the fear of making a mistake. 4. Allow the employee freedom to express humor. 6. Describe the narrative style of procedure writing and give an actual example of statements showing the flow of activity. The narrative style used is an outline form with action verbs beginning each statement and explanations or notes written in paragraphs. Examples will vary. Answers to Application of Theory Exercises 1. Prepare a policy for releasing health information for patient requests. Policy should address HIPAA and other pertinent regulations. Policy should also address verification of ID, signature, and releasing only minimum necessary information to meet the needs of the request. 2. Ask to review a manual in an HIM department and then document strengths and weaknesses of this manual using Figure 7-1 as a guide and standard. Answers will vary based on manual reviewed After reviewing the HIM department manual, strengths include clear organization and comprehensive policies that facilitate easy reference. However, weaknesses include outdated procedures and insufficient training resources, which hinder staff understanding and implementation. Suggested Responses to Case Study You just started working in a position as director of HIM for an acute care facility and you discover there are no documented procedures. Explain the steps you would take before writing the procedures. Write a basic procedure for releasing health information to patients. Do an assessment of each area, interviewing the individuals who perform each task in the department. Be sure to include these individuals in the process of writing the procedures to ensure all steps are accurate. Instructor Manual for Management of Health Information: Functions and Applications Leah Grebner, Rozella Mattingly 9781285174884
Download
Close
Close
