This Document Contains Chapters 15 to 21 Chapter 15 Communicating in the Health Care Environment Learning Objectives After completing this chapter, the learner should be able to: 1. Describe the process of communication as the message flows from the sender to the receiver. 2. List several barriers to effective communication and steps managers can take to reduce these barriers. 3. Create the outline for a training session involving a new process in the HIM department. 4. Develop and document a speech for an in-service education meeting. 5. Suggest positive uses for the grapevine communication network. 6. Describe the use of communication skills when interacting with HIM department customers. Key Terms Certification Commission for Healthcare Information Technology (CCHIT) Channel Communication Decoding e-HIM Encoding Feedback Grapevine Health information exchange (HIE) Health literacy Message Noise Patient portal Lecture Notes I. Introduction II. The process of communication A. Message B. Encoding C. Channel D. Noise E. Sender F. Receiver G. Media H. Decoding III. Types of communication A. Verbal 1. Face-to-face 2. Phone 3. Internet 4. Active listening B. Written C. Electronic 1. Positives with electronic communication 2. Challenges with electronic communication 3. Electronic communication standards IV. Barriers in the communication process A. Distortion B. Noise C. Filtering D. Selective perception E. JOHARI Window F. Time constraints G. Language H. Emotions I. Nonverbal cues V. Overcoming barriers in communication A. Feedback skills B. Empathy skills C. Listening skills D. Language simplification VI. Applications of the communication process A. Patients seeking health care services B. Data collection VII. Evolving HIM communication A. Health information exchange B. Patient portals VIII. Group dynamics and leading A. Training sessions and in-service seminars B. Grapevine communications Teaching Strategies 1. Perform exercises in the classroom that demonstrate the different steps in the communication process. Include a variety of noise and distractions, then discuss how those might be overcome. 2. Discuss the importance of active listening as the most important communication skill. How might lack of active listening be considered a form of noise in the communication process? Answers to Critical Thinking Exercises 1. Answer “yes” or “no” to the following communication questions; be prepared to discuss them in class. a. I choose to use face-to-face communication when talking with a friend about a sensitive topic. b. My writing is clear, reasonably concise, and free of clichés. c. When I am talking with other people, I am an active listener by keeping their points of view in mind without being judgmental. d. When I am talking with others about problems or opinions, I listen and ask questions, rather than offer lectures. e. I keep alert for nonverbal communication when interacting with others. f. I ask my friends for feedback on my communication skills. g. I keep my eyes on the speaker as much as I can. h. I use open-ended questions that encourage another person to share more freely. i. I let the other person finish her own sentence, even when pauses seem quite lengthy. Responses will vary according to student opinions. a. Yes b. Yes c. Yes d. Yes e. Yes f. Yes g. Yes h. Yes i. Yes 2. Outline six steps in communicating and describe each step briefly. Creation of a message Encoding the message Identification of appropriate channel to send the message Elimination of/overcoming noise barriers Decoding the message Receiver provides feedback 3. Explain how the communication process can be distorted by barriers. These barriers may be illegible writing, garbled speech, telephone static, inattention, cultural differences, attitudes, or knowledge. 4. What are the major disadvantages to grapevine communications? Information may lead to false conclusions. Answers to Application of Theory Exercises 1. Prepare an outline for an in-service education talk on a topic of your choice. Answers will vary based on topic of in-service. Outline for In-Service Education Talk: "Effective Communication in Healthcare Settings" I. Introduction • Importance of communication in patient care • Overview of common barriers II. Key Communication Skills • Active listening and empathy • Clear and concise messaging III. Strategies for Improvement • Techniques for managing difficult conversations • Utilizing nonverbal communication effectively IV. Role-Playing Scenarios • Practical exercises for real-world application V. Conclusion • Recap of key points • Open discussion and feedback session 2. Examine the roles of the following stakeholders involved in HIM processes and relate them to the most effective methods of communication that should be used. More than one may be used and each role may involve communication of different methods with different people. • Coder • Release of information specialist • Director of HIM • Physician • Risk manager • Health care consumer • Coder—Written communication in the health record or physician queries • Release of information specialist—Verbal or written communication from customers requesting records; written communication when providing health record documentation • Director of HIM—Will vary with different aspects of directing • Physician—Verbal communication with patients, written communication in health records • Risk manager—Written communication in health records and incident reports • Health care consumer—Verbal or electronic communication via patient portal with health care provider Suggested Responses to Case Study You are the HIM director for a 500-bed acute care hospital, which is part of a health care network that includes four other hospitals and 30 physician office practices. You have been asked to help develop a communication policy that addresses selection of appropriate media and guidelines for use of each type of communication media. List suggestions that you might make for the guidelines. Suggestions may include but are not limited to: • HIPAA compliance pertinent to selected communication media • Documentation requirements for selected communication media • What type of messages may be communicated by specified media Chapter 16 The Focus of Control in Health Information Management Learning Objectives After completing this chapter, the learner should be able to: 1. Define controlling, and explain the relationship to the other management functions. 2. Describe ways management information systems (MIS) assist HIM managers in quality improvement (QI) activities. 3. List the four major steps involved in the control process. 4. Give several methods managers can use to obtain subjective monitoring information. 5. Identify steps that will ensure integrated information systems for obtaining valid monitoring data. Key Terms Integrated systems Monitoring Total quality management (TQM) Work transformation Lecture Notes I. Introduction II. Controlling defined A. Setting standards and monitoring performance 1. Joint Commission 2. Centers for Medicare and Medicaid Services 3. Tools a. Questionnaires b. Surveys III. History of total quality management A. Deming, Shewart, and Juran B. Joint Commission C. ISO 9000 1. Customer focus 2. Leadership 3. Involvement of people 4. Process approach 5. System approach to management 6. Continual improvement 7. Factual approach to decision making 8. Mutually beneficial supplier relationships IV. Terminology and integrated information management A. Continuous quality improvement B. Performance improvement V. Information systems for control A. Manual based B. Computer based C. Integrated system 1. Evaluate present flow of data and points where decisions are made 2. Determine source of information needed at points of decision making 3. Analyze information requirements at decision points 4. Aggregate decision needs and ensure data are only collected once 5. Develop uniform data definitions 6. Standardize documentation 7. Ensure quality improvement data are available for analysis 8. Assist in designing integrated system Teaching Strategies Provide access to a Joint Commission manual for students. Discuss the areas in which health information management professionals should be involved. Share real-world examples of what a Joint Commission accreditation survey is like. Answers to Critical Thinking Exercises 1. Outline the history of TQM, describing its adoption globally and the modifications that increase its value in health care settings today. Several Americans introduced initial TQM theories; among them are W. Edwards Deming, Walter Shewhart, and Joseph Juran. AT&T initiated early efforts toward quality control. The Japanese learned from the theories of Deming and Juran by inviting them to present seminars in the 1950s and then developing the ideas further with their guru, Kaoru Ishikawa (Palmer, 1992). As the Japanese began sharing their success stories, corporate America listened and responded. Deming was invited to consult with several major corporations, some of which significantly raised the quality of their products and lowered production costs. By the mid-1980s, articles appeared on the successes of these companies. Most of them were in the manufacturing sector of the economy (Robbins, 1994). The health care industry has watched this quality movement with interest, and seminars on Japanese-style quality circles, one component of the Japanese TQM system, slowly began to emerge by 1990. The quality assurance component of monitoring patient care retrospectively had been in place since the 1970s, with structure and form outlined by the (then-named) Joint Commission on Accreditation of Healthcare Organizations (JCAHO). However, TQM necessitated a change in culture as well as in process management for continuous quality monitoring (vanMatre, 1992). 2. Describe how an integrated MIS assists in the controlling function and list eight steps in integrating data for performance measurement. 1. Evaluate present flow of data and points where decisions are made 2. Determine source of information needed at points of decision making 3. Analyze information requirements at decision points 4. Aggregate decision needs and ensure data are only collected once 5. Develop uniform data definitions 6. Standardize documentation 7. Ensure quality improvement data are available for analysis 8. Assist in designing integrated system 3. List three subjective monitoring methods and give one example of how each of these methods is best used. 1. Questionnaires 2. Surveys 3. Worksheets Answers to Application of Theory Exercises Identify activities that would represent each of the ISO 9000 principles. Responses will be individual. Suggested Responses to Case Study Outline how ISO standards may be specifically applied to a situation in health information management. Answers will vary by situation selected. Chapter 17 Quality and Performance Improvement Learning Objectives After completing this chapter, the learner should be able to: 1. List the results HIM managers can achieve when the model for integrated QI management is implemented in the department. 2. Identify changes in the culture of an HIM department when customers become the focus of activities. 3. Explain the value of a facilitator when educating HIM teams in QI concepts. 4. Give examples of the value of benchmarking as a tool for QI management. 5. Suggest appropriate rewards for employees and the reasons why managers may choose different rewards. Key Terms Accreditation Benchmarking Concurrent review Customers Eighty-five/fifteen (85/15) rule Prospective review Quality Quality improvement Retrospective review Sampling Service organizations Six Sigma Statistical modeling Lecture Notes I. Introduction II. Quality improvement A. Quality assurance B. Quality gap C. Evolution of AHIMA D. Agency for Healthcare Research and Quality (AHRQ) III. Adjusting to managing the QI process IV. Accreditation A. Joint Commission 1. Oryx initiative 2. Tracer methodology 3. Intracycle monitoring V. Utilization management VI. Total quality management A. Six Sigma B. Performance improvement teams C. Time studies D. Questionnaires and surveys E. Analysis tools 1. Root cause analysis 2. Fishbone diagram 3. SWOT analysis a. Strengths b. Weaknesses c. Opportunities d. Threats 4. Process flow diagram 5. Force field analysis F. Data display tools 1. Dashboard 2. Storyboard VII. QI planning strategies A. Customer-driven attitudes B. Employee education needs C. Encouraging a team spirit VIII. Managing data needs with QI A. Benchmarking B. Plan Do Check Act (PDCA) IX. Communicating performance improvement findings X. Productivity measurement, performance standards, and work sampling XI. Tools for performance measurement Teaching Strategies Provide students with access to a Joint Commission accreditation manual, and explore the performance improvement standards. Discuss how HIM professionals may have an impact and what role you might play in performance improvement as an HIM professional. Apply continuous quality improvement tools to something that is common for all in the class. Demonstrate how the tools may be used across any industry, not just health care. Answers to Critical Thinking Exercises 1. Describe the role of a facilitator in QI implementation. A facilitator has the ability to present the tools and techniques in an informative yet interesting way and is available to give in-service programs and special training sessions to teams. 2. Explain how health information services develop a customer-driven attitude. Examine stakeholder wants, needs, and expectations. 3. How do managers use the tool known as PDCA? Quality improvement activities are planned (plan), put into action (do), monitored (check), and corrective action (act) is taken to further improve performance based on monitoring activities. 4. Define productivity and document specific quality and quantity items that the coding and reimbursement team might use in creating performance measurement tools. Productivity is basically the amount of work completed in a specified period of time. Coding and reimbursement productivity should not only focus on the quantity of coding completed, but also on the accuracy of coding. Answers to Application of Theory Exercises 1. Develop a model for encouraging a team spirit among members of the record activity section of health information services in an acute care facility. The coding section is frustrated because the assembly/analysis team within the record activity section is increasingly unable to obtain and complete all discharged records within their procedural guidelines. In discussing the problem with the managers on the patient units, the record activity section manager and the assembly/analysis team leader discovered the patient care givers are holding records for completion because of the recent staffing change to 12-hour shifts from 7 A.M. to 7 P.M. They frequently need to complete documentation after 7 P.M. At present, the team members assemble and analyze the available records from 7 P.M. to 10 P.M., ready for coding the next morning. Plan a brainstorming session with the team to solve this problem; state who should participate in finding a solution; offer two creative ideas; and then give rationale for using these ideas as tools to build team spirit. Responses will vary based on student creativity. Model for Encouraging Team Spirit in the Record Activity Section Brainstorming Session Plan Participants: • Record Activity Section Manager • Assembly/Analysis Team Leader • Coding Team Members • Representatives from Patient Care Units • Administrative Support Staff Session Objectives: 1. Identify challenges related to record completion. 2. Generate creative solutions to improve collaboration and efficiency. Creative Ideas: 1. Implementation of a "Documentation Handoff" System: • Establish a structured handoff process where patient care providers can transfer incomplete documentation to a designated team member before their shift ends. • Rationale: This encourages collaboration between teams and ensures accountability, fostering a sense of teamwork and shared responsibility for patient care. 2. Flexible Scheduling and Cross-Training: • Introduce flexible hours for assembly/analysis team members to cover late documentation needs or provide cross-training for coding staff to assist with assembly tasks during peak times. • Rationale: By allowing team members to support each other during critical periods, this promotes a culture of mutual aid and strengthens relationships among staff, enhancing overall team spirit. Conclusion: Encouraging open communication and collaboration through these strategies will not only address the immediate issue of record completion but also build a stronger team dynamic, enhancing morale and productivity in the Record Activity Section. 2. Select a problem that you have recently experienced and evaluate it using a fishbone diagram. Students should use the following template for solving the identified problem: Suggested Responses to Case Studies 1. You have been designated as a performance improvement trainer for an acute care hospital and have been assigned the task of outlining training priorities for the organization. Describe how you would approach this task, including which levels of management and staff must be trained and which tools should be included in initial training. There are a variety of options for how this case may be solved. Students should be creative in their responses, identifying all levels of management, including the C-suite, directors, managers, supervisors, team leads, and frontline staff members. Priorities will be dependent upon the approach that each student takes to the problem. 2/3.You are the coding supervisor for an acute care facility. Coders will be receiving merit-based wage increases based on productivity and quality using the following criteria. Determine the merit wage increase based on the coding productivity and quality audit findings.
Coder Wage Increase
Jasmin 2%
Ricardo 4%
Aaryn 4%
Annika 0
Eduardo 0
Chapter 18 Project Management in Health Care Learning Objectives After completing this chapter, the learner should be able to: 1. Identify the steps in the project management life cycle. 2. Outline the processes involved in the initiation phase of the project management life cycle. 3. Create a project plan that includes vendor selection or contracted services. 4. Implement the project plan in the execution phase of the project management life cycle. 5. Evaluate and monitor the effectiveness of a project following implementation. Key Terms Due diligence Execution Initiation phase Planning phase Project charter Project management Request for information (RFI) Request for proposal (RFP) Scope Scope creep Statement of work Lecture Notes I. Introduction II. Project management life cycle A. Initiation phase 1. Statement of work/project charter 2. Determination of need B. Planning phase 1. Scope 2. Contracts a. Request for information b. Request for proposal 3. Due diligence 4. Decision matrix C. Execution phase 1. Scope creep D. Closure E. Evaluation/monitoring Teaching Strategies Have students create a decision matrix representing a recent important decision they made, such as returning to school while working full time or buying a car. Then, have students work in small groups to compare their grids and discuss alternative routes they could have chosen. Ask them to challenge each other on how priorities were assigned to the different options. Answers to Critical Thinking Exercises 1. List the steps in the project management life cycle. Initiating, planning, execution, and controlling/monitoring/closure. 2. Interview an HIM professional involved in planning a project. Document the tools being used in planning the project and in carrying it into implementation. Responses will differ based on interviews. In my interview with an HIM professional, they highlighted using project management software (like Asana) for task tracking and timelines, alongside Gantt charts for visualizing project progress. Additionally, they emphasized the importance of stakeholder communication tools (such as regular status meetings and updates) to ensure alignment and collaboration throughout the implementation phase. Answers to Application of Theory Exercise You are an HIM professional employed as an education coordinator for the department of public health and want to propose a community health literacy education campaign. Describe the activities that you must complete during the initiation phase, including elements that you might include in a determination of need for the project. A statement of work or project charter must be established and proposed to pertinent stakeholders to define the broad scope and objectives of the project. An impact analysis with a cost-benefit analysis should be completed. The determination of need should identify if there are any other similar campaigns in the area, and a survey of stakeholders will determine if a need for the program exists. Suggested Responses to Case Study You are the HIM director of a 500-bed acute care hospital and have been asked to serve on the planning committee for EHR implementation. Your purpose on the committee is to identify needs from an HIM perspective. Make a list of information that would be useful for you to receive with the RFI, which could help you contribute to the decision-making process. Also make a list of important issues to be addressed during the contract negotiation phase. Items identified may include, but are not limited to: • Hours of support • Compatibility with other EHR components • Compatibility with coding and billing software • Training • How hybrid records and scanning are incorporated Chapter 19 The Effective Committee Learning Objectives After completing this chapter, the learner should be able to: 1. List several reasons why managers choose to use committees and meetings for managerial tasks. 2. Weigh the advantages and disadvantages of using committees for decision making. 3. Identify the major techniques for group decision making and suggest appropriate uses for each. 4. Give the major responsibilities of a committee chairperson and committee participants. 5. Describe the components of a meeting agenda and state why each one is necessary. 6. Explain the value of each of the components that are a part of minutes. 7. Identify advantages and disadvantages for using computer technology to create electronic meetings. Key Terms Action plan Ad hoc Agenda Brainstorming Delphi technique Forming Minutes Nominal group technique Norming Performing Standing committee Storming Lecture Notes I. Introduction II. Team building A. Forming 1. Hesitation 2. Silence 3. Observing others 4. Politeness 5. Impersonal 6. Questioning purpose of team 7. Caution B. Storming 1. Threatening to leave the group 2. Disagreement about purpose of team 3. Becoming confrontational with other team members 4. Feeling trapped 5. Lack of motivation 6. Questioning reason for team 7. Questioning purpose of members selected for the team C. Norming 1. Organization 2. Setting priorities 3. Constructive feedback D. Performing 1. Sharing 2. Open communication 3. Tolerance of diverse opinions III. Creating and participating in effective meetings A. Ad hoc B. Standing committees 1. Medical staff committee 2. Quality steering committee 3. Safety committee 4. AHIMA practice council 5. AHIMA workgroup 6. Board of directors for AHIMA, CSA, or other professional organizations C. Guidelines for effective committees and meetings 1. Delegated authority 2. Membership 3. Chairperson 4. Agenda 5. Recorder and minutes IV. Advantages of committees and meetings A. Group judgment aids in improving quality of decision B. Group interaction stimulates creativity C. Interteam committees coordinate activities D. Committees enhance acceptance of decisions and group cohesion as the pooling of specialized knowledge aids in understanding E. Group decisions divide responsibility and thus can increase commitment and motivation toward goals as knowledge of the problem is enhanced through discussion F. Agendas, minutes, and action plans communicate information and lead to coordinated efforts by the group and then by the departments and/or teams represented by each member V. Disadvantages of committees in decision making A. Cost of bringing groups of employees together to make decisions is high—employee salary time is significant. B. Committees are time-consuming; decisions may need to be made and implemented in a shorter time frame. C. Motivational deadlocks can occur when committee members have conflicts with the objectives; these deadlocks can create unrealistic compromises. D. Divided responsibility can also be a disadvantage since members may not feel individual responsibility for decisions or recommendations. E. Compromised decisions can be mediocre; therefore, when decisive action must be taken, one person may be better suited to making the decision. Committee recommendations can then be used for information only, not decision making. F. Strong-minded, vocal members can control meetings; chairpersons may thus find it difficult to use group process methods effectively to assure everyone has the opportunity for input VI. Techniques for effective group decision making A. Consensus building 1. Constraints from upper-level management will not prevent acceptance of group decision. 2. Manager can support and implement group decisions. 3. Each group member has time to present views and alternatives for a solution. 4. Areas of disagreement are exposed, discussed, and resolved. 5. Areas of agreement are explored fully. 6. Use of bargaining or voting is avoided. 7. Support of decision is possible for all group members B. Brainstorming 1. Develop a clear understanding of the subject or problem and a set of questions to begin the session. 2. Gather tools for the session such as flip charts/wall charts and writing supplies for recording ideas. 3. Ask someone who is not a group member to serve as recorder for the meeting. 4. Begin the session with an introduction to brainstorming technique and the goals of the meeting. 5. Exhaust idea generation, making sure each group member contributes. 6. Cluster the ideas by grouping similar points together and assist the group in looking for patterns of similarity. 7. Encourage the group to suggest additional improvements from these clusters, refine wording, and develop alternatives for the subject or problem through consensus. 8. Inform the group of how the developed alternatives will be used. C. Nominal group technique 1. Develop a clear understanding of the subject or problem and a set of questions to generate creative thinking. 2. Gather tools for the session such as pads of paper for members, flip charts/wall charts, and writing supplies for recording suggestions and priorities. 3. Ask someone who is not a group member to serve as recorder for the meeting. 4. Explain the NGT process to the group. 5. Begin the silent idea-generation phase; allow ample time. 6. Ask each member, in turn, to read one idea for recording on the flip chart; repeat in sequence until all ideas are recorded. 7. Cluster ideas and encourage evaluation and discussion of pros and cons. 8. Assign a letter of the alphabet to each idea or cluster of like ideas. 9. Ask members to record, on paper, their ranking of the ideas, using the letter assigned, prioritizing by order of importance. No discussion is allowed during this phase. 10. Pick up papers and record votes on the flip chart next to the corresponding letter. Total them for each idea. 11. Choose the ideas with the highest ranking (5 to 10 of them) for further discussion, refinement, and improvement. 12. Inform the group of how the ideas and rankings developed will be used. D. Delphi technique 1. Identification of the subject or problem occurs and group members are chosen. 2. Questionnaires are carefully designed to elicit responses from group members toward solving the problem or developing ideas about the subject. 3. Group members complete this first set of questionnaires and return them for compilation. 4. Group members receive the compilation and a second questionnaire that will hopefully elicit new alternatives and narrow the options. 5. Compilation of the second set of questionnaires brings the group closer to consensus and another questionnaire is developed and distributed with the second compilation, if necessary. 6. Distribution of compiled information VII. The effective meeting participants A. Chairperson 1. Robert’s Rules of Order 2. Parliamentarian B. Members VIII. Documentation tools for committees and meetings A. Agenda 1. Name of the group or committee that is having the meeting 2. Location of the meeting 3. Date and time of the meeting 4. List of invited attendees 5. Start time 6. Items or issues to be discussed during the meeting 7. Name of the individual who will be presenting each item 8. Amount of time allotted for each item 9. Adjournment time 10. Robert’s Rules of Order B. Minutes 1. Name of meeting, date, time, and location 2. Those present at the meeting; should also include those absent to assure members unable to attend will receive a copy of the minutes. 3. Items brought before the group, with motions, votes, consensus decisions, actions, deferments; expressed in clear, concise language. Deadlines, persons responsible for future action are included. 4. Substantiating materials are attached to the official minutes such as outlines of in-service presentations, recommendations brought before the group from another committee, or supporting documents. 5. Name and title of the chairperson and of the recorder are indicated. 6. The action plans are also attached to the minutes and distributed. C. Action plans IX. Technology use for meetings X. Conflict in groups Teaching Strategies Hold a mock meeting in the classroom. Work as a group to develop an agenda. Assign a student to act as the chairperson. Have each student take minutes during the meeting. Answers to Critical Thinking Exercises 1. What qualities would you like to see in the chairperson of a committee where you are a member? Answers will be personalized and may include: organized, accountable, intelligent, knowledgeable, compassionate 2. List five techniques managers can use for group decision making. Which technique would the manager of a coding and reimbursement team most likely use for gathering proposed workstation designs for the team’s area of the new department? The alternatives are to be submitted to the department manager in 10 days. The final decision will be made by the construction planning team. Consensus building Structured brainstorming Unstructured brainstorming Nominal group technique Delphi technique 3. What is the follow-up document that accompanies the minutes? Who uses this document and why? The action plan reminds members of the group what they are responsible for. 4. Obtain copies of the agenda and minutes from a recent meeting and analyze them for effectiveness in serving as communication documents. This response will be dependent upon the agenda and minutes obtained. 5. Attend a committee meeting, take minutes, and prepare the minutes for distribution. This response will be dependent upon the meeting attended. Answers to Application of Theory Exercises 1. Identify two situations in which you encountered conflict, either in the workplace or another setting—one that was effectively resolved and the other that was not. Describe the conflict situations and explain how each was addressed. Explain what was effective and ineffective with the management of each situation and how each might have been managed to have different results. Responses will be based on individual experiences. In one workplace conflict, a scheduling disagreement between team members was effectively resolved through a mediation meeting, allowing everyone to voice concerns and agree on a compromise. Conversely, a project miscommunication between departments was not resolved effectively; issues lingered due to a lack of follow-up and clarity, leading to frustration. For the latter, implementing regular check-ins could have fostered better communication and alignment, potentially preventing escalation. 2. Summarize your activities from last weekend using one of the formats presented for meeting minutes in Figure 19.2. Provide a brief discussion of each activity that is identified as a opic. Identify any action items that emerged, along with a due date and individuals responsible for the items. Responses will vary based on experience, but should follow the format in Figure 19.2. Suggested Responses to Case Studies 1. You are the manager of a large HIM department that has recently experienced loss of three supervisory positions. You have decided to approach the situation by organizing your department into self-directed teams. Which HIM functions would you combine in teams and which functions would you keep on separate teams, and why? How will you explain this change to your staff members? What kind of support or guidance should you be prepared to provide to facilitate the change? Responses will vary, as students may be creative in their approaches to the problem. 2. You are the HIM director of a 400-bed acute care hospital. The vice president of finance has assigned you with the task of developing a revenue cycle management committee. Create a proposed plan that outlines what key positions from which departments in the organization should be included, frequency of meetings, and standing agenda items. Responses may vary, but answers may include (but are not limited to) HIM, finance, lab, diagnostic imaging, admitting, case management, emergency department, nursing, patient accounts, respiratory care, cardiac services, and other ancillary departments. Chapter 20 Managing Change as a Health Care Professional Learning Objectives After completing this chapter, the learner should be able to: 1. List the major forces that are creating a mandate for change in the health care industry. 2. Give three categories where change typically occurs in health care organizations. 3. Identify major challenges that face HIM professionals initiating change in both acute care facilities and ambulatory settings. 4. Define revitalization and explain why change experiences are needed for professional career growth. 5. List four underlying reasons why employees may resist change and explain the rationale for each. 6. Discuss six steps managers can take to reduce resistance to change. 7. Explain the factors that offer value to the role as a broker of health information. Key Terms New vision Organizational development (OD) Revitalization Lecture Notes I. Introduction II. Change is inevitable A. External forces 1. Government laws and regulations 2. Community B. Internal forces 1. New management team 2. Change in organizational structure III. Major categories of change A. Changing technology B. Changing structure C. Changing employees/interpersonal relationships IV. Change: The challenges and the rewards A. Within the department B. Within ambulatory settings C. Within other settings V. Professional revitalization and new vision A. Create time for planning B. Initiate activities for growth C. Practice new thought patterns D. Embrace creative tension E. Share the new vision F. Shaping the curve 1. Scarring 2. Self-protection 3. Emerging roles for advancement VI. Reducing resistance to change A. Reasons for resistance to change 1. Change creates uncertainty 2. Fear of loss 3. Team pressure to resist 4. Belief that change is not in the best interest of the department B. Steps for reducing resistance to change 1. Communicate 2. Educate 3. Participate 4. Facilitate team building and interpersonal relationship enhancement 5. Negotiate and reward 6. Evaluate and make corrections VII. Becoming a broker of health information resources Teaching Strategies Share examples of articles or news stories about health care organizations that have gone through significant changes and discuss how the changes were handled. Answers to Critical Thinking Exercises 1. Give the five steps that HIM professionals can take toward revitalization. 1. Create time for planning 2. Initiate activities for growth 3. Practice new thought patterns 4. Embrace creative tension 5. Share the new vision 2. Choose one of the four factors for resistance to change and discuss reasons for the resistance. Reasons for resistance are: • Change creates uncertainty • Fear of loss • Team pressure to resist • Belief that proposed change is not in the best interest 3. Choose one of the steps for reducing resistance to change and discuss the rationale for its effectiveness. Steps for reducing resistance are: • Communicate • Educate • Participate • Facilitate team building and interpersonal relationship enhancement • Negotiate and reward • Evaluate and make corrections Answers to Application of Theory Questions 1. Interview an HIM manager who is planning a departmental change. Prepare a table that shows the following: a. Planned change—separate the change into subsets showing how a change in one factor of the department will create the need for changes in other factors. b. State which of the three major categories of change is involved for each subset of change planned. c. List some challenges the manager will face for each of the subsets of change. d. Offer some possible reasons why the employees may resist the proposed changes. e. Discuss steps the manager can take to reduce the resistance reasons offered above. Responses will vary based on interview responses. Interview Summary Table for HIM Manager Planning Departmental Change Additional Notes • Communication is key throughout the change process to ensure employees feel involved and informed. • Support mechanisms such as mentorship programs or feedback sessions can help ease transitions. 2. Interview an HIM professional who has changed career paths at least twice. Prepare a curve line that shows revitalization and any self-protection efforts taken because of scarring experiences. Responses will vary based on interview responses. The curve line depicting the HIM professional's career path illustrates initial revitalization during each transition, with peaks representing new opportunities and learning experiences. The dips indicate scarring experiences from previous roles, prompting self-protection efforts like seeking mentorship and additional training to build resilience and confidence in future changes. Suggested Responses to Case Study Sarah has been working as a coder in the same acute care facility for nearly 20 years. The transition to using EHRs has been difficult for her, and now her organization is starting to discuss adoption of computer-assisted coding. Discuss how her manager might facilitate the change and help Sara accept it better. What might Sarah do herself to reduce the anxiety she is feeling about the change? Help Sarah understand where she falls along the change timeline, and encourage her to identify what her biggest fears or hesitations might be. Having her acknowledge her reasons for resisting change will be an important step in helping her navigate the change. Use the steps to reducing resistance to change—communicate, educate, participate, facilitate, negotiate, evaluate—to help Sarah embrace the changes at a pace that is comfortable for her. Set up a short weekly touch base with Sarah so that you can both monitor her progress. Suggest to Sarah that she team up with a co-worker who has successfully navigated the new system and who can help her appreciate the benefits and ease of the new system, which will make the changes seem less intimidating. Chapter 21 Personal and Professional Career Management Learning Objectives After completing this chapter, the learner should be able to: 1. Describe the content of professional resumes and state four principles that guide in their preparation. 2. Explain four reasons for writing a cover letter that introduces the resume. 3. Identify three major reasons for careful planning prior to a position interview. 4. List 10 major personality organizational types and explain how each type tends to organize personal work. 5. Describe five major tools and techniques for effective personal and office time management. 6. Identify aspects of professionalism that are of concern to health care professionals. 7. Describe opportunities HIM professionals have to enhance personal and professional growth. Key Terms Chronological resume Cover letter Curriculum vitae Functional resume Professionalism Remote work Resume Soft skills Lecture Notes I. Introduction II. Personal planning for a professional career III. Planning a resume A. Resume B. Curriculum vitae C. Chronological format D. Functional format E. Combination format IV. Writing your resume A. Heading B. Career objective C. Work experience and education D. Main headings E. Phrases versus sentences F. Abbreviations G. Action verbs H. Gaps in work history I. Previous employer information J. Accomplishments K. Publications L. Personal information M. References N. Appearance O. Attachments P. Individualize for employers V. Cover letter VI. Planning for a position interview VII. Planning for positive performance evaluations VIII. Personal time management IX. Professionalism A. Soft skills B. Hygiene C. Appearance D. Dress E. Attitude F. Behaviors G. Work quality H. Communication I. Outside of the workplace J. Smoking K. Credit checks L. Remote office X. Professional growth Teaching Strategies Provide practice with interview skills by performing mock interviews in class. Answers to Critical Thinking Exercises 1. Describe several tasks you will undertake in your personal planning for your first HIM position following graduation. Responses will vary by student. In my personal planning for my first HIM position, I will update my resume and LinkedIn profile to highlight relevant skills and internships, and practice interview techniques to enhance my confidence. Additionally, I will network with industry professionals and join HIM associations to stay informed about job openings and industry trends. 2. List the major features of a resume. Which format will be most appropriate for you? Students may identify whether they want to use a chronological, functional, or combination format. Answer to Application of Theory Exercise Create a resume that includes the elements discussed in this chapter. Responses will vary based on student work and education experience. Suggested Responses to Case Study You are getting ready to graduate with an associate degree in health information technology. You have never worked in the career field, but you have held previous positions at two different employers in food service. You were an excellent student in college, maintaining perfect attendance and frequently appearing on the dean’s list. You just found out about an entry-level HIM position and plan to apply for it. Describe how you will organize your resume and list items you may wish to discuss in an interview to demonstrate why you would be a good candidate for the position, even though you do not have previous HIM experience. The resume should be organized with education listed first, including statements about perfect attendance and dean’s list. Include a list of pertinent courses that were taken. In the interview, share examples of things learned in classes as they may relate to the real world. Instructor Manual for Management of Health Information: Functions and Applications Leah Grebner, Rozella Mattingly 9781285174884
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