This Document Contains Chapters 8 to 14 Chapter 8 Planning the Physical Environment Learning Objectives After completing this chapter, the learner should be able to: 1. Define the term ergonomics and give several reasons for applying ergonomic principles when designing or remodeling the HIM work environment. 2. State the reasons for implementing an ongoing inventory of equipment and furnishings in an HIM department. 3. List the specialists best prepared to participate in the design of a new department or a remodeling project; give ways the expertise of these specialists can be useful. 4. Outline the principles used to create a space model that can lead to success in planning the new environment. 5. Give examples of the tools used in planning a remodeling project or new construction and explain ways HIM managers would use these tools. 6. Present a space model for an HIM department, defend the placement of each section within the department, and describe how automated technology placement is considered. 7. Discuss the value aesthetics play in the work environment and how the efforts of interior designers can impact the comfort and satisfaction of employees. Key Terms Aesthetics Ergonomics Facility access controls Space modeling Template Two-dimensional template Workflow Lecture Notes I. Introduction II. Current trends in physical environment design A. ADA B. OSHA C. MSDS D. Ergonomics E. Workstations III. Ergonomic principles IV. Department redesign A. Workflow B. Aesthetics C. Evaluation of tasks D. Employees E. The department F. The organization V. Planning for new department design A. Planning participants B. Setting priorities VI. Functional/product flow lines pattern A. Principles for planning revised workflow patterns VII. The space model VIII. Tools for layout design A. Templates B. Architectural symbols C. Record activity section D. Aesthetics E. Maintaining the team’s environment F. Maintaining a clean and neat environment G. Looking forward to change IX. Managing the remote work environment Teaching Strategies Share stories about experiences with department design or redesign, focusing on strengths and weaknesses of the projects. Answers to Critical Thinking Exercises 1. List several factors you would bring into a remodeling project to give satisfaction and comfort to the team that is facing a change from a manual record-tracking system to an automated system. Answers will vary, but may include ergonomics, furniture, ventilation, aesthetics, and computer placement. 2. Define the phrase ergonomic principles. Ergonomic principles refer to the design of products, processes, and systems to meet the requirements and capacities of those people who use them. 3. Delineate six factors in job design that concern ergonomists. Answers may include any of the following: Positioning of computer monitor Positioning of hands of keyboard Left-handed versus right-handed employee needs Height of desk and chair Glare on computer screen Employees wearing bifocals or reading glasses Back support or elbow support on chairs Excessively tall or short employees Frequency of lifting Frequency of twisting 4. What does the phrase space modeling mean, and how is it used in a remodeling project? Space modeling refers to the layout model created to depict the plans and decisions made for a physical environment that includes ergonomic principles. 5. Create a list of several steps a manager would appropriately take in preparing and maintaining an inventory of furnishings and equipment for an HIM department. Answers will vary and can include an automated spreadsheet for documenting inventory and listing relevant information such as date of purchase, condition, location, and so forth. 6. Explain the role vendors can take in planning the physical layout of an HIM department. There are commercial office design vendors who are experts in ergonomics and office layout, so they can offer suggestions for efficient use of space, workflow patterns, customer access, storage, convenience, lighting, and a number of other considerations. 7. What steps would you take in preparing an in-service education for the employees on maintaining a clean, safe, and attractive work setting? Outline your major topics. In preparing an in-service education session, I would outline major topics such as the importance of cleanliness, proper waste disposal procedures, and ergonomic practices. Additional topics would include safety protocols, regular maintenance schedules, and tips for creating a positive work environment, followed by hands-on demonstrations and Q&A sessions. Answers to Application of Theory Exercises 1. Choose an HIM work setting and assess its present environment using the seven general principles of ergonomics. Recommend any major changes you would make to improve the work setting for the employees. Answers will vary according to work setting. The seven general principles of ergonomics are: 1. Select the best worker for the task. 2. Train workers in human factor habits and practices. 3. Analyze and design jobs in order to produce interest, efficiency, and safety. 4. Design equipment that fits human anatomy and physiology. 5. Eliminate stressors that reduce productivity and quality. 6. Design organizational systems that support and involve workers. 7. Build effective organizational communication systems. 2. Create a simple space model of an HIM department with which you are familiar and show how the work flows through the department. Include the entrance doors on the model and defend your assertion that they are well placed or poorly placed for efficiency and effectiveness. Answers will be individualized. In my HIM department model, the entrance doors are located near the reception area, facilitating easy access for staff and visitors while minimizing disruptions to workflow. This placement enhances efficiency by allowing quick document drop-off and access to personnel without interfering with the processing areas, which are strategically organized for optimal work flow. 3. Prepare two-dimensional templates of workstations for one section of an HIM department and present at least two layout alternative plans that could be used effectively and efficiently for this section. Answers will be individualized. For the HIM department’s coding section, one layout alternative features a linear workstation arrangement to promote easy collaboration among coders. A second option utilizes a cluster layout, allowing for more privacy and focused work while still enabling quick communication through strategically placed shared resources, enhancing both efficiency and effectiveness. 4. Outline items that you would include in a policy for setting up a remote home office. Address HIPAA compliance, equipment, safety, ergonomics, and communications. Answers may include, but are not limited to: lockable door, ergonomically correct desk and chair, ownership of computer and any other equipment, and means of communication (phone, messenger, e-mail, etc.). Suggested Responses to Case Study You are the HIM director for a department that is going to be moved to a new area of the facility. Design a floor plan for the new department. Include the following items: • Office for HIM director • Office for HIM assistant director • Two release of information clerks • Two scanning stations • Four inpatient coders • Six outpatient coders • One tumor registrar • Three assembly and analysis clerks • One physician record assistant • Four transcriptionists • One transcription clerk • Fax machine • Copy machine • Small reception area • Dictation and record completion area for physicians • Record review area • Break room with table, sink, microwave, and refrigerator Create a separate document that describes additional details of the department, including color scheme, ergonomic considerations, type of desks or workstations, chairs, lighting, computers, and anything else you feel is significant to your department design. Floor plan should be formatted using symbols similar to Figure 8-9. Chapter 9 The Process of Organizing Health Information Services Learning Objectives After completing this chapter, the learner should be able to: 1. Define the management function of organizing. 2. Describe the three main parts of the basic model for organizational structure. 3. Give the advantages and disadvantages of dividing labor into discrete parts. 4. Demonstrate ways that rules and policies are used in creating a formalized organizational structure. 5. Contrast managerial power with managerial authority. 6. Identify differences between line and staff relationships. 7. List reasons why the span of control varies from one manager to another. 8. Give the four departmentalized organizational structures and an example of each for health care facilities. 9. Explain the advantages of using a contingency management approach in organizing. Key Terms Authority Bylaws Centralization of authority Conceptual skills Cultural competence Delegation Departmentalization Division of labor Formalization Interpersonal skills Mentoring Power Servant leadership model Span of control Span of management Specialization of labor Staff authority Technical skills Unity of command Values statement Lecture Notes I. Introduction II. Organizing defined A. Differentiation B. Degree of regulations C. Concentration of authority D. Managerial power and authority 1. Coercive power 2. Reward power 3. Legitimate power 4. Expert power 5. Referent power E. Resources F. Unity of Command G. Span of control III. Organizational structure A. Work team structures 1. Self-directed teams 2. Shared leadership teams 3. Temporary work teams B. Informal organizational structure 1. Organizational culture 2. Cultural competence 3. Bylaws IV. Role of contingency approaches in organizing A. Servant leadership B. Leadership grid C. Management skills 1. Technical 2. Interpersonal 3. Conceptual D. Delegation E. Mentoring Teaching Strategies Share examples of the different types of power discussed in the chapter and how each may be effective. Answers to Critical Thinking Exercises 1. Describe the organizing function and give several reasons for organizing. Organizing is the management function that determines what tasks are to be done, who shall do them, the reporting structure, and at what level decisions will be made. 2. Relate how a manager integrates the planning process into the organizing function. Some organizations have redesigned their structure and are now following the trend toward process or customer departmentalization. This trend is likely to increase as needs of the customers continue to be emphasized as the strategic planning process envisions goals and objectives. 3. How is power and authority given to an HIM department manager? Authority refers to the rights inherent in a managerial position to give orders and expect them to be obeyed. Power refers to the capacity to influence the decision-making process. 4. Describe several aspects of an informal organization that differ from those of a formal organization. Informal organizational factors include: 1. Small groups: Small groups come into being to satisfy individual needs that cannot be fully met by the formal organizational structure. 2. Leaders: Members choose leaders they perceive as important for satisfying their needs. 3. Informal groups: Informal groups are inevitable within HIM departments. 4. Positive aspects: Informal groups can complement the formal organizations and provide stability to work teams. 5. Negative aspects: Role conflicts can occur when goals of the groups are not compatible with the goals and objectives of the formal organization. 5. What is the organizing phrase used to describe the structure when the coding specialists are organized into a team that works independently, making most of the decisions regarding coding activities? Self-directed team The organizing phrase used to describe this structure is a "self-managed team." In this setup, coding specialists operate independently, taking responsibility for decision-making related to their coding activities, which fosters autonomy and accountability. 6. Which of the four departmentalizations would be used to best advantage in an HIM department? Defend your answer. Answers will vary based on opinion. The best departmentalization for an HIM department is functional departmentalization. This structure allows specialization in areas such as coding, billing, and records management, enhancing efficiency and expertise while facilitating clear communication and collaboration within each function. Answers to Application of Theory Exercises 1. Identify at least two individuals you have encountered or observed as a leader. Compare the traits you noticed about each person. Did the individual have formal or personal leadership power? What leadership models did each seem to follow and what activities or behaviors reflected their leadership styles? Examples will vary based on experiences. I observed two leaders: one was a department manager who demonstrated transformational leadership through inspiring teamwork and fostering innovation, while the other was a peer who exercised informal leadership by mentoring colleagues and encouraging collaboration. The manager had formal power, while the peer relied on personal influence, both reflecting their respective styles through supportive communication and proactive problem-solving behaviors. 2. Give examples of the five types of power you have seen while interacting with employees in a health care setting. Examples will vary based on experiences. The five types of power are recognized as: coercive, reward, legitimate, expert, and referent. 3. Show how automating several record tasks can lead to a change in the span of control for the managers. Answers will be individualized. Automating several record tasks can increase a manager's span of control by reducing the time spent on routine tasks, allowing them to oversee more employees or projects effectively. This shift enables managers to focus on strategic decision-making and mentoring, enhancing overall productivity within the team. Suggested Responses to Case Study You are a coding supervisor for large physician group practice. The lead physician in the group insists that you instruct your coding staff members to code all office visits across the board as the highest level code so that they get higher reimbursement. You inform the physician that coding must be based on documentation, but the physician responds, “all of the physicians in this practice perform high-level office visits, but they just do not have time to document everything.” Following this conversation with the physician, the practice manager calls you in to reinforce the message with an implied message that your job security may depend on cooperation with the physician’s directions. The practice manager also reminds you that you should never question anything that the physicians tell you to do since they are the ones providing your paycheck. Outline your options in this situation and discuss the one you would choose, providing rationale for your decision. Options may include (but are not limited to): 1. Following the instructions of the lead physician 2. Refusing to comply with the instructions 3. Resigning Chapter 10 The Organizational Model Learning Objectives After completing this chapter, the learner should be able to: 1. Outline factors that contribute to organizational culture. 2. Describe mechanistic structural design and state how functional departmentalization becomes a part of this design. 3. Create organizational charts for the health care environment. 4. Describe critical factors involved as health care facilities choose reengineering the organizational structure in an effort to solve problems. 5. Give examples of reengineering activities that can appropriately belong to HIM professionals. 6. Explain the major features involved in the three phases of reengineering. 7. Describe positions in the C-suite in the health care environment. Key Terms Adhocracy Board of directors Committee structure Functional departmentalization Mechanistic design Multiskilled health professional Network structure Organic design Organizational chart Reengineering Task force Lecture Notes I. Introduction II. Mechanistic structural designs A. Functional departmentalization B. Organizational chart C. Board of directors III. Organic structural designs A. Adhocracy B. Simple structure C. Modified simple structure D. Matrix structure E. Network structure F. Task forces G. Committees IV. Reengineering and contemporary model structure V. The C-suite Teaching Strategies Share examples of organizational charts from places where you have worked. Answers to Critical Thinking Exercises 1. Obtain an organization model presently in use at a HIM department and review it before answering the following questions: a. Does the model tend toward a mechanistic or organic structure? b. Are the sections within the department organized by functional, customer, product, or process departmentalization? c. Are the line relationships clearly drawn? Responses will vary based on organization. The organization model in the HIM department tends toward an organic structure, promoting flexibility and adaptability. The sections are organized by functional departmentalization, with clear line relationships that facilitate communication and accountability among roles. To analyze the HIM department's organization model: a. Structure Type: The model tends toward a mechanistic structure if it has clear hierarchies, rigid roles, and formal communication. An organic structure is indicated by flexibility, collaboration, and less defined roles. b. Departmentalization: The sections are typically organized by functional departmentalization, focusing on specific tasks like coding, records management, and compliance. c. Line Relationships: If the reporting lines and authority are clearly defined, then the relationships are clearly drawn. If there's more fluidity and overlap, they may be less distinct. For a thorough evaluation, specific details from the organization model would be needed. 2. Now create a revised model that uses one or more organic structural designs after making assumptions about reengineering the workflow. Responses will vary based on organization. The revised model adopts a matrix structure, combining functional teams with cross-functional project groups to enhance collaboration and responsiveness. This design encourages knowledge sharing and flexibility, allowing staff to work on multiple projects while maintaining their specialized roles in coding, records management, and quality assurance. 3. As an HIM department manager, choose to use a network structure to meet departmental objectives by contracting with several firms for departmental services. List several types of firms you would choose for this and the expertise you would expect from each of them. Responses may vary, but may include coding, transcription, EHR, or release of information. As an HIM department manager using a network structure, I would contract with firms specializing in coding services for expert coding compliance, data analytics for advanced reporting and insights, and IT support for robust electronic health record management. This collaboration would enhance operational efficiency and ensure adherence to regulatory standards. Answers to Application of Theory Exercises 1. Discuss what type of additional education or experience you might need if you were to pursue one of the C-suite positions. Many require a master’s degree, plus additional experience in the field. To pursue a C-suite position, I would need additional education, such as an MBA with a focus on healthcare management, and extensive experience in strategic leadership roles. Gaining expertise in financial management, regulatory compliance, and organizational behavior would also be crucial for effective decision-making at that level. 2. You have made a decision that immediately after graduation you will find employment, for 6–9 months, as a transcriptionist. During that time, you will explore opportunities for starting a transcription service in an underserved area. Develop an organizational model for use during the first 3 years your new company is in operation; then redesign it for an expanded business beginning in the fourth year. Answers will vary, as this may be creative in nature. For the first three years, the organizational model for the transcription service would be flat, with a small team of transcriptionists reporting directly to me as the owner, facilitating quick decision-making and adaptability. In the fourth year, as the business expands, I would transition to a functional structure, adding specialized roles such as a quality assurance manager, marketing director, and customer support team to improve efficiency and service delivery. Suggested Responses to Case Study 1 You have been contracted as a management consultant for a health care organization that is planning to change from a traditional organizational structure to a matrix organizational chart structure. What steps would you recommend to effectively accomplish this task? Responses may vary but should include assessment of what each position is responsible for and how the workflow is between departments. Suggested Responses to Case Study 2 Community Hospital is licensed for 200 beds and has a medical staff of 45. The health information services is responsible to the CFO, and the department manager has the following employees: 1. Ql specialist involved in projects and medical staff meetings. 2. Team leader for transcription with three full-time transcriptionists, two part-time transcriptionists, and one part-time courier. 3. Team leader for reimbursement (coding, case management) with four full-time coders, one part-time case management statistician, one full-time tumor registry specialist, and two part-time on-call coders. 4. Team leader for record activity with one full-time second-shift team leader, two full-time record activity team members, two part-time record activity team members, and one full-time physician liaison. 5. Team leader for customer services, which includes information management, two full-time receptionists/legal correspondence team members, and one full-time correspondence team member. 6. One part-time resource registered record administrator cross-trained to perform many tasks; performs orientation and training activities. The department is open from 7 A.M. to 11 P.M. 7. Develop an organizational design for the health information services using one of the designs discussed in this chapter. 8. Use an organizational design software package, if possible. Answers will vary and will be individualized. Chapter 11 Organizing Position Designs for Employees Learning Objectives After completing this chapter, the learner should be able to: 1. Outline processes involved in recruiting, interviewing, and hiring. 2. Compare aspects of salary and benefits. 3. Develop training materials for new staff orientation and ongoing routine training. 4. Give a historical description of job design and explain how specialization has been especially important in health care organizations. 5. Explain the value of position analysis and methods used in this analysis. 6. Outline the major components of position descriptions. 7. Assess employee performance using performance evaluation tools. 8. Interpret laws impacting human resources. 9. Identify advantages of job rotation; then give possible drawbacks to its use in health care settings. 10. Contrast job enlargement with job enrichment. 11. Describe the use of work teams and how self-managed teams can increase employee productivity and morale. 12. Summarize the advantages of flexible work schedules. Key Terms Compensation Compressed work week Diversity Diversity training Employment at will Job characteristics model Job description Job design Job scope Merit raise Noncompete clause Outsourcing Performance evaluation Performance standards Point method Position depth Position description Position design Position enlargement Position enrichment Position rotation Probationary period Recruitment Self-evaluation Shift differential Sign-on bonus Trainee Train-the-trainer Work sharing Lecture Notes I. Introduction II. Recruiting, interviewing, hiring, and training A. Shift differential B. Sign-on bonus C. Resume D. Curriculum vitae E. Outsourcing III. Salary, benefits, and other aspects of human resources A. Compensation B. Employment at will C. Noncompete clause IV. Training A. Train-the-trainer B. Diversity training C. Position description/job description V. Analysis and design of position descriptions VI. Documenting position descriptions A. Job characteristics model VII. Performance evaluation tools A. Probationary period B. Performance evaluation C. Performance standards D. Point method E. Merit raise F. Self-evaluation VIII. Job design options A. Position enrichment B. Position enlargement C. Position rotation D. Job sharing E. Compressed work week Teaching Strategies Share experiences about interviewing and perform mock interviews. Answers to Critical Thinking Exercises 1. Describe the two major components in the content of a position description. 1. Title of the position 2. Name of the department, position number for human resources use, salary range (optional) 3. Title of the person to whom this position is accountable 4. Status—that is, permanent/temporary, work hours, flextime option 5. Position purpose or mission, may be titled the position summary 6. Major responsibilities of the position—these should be specific to the point that performance can be measured 7. Specifications or minimum knowledge, skills, experience, and abilities required; credentials, if required 8. Working conditions 9. Approvals, dates, revision dates 2. Briefly explain the major uses of position descriptions. 1. Assist in clarifying relationships between jobs and teams, avoiding overlaps or gaps in responsibility. 2. Enable managers to prepare position orientation materials and procedures. 3. Establish the basis for a just and fair salary within the compensation structure. 4. Create one tool for use in performance appraisals. 5. Establish a base for position analysis and further redesign in the future. 6. Assist manager in position interviews with prospective employees. 7. Create base for benchmark comparison with positions in other health care facilities and with regional compensation reports. 8. Help with strategic planning and budget review. 3. Explain how the job characteristics model assists managers in redesigning position descriptions. The job characteristics model is a framework for analyzing and designing jobs around five major qualities and their impact on outcome variables. 4. Give five options to traditional job designs that assist managers in better meeting employee needs. 1. Position enrichment 2. Position enlargement 3. Position rotation 4. Job sharing 5. Compressed work week Answers to Application of Theory Exercises 1. Interview an HIM professional and document major responsibilities. Develop a position description for the professional. Responses will vary based on interview responses. After interviewing an HIM professional, their major responsibilities include managing patient records, ensuring compliance with regulations, and overseeing coding accuracy. The position description highlights duties such as maintaining health information systems, conducting audits, and training staff on documentation standards, all essential for efficient departmental operations. 2. Redesign the work schedules for an HIM department staff of 16 where rightsizing plans call for an FTE budget for 14. Choose among the position design options. Responses will vary, as this requires creativity. To redesign the work schedules for the HIM department staff of 16 down to 14 FTEs, I would implement a job-sharing model for certain roles, allowing two employees to cover one position, enhancing flexibility. Additionally, cross-training staff would enable better workload distribution and coverage during peak times, ensuring operational efficiency without sacrificing service quality. 3. Create position descriptions for two employees who share one full-time position—that of team leader for the coding and reimbursement team. Responses will vary and should include elements of position description in Figure 11-3. 4. Construct a position description for a release of information specialist that includes all of the elements discussed in the chapter. Responses will vary and should include elements of position description in Figure 11-3. Suggested Responses to Case Studies 1. You are the director of HIM for a 600-bed hospital and need to hire somebody to fill the position of coding supervisor in your department. There are eight outpatient coders and seven inpatient coders. Compile a list of questions that you might ask during the interview. There will be some variation in responses, but questions may address aspects including experience, technical questions, asking for examples of situations encountered in the workplace, previous supervisory experience, and responses to proposed scenarios. 2. You are being interviewed by the director of HIM for a 600-bed hospital as an applicant for the position of coding supervisor. There are eight outpatient coders and seven inpatient coders. Compile a list of questions that you might ask the HIM director during the interview. There will be some variation in responses, but questions may address aspects including work schedule, salary, benefits, reporting relationship, job description, and working conditions. Chapter 12 Managing with Evolving Technology Learning Objectives After completing this chapter, the learner should be able to: 1. Discuss considerations of HIM managers related to new technology. 2. Identify new technology being used in HIM. 3. Outline the importance of backup systems for technology. Key Terms Chart tracking Health Level Seven International (HL7) Hybrid health records Master patient index (MPI) Lecture Notes I. Introduction II. Organizational problems with new technologies III. Evolution of automation of traditional HIM functions A. Master patient index B. Chart tracking 1. Bar codes 2. Deficiency tracking C. Transcription D. Coding IV. Electronic health record A. Office of the National Coordinator for Health Information Technology (ONC) B. HITECH Act C. ARRA D. Meaningful Use E. Hybrid health records F. Health Level Seven International (HL7) V. Downtime and recovery planning VI. Health care informatics A. Introduction of new processes using technology VII. Telemedicine VIII. Health Teaching Strategies Discuss changes necessary for Meaningful Use and have a brainstorming session for additional ways that organizations may increase compliance for future changes that will be required. Answers to Critical Thinking Exercises 1. Choose an automated application for HIM services and explain its impact on organizational design. Answers may vary and could address EHR, MPI, chart tracking, ROI, or coding. 2. Identify three avenues that HIM professionals can use in becoming knowledgeable about new technologies. Masters in informatics HIMSS 3. Describe how HIM professionals can enhance strategic planning decisions within an organization. Responses will vary, this may allow for creativity with answers. HIM professionals enhance strategic planning by providing accurate data analytics that inform decision-making and ensuring compliance with regulatory standards. Their expertise in information management also aids in identifying trends and optimizing resource allocation for improved organizational efficiency. Answers to Application of Theory Exercise 1. Discuss considerations of HIM managers assisting with implementation of CAC. HIM managers must advocate for the importance of continuing to use credentialed coders in addition to using CAC, as CAC is simply a tool but not a solution. Suggested Responses to Case Study You are the EHR coordinator for a 1,000-bed acute care hospital with a level one trauma center and high-risk pregnancy unit with neonatal intensive care services. As you are developing policies and procedures for EHR management, one of the tasks you must complete is selection of the location for planned redundancy of the EHR system. The table below provides the locations that have been proposed for maintaining a redundant system. Identify the pros and cons for each site and identify two other locations that may be considered, along with their pros and cons. After evaluating the pros and cons of each location, provide your recommendation for the site you would select and justify your selection. Location Pros Cons Rural Oklahoma Remote location, easy to keep secure Risk of tornado New York, NY Easily accessible Risk of terror attack New Orleans, LA Rick of hurricane Small town in Colorado Remote and easy to secure Another location in the same city Easily accessible Same natural disaster could hit both locations An adjacent city 50 miles away Easily accessible Same natural disaster could hit both locations Canada Far enough away to prevent similar disaster—low risk of natural disaster HIPAA not enforceable India Far enough away to prevent similar disaster HIPAA not enforceable Additional location 1: Additional location 2: Chapter 13 Leading: The Interpersonal Aspects of Management After completing this chapter, the learner should be able to: 1. List synonyms for the term leading, and state how their meanings differ in emphasis. 2. Describe how leaders use power within organizations to accomplish objectives. 3. Contrast the traits of leaders with the traits of managers. 4. Give the three components of attitudes, and state how attitudes can predict employee behavior. 5. Describe how HIM managers can identify appropriate personality traits for specific positions in a hospital HIM department. 6. Define formal and informal groups within the organization and the role HIM managers have in each. 7. Give advantages of using the team approach for accomplishing objectives in the HIM workplace. 8. Define followership and outline the role managers have as followers. Key Terms Attitudes Authoritarian leadership Autocratic leader Bureaucratic leader Cognitive dissonance Consistency perception Democratic leadership Directing Followership Formal leader Informal leader Laissez-faire Leadership Locus of control Machiavellianism Perception Self-esteem Self-monitoring Trait approach Lecture Notes I. Introduction II. Leading defined A. Actuating B. Directing III. Leadership power and authority A. Informal leader B. Formal leader IV. Trait approach to leadership A. Accountable B. Ambitious C. Assertive D. Balanced E. Caring F. Competent G. Confident H. Courteous I. Ethical J. Experienced K. Fair L. Focused M. Helpful N. Honest O. Humble P. Insightful Q. Inspiring R. Knowledgeable S. Open-minded T. Patient U. Reliable V. Respectful W. Supportive X. Trustworthy Y. Visionary V. Attitudes as predictors of behavior A. Cognitive attitude component B. Affective attitude component C. Behavior attitude component D. Cognitive dissonance VI. Personality traits as predictors of behavior A. Myers-Briggs Type Indicator (MBTI) 1. Introversion versus extroversion 2. Sensing versus intuition 3. Thinking versus feeling 4. Judging versus perceiving B. Laissez-faire leader C. Authoritarian leadership D. Democratic leadership E. Bureaucratic leadership F. Machiavellianism G. Self-esteem H. Locus of control VII. Perceptions as predictors of behavior VIII. Leadership and group behavior A. Formal group structure 1. Dynamic teams 2. Quality circles B. Informal groups 1. Positive informal group elements 2. Negative informal group elements IX. Leadership and followership A. Six skills of exemplary followers 1. Attending to self-management 2. Caring and commitment 3. Building confidence 4. Learning how to contribute 5. Building credibility 6. Having a courageous conscience Teaching Strategies Provide examples of famous leaders with the traits or styles described in this chapter and discuss the effectiveness of each. Answers to Critical Thinking Exercises 1. Develop a profile of personality traits that an HIM professional beginning her own transcription firm would value. Responses will vary, and may include: responsible, honest, experienced, etc. An HIM professional starting her own transcription firm would value being detail-oriented and organized to ensure accuracy and efficiency. Additionally, adaptability and strong communication skills are essential for navigating client needs and technology changes. 2. Assess the attitudes of employees you have observed recently and categorize them into three attitudes as predictions of behavior. Responses will vary based on experiences. Recently observed employee attitudes can be categorized as positive (proactive and engaged), neutral (indifferent and compliant), and negative (disengaged and resistant). These attitudes predict behaviors such as high productivity, minimal effort, or counterproductive actions, respectively. 3. Relate a personal experience with cognitive dissonance and the action you took to return to consistency perception. Responses will vary based on personal experiences. I experienced cognitive dissonance when I promoted healthy eating but often indulged in junk food. To regain consistency, I started meal prepping healthier options and educated myself about nutrition, aligning my actions with my beliefs. 4. Document the informal groups to which you belong and state the value you find in membership. Examples of informal groups may include study groups, lab partners, etc. 5. Identify three reinforcement tools of value to managers. Positive reinforcement, negative reinforcement, punishment 6. Describe how formal groups are structured in the workplace and how they differ from informal groups. Formal sections or teams are organized to perform specific tasks within the HIM department and are detailed in the organizational design model. Many employees join informal groups because they find informal groups meet their social needs for security, status, and self-esteem. 7. Give five behavioral steps in team building. 1. Understand employees and know the strengths and weaknesses of each. 2. Manage by negotiation and dialogue with a mentoring stance. 3. Build a sense of ownership that leads to continuous quality improvement. 4. Flatten the organizational structure and reduce costs. 5. Develop department teams that become self-directed groups, operating efficiently in the absence of the manager. Answers to Application of Theory Exercises 1. Using the personality traits identified in this chapter, develop a list of the traits best adapted for various positions in an HIM work setting. Coder: Accountable, competent, ethical, experienced, focused, knowledgeable Manager: List all traits under the trait approach Release of Information Clerk: Accountable, competent, courteous, ethical, experienced, helpful, honest, knowledgeable, patient, reliable, respectful 2. Interview two HIM professionals by asking questions about their skills in followership. Be prepared to discuss the results of this survey in class. Responses will vary based on personal experiences. In interviewing two HIM professionals, I found that both emphasized the importance of active listening and adaptability in followership. They highlighted how supporting leadership initiatives and providing constructive feedback fosters a collaborative work environment and enhances overall team performance. Suggested Responses to Case Study Sara has worked for 10 years as a scanning clerk for Memorial Hospital, which is a union organization. Her previous experience includes a variety of positions in the organization over a period of 8 years. Her father serves on the facility’s governing board. Over the years, Sara had been subject of many different disciplinary actions related to attendance, poor performance, and conduct. Rumor had it that Sara had threatened physical harm to supervisors over the years, so her behavior and performance problems were overlooked by management. Sara also had a history of work-related injuries, and she was on medical leave when Rhonda was hired as Sara’s new supervisor. Upon hire, Rhonda reviewed the duties of all in the department and developed new performance standards. Upon Sara’s return, she was provided with training on the new performance standards and requirements to submit daily work logs. Sara did not submit her daily logs and had to be reminded several times by Rhonda to do so. Rhonda performed random audits of work reported and found the following: 1. Loose reports were logged as being scanned but were found hidden at a later date. 2. Information had been requested for billing, but documentation was never sent, which resulted in jeopardizing insurance payments. 3. Sara had been caught multiple times making personal phone calls, including ordering a pizza during a time that was not a scheduled break period. When Rhonda confronted Sara about these issues, Sara raised her voice so that the entire department could hear and accused Rhonda of targeting her as an individual. The following day, Rhonda met with Sara first thing in the morning to provide a task list for the day and helped her set priorities. Through positive reinforcement and continued daily coaching, Rhonda attempted to motivate Sara to complete required tasks in a professional manner. After 2 weeks of this daily process, Sara continued to have performance issues, including a significant incident that resulted in a $60,000 billing loss. Rhonda had submitted all of the issues to the department director, Abigail, who forwarded them to administration for further discussion. Abigail and Rhonda were told to approach the situation carefully, as administration feared that Sara and her father may start a legal battle since her father had already voiced concern to administration that Sara was being treated unfairly. Additionally, others in the department had complained to Rhonda regarding Sara’s unprofessional behaviors and poor performance issues. Some of the employees were so discouraged that they were considering transfer to other departments to escape the issue. How should Rhonda proceed with the situation in a manner that addresses all areas of concern? Share the rationale for your decision. Responses will vary according to student opinion of how to best handle the situation. Chapter 14 Motivating for Leadership in the Health Care Environment Learning Objectives After completing this chapter, the learner should be able to: 1. Relate motivational theories to HIM situations 2. Apply motivational methods to improve productivity. 3. Describe the three major views of conflict and the differences among them. 4. Explain the role of the HIM manager in conflict resolution when self-directed teams perform departmental activities. 5. Suggest strategies for motivating difficult employees. 6. Define stress and suggest methods HIM managers can use to keep stressors from disrupting departmental activities. Key Terms Conflict Conflict resolution Expectancy theory of motivation Extrinsic motivation Hawthorne effect Intrinsic motivation Motivation Productivity Stress Theory X Theory Y Lecture Notes I. Introduction II. Motivational content theories A. Intrinsic motivation B. Extrinsic motivation C. Expectancy theory of motivation D. Hawthorne effect E. Maslow’s hierarchy of needs 1. Physiological 2. Safety 3. Social 4. Esteem 5. Self-actualization F. Herzberg’s two-factor theory 1. Motivating factors 2. Maintenance factors G. Victor Vroom’s expectancy theory 1. Choice 2. Expectancy 3. Preferences H. Theory X I. Theory Y III. Integrating motivation theories IV. Motivational methods to improve productivity A. Productivity standards B. Productivity bonus V. Managing conflict and stress A. Functional conflict B. Dysfunctional conflict C. Conflict resolution 1. Avoidance of personal attacks or sarcastic comments 2. No interrupting other participants 3. Use of specific examples VI. Managing difficult people amid conflicts A. Be assertive and positive B. Give choices C. Refuse to listen to gossip D. Empower the team and challenge negative team members E. Use an anonymous questionnaire F. Take a tough line with difficult people VII. Managing stress A. Avoid work overload B. Make it possible for people to succeed and then let them know they are doing a good job C. Give employees a sense of involvement and control D. Offer employees information and feedback E. Admit mistakes honestly and grow from them Teaching Strategies Discuss stressful situations and conflicts that students may have experienced, sharing how things may have been handled appropriately or how they might have been handled more effectively. Answers to Critical Thinking Exercises 1. Identify two major motivational theories and contrast their premises. Expectancy theory of motivation Hawthorne effect Maslow’s hierarchy of needs Herzberg’s two-factor theory Victor Vroom’s expectancy theory Theory X Theory Y 2. Choose two contemporary motivating factors that especially appeal to you and give reasons for their value in the workplace. Responses will vary based on students’ values. Two contemporary motivating factors that appeal to me are flexible work arrangements and professional development opportunities. Flexible work promotes work-life balance and increases job satisfaction, while ongoing training enhances skills and career growth, fostering employee engagement and retention. 3. Explain how managers respond to functional conflicts versus dysfunctional conflicts. A manager may reinforce the organizational goals in response to functional conflict, while it may be best to attempt to eliminate or minimize dysfunctional conflicts. 4. List four steps that lead to conflict resolution. See Figure 14-6. 5. Offer five options managers have for lowering stress in their activities. 1. Avoid work overload—this includes too much work, too little time to perform tasks, having necessary skills for the position, and having the tools to perform effectively. 2. Make it possible for people to succeed and then let them know they are doing a good job. 3. Give employees a sense of involvement and control by empowering them in decision making. 4. Offer employees information and feedback. Let them know what is happening in the department and the facility. Let them know how they are performing on a routine basis. 5. Admit mistakes honestly and grow from them. Answers to Application of Theory Exercises Individuals have unique priorities in life that provide motivation. Do you know what your life priorities are and what motivates you the most? Review the following list and rank them according to how you see them as personal priorities, starting with your highest priority and ending with your lowest priority. Compare your rankings with your classmates or even family members. Write a brief analysis of why your priorities are ranked the way they are and why you think others from your comparisons are different. _____ Career _____ Family _____ Friends _____ Health _____ Money _____ Relaxation _____ Spirituality Responses will vary according to student priorities. Suggested Responses to Case Study You are the director of Health Information Management at a 100-bed acute care hospital. The community is experiencing economic changes due to a large factory shutting down, which has impacted some of your employees and their families. Administration has informed you that you must eliminate one full-time equivalent from your staff and pay rates have been frozen, so raises will not be awarded this year. Because of these changes, morale in your department has decreased slightly. Your department is composed of long-term employees who are generally satisfied with the work environment, so you want to do what you can to retain them and keep them motivated to continue working in your area. Sarah is a coder who lives an hour away from work and is concerned with increasing cost of gasoline, especially since her husband lost his job with the factory closure. The release of information coordinator, David, is an RHIT, who is in school pursuing a bachelor’s degree so he can become an RHIA, but the classes in the upcoming semester are scheduled when he works. Janet and Ellen are full-time scanning quality reviewers, who both have young children in day care and have expressed an interest in cutting their hours to spend more time home with their children and save money on day care. The facility has finally made the transition from hybrid records that are mostly scanned documents to an electronic health record with a small hybrid component of few scanned documents. Write a plan for how to address the employee needs, changes in tasks, administrative changes, and decreased morale related to the economy and pay rate freeze. Responses will vary based on student creativity. Instructor Manual for Management of Health Information: Functions and Applications Leah Grebner, Rozella Mattingly 9781285174884
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