Sayles Chapter 19 (Management)

FYI (for your information)

FYI: A contract is a legal document that details the relationship between two entities—for instance, the contracted coders mentioned earlier and the department manager enter into a contract to provide coding services to the HIM department. In this case the vendor is the outside coding department and the HIM department manager is contracting with the vendor for coding services. Choosing a vendor or contractor includes identifying the need, designing the system, submitting a request for information (ROI), analyzing the ROI, submitting a request for proposal (RFP), and establishing a contract for services with the chosen proposal.

budget

A ____ is a plan that converts the organization's goals and objectives into targets for revenue and spending.

vendor

A _____ is a company outside the healthcare organization with which an HIM department conducts business; for example, coders may use an encoding system that is owned and operated by an external company.

contractor

A _____ is an outside company or individual who provides or performs a service for the HIM department; for example, the coding functions could be contracted to a company that specializes in coding. HIM professionals must understand the process for selection, implementation, and managing of outside vendors and a (n) ______.

Enterprise information management (EIM)

ensures the value of information assets, requiring an organization-wide perspective of information management functions; it calls for explicit structures, policies, processes, technology, and controls. It also includes the infrastructure and processes to ensure the information is trustworthy and actionable. It is the set of functions used by organizations to plan and organize, and coordinate people, processes, technology, and content for managing information as a corporate asset that ensures data quality, safety, and ease of use.

External Analysis

includes development of the market assessment to determine opportunities and threats to the future of the organization. For example, an _____ is performed by facility A within the service area in which it operates. The analysis determines that at facility B, operating within the same service area, coders are paid 25 percent more than what facility A is paying. Facility A concludes that the reason experienced coders are not applying for open coding positions is because they can be paid more at facility B. Facility A has the ______ information needed to understand it must increase the wages of coder to be competitive within its' service area.

Strategic Planning

involves how the organization will react to changes in the external environment in the foreseeable future. Usually the time frame is three to five years in the future.

Accrual Accounting

involves recording known transactions in the appropriate time period before cash payment (receipts) are expected or due.

Internal Analysis

involves reviewing the inner working of the healthcare organization to determine strengths and weaknesses of the business practice and process. For example, an ____ of the coding department may reveal that 10 of the coders are credentialed and have at least 10 years of experience; however, the top five coders are all leaving their employment within the next three months.

Middle Management

involves the people within the organization who oversee the operation of a broad scope of functions; for example, the HIM manager may oversee coding, transcription, and release of information at the departmental level or they may oversee a defined product or line of service, such as in the case of a radiology department manager.

budget management

involves the process of maintaining financial viability by ensuring operating revenues for the year are sufficient to cover the operating expenditures.

Organizational behavior

involves the ways in which people interact with one another within a healthcare facility. (EX. A coding supervisor speaking negatively about the HIM director to the people who report to her demonstrates the organizational behavior of that particular department, meaning the coding supervisor is creating a behavior of negativity within the department and the supervisor's direct employees may view such speech as an indication that it is acceptable to speak negatively about others in the department. Supervisors and managers should be aware of the culture of their department and control the organizational behavior to provide positive human interaction.)

impact analysis

is a collective term used to refer to any study that determines the benefit of a proposed project, including cost-benefit analysis, return on investment, benefits realization study, qualitative benefit study, or how change affects workflow.

Planning

is the examination of the future and preparation of action strategies to attain goals of the department or healthcare facility; for example, a director in the HIM department may use this function to prepare for the future state of the department after the implementation of a new release of information software system installation. The director will anticipate the changes in staffing, processes, and procedures to determine what changes will be necessary in preparing, implementing, and managing the new system. Short-term _____ may involve staffing coverage for an employee who is taking leave time.

Case Management

is the formal process of introducing change, adopting the change, and diffusing it throughout the organization.

Leadership

is the function in which people are directed and motivated to achieve the goals of the healthcare organization. In an HIM department, this involves assigning responsibilities to the tasks the department needs to accomplish. For example, in the case of a disaster where multiple patients are brought to the facility, the HIM director may ask all personnel to report to the emergency staging area to help with record management. The day-to-day operations of the department requires the director to understand the policies and procedures to determine when a change may be needed.

Controlling

is the function in which performance is monitored according to policies and procedures. In HIM, this includes monitoring the performance of employees for quality, accuracy, and timeliness of completion of duties. For example, the policy of the department may include a 90 percent accuracy rate for all codes for surgical procedures. The coding supervisor will monitor accuracy for all coders to ensure compliance with this standard. If an employee falls below the stated standard, training will be provided to the employee.

Supply Management

is the management and control of the supplies used within an organization. It can be physical goods, services, information, or any resources needed to run the organization.

Financial Management

is the mechanism that all organizations and businesses use to fully comprehend and communicate their financial activities and status. It is usually managed by top-level executives in the organization with input from department leaders.

Functional definition

principles of organization: All employee job tasks, responsibilities, and relationships toward each other are clearly defined. Managers who define and adhere to the functions of their department staff provide a healthy working environment. The HIM department employees working in the transcription department know exactly which reports they are responsible for transcribing (for example operations reports) and the time frame expected for completion (within one hour post-dictation). There is a clear understanding of the supervision and direction for the department.

Specialization

principles of organization: Each employee has a special qualification or skill that allows that individual to perform his or her designated job to the best of his or her ability; managers who employ this principle assign work among their reporting employees according to this type of organization, such as assigning the most complex coding cases to the coder who has the highest quality performance on coding reviews. The manager is able to divide and conquer the work of the department using each employee's strengths, which results in a positive outcome for the organization.

Unity of command

principles of organization: In this management principle, it is assumed that each employee reports to one manager. The employees in the coding department report to the coding supervisor and the coding supervisor reports to the HIM director

Span of control

principles of organization: The number of employees a person manages is called the ____ and is influenced by the size of the organization (such as a department with only two employees compared to department with 100 employees), the skill level of the employees (entry-level employees require more supervisor time), and the responsibilities of the supervisor and employees. This can be high, where there are a lot of employees to manage, or low, with few employees to manage. If it's high it may cause the manager to be ineffective because too many people report to him or her, or if it is low a manager may feel he or she is not being used effectively, meaning he or she feels that they are capable of more responsibility.

Hierarchical chain

principles of organization: This is a management principle in which each member is assigned a specific rank that reflects his or her level of decision-making authority within the organization. An HIM director who reports to the chief financial officer (CFO) gives advice and guidance to the CFO; however, ultimately the CFO has a higher authority in making decisions.

Organizational Chart

sometimes called an org chart, is a visual graphic or diagram showing the structure and reporting relationships between positions, departments, and employees of an organization. The org chart shows the relation of one department to another and a department org chart shows the relationships among staff, supervisors, and managers within a single department.

organizational structure

the framework of authority and supervision for the employees within the healthcare organization. (The structure follows a chain of command, or the hierarchical structure within an organization. Employees are able to understand to whom they report and to whom their supervisor reports and so forth. A manager may have many reports but an employee only reports to one manager)

Workflow

the process and steps it takes to complete a task.

project plan, Gantt charts, and PERT charts

what are the tools needed for project management?

capital budget

Schedules the purchase of assets that will be purchased in the future (for example, a new piece of radiology equipment).

allocated cost

Takes into account departments that are not revenue-producing but are necessary for operation—for example, maintenance, utilities, and insurance.

Procedures

define the processes by which the policies are put into action. They are written documents that describe the steps involved in performing a specific function. This could be how to code a chart or how to abstract data. It includes steps taken to adhere to the policy.

forecasted revenue (amount of money expected for the year) and forecasted expenses (cost of doing business for the year).

A comprehensive organization master budget includes what?

salaries and benefits

Allocates all of the employee wages and benefits taking into consideration salary and cost of living increases

operating budget

Allocates and controls resources to meet an organization's goals and objectives for a fiscal year

for your information (FYI)

FYI: Chapter 1 describes mission, vision, and values—tools healthcare organizations use to set the direction and define their purpose and philosophies. A mission statement is a written statement that identifies the core purpose and philosophies of a healthcare organization; it defines the healthcare organization's general purpose. The vision statement is a short description of an organization's ideal future state, and the values statement is a short description that communicates an organization's social and cultural belief system. These statements can range from analytical to creative, but they are always a Screenshot of what the healthcare organization represents, its goals for the future, and what the healthcare organization believes in. Healthcare organizations update their mission and vision statements regularly as part of the strategic planning processes (strategic planning is discussed later in this chapter). All employees of the healthcare organization should know and understand the mission and vision of the organization. By understanding the mission and vision, managers are able to determine the direction of their department and if it fits into the overall strategy of the organization. For example, if the mission of a facility includes serving only female patients, managers will not look at expanding services to male patients with prostate cancer.

FYI (for your information)

FYI: Staffing is the managerial function that involves proper and effective selection, appraisal, and training of personnel. The HIM manager must be aware of (and budget for) the staffing needs of the department and take into consideration employee paid time off, leave, and illness. When it comes to staffing, the manager should keep in mind the following: • Staff recruitment and selection • Performance management • Staff retention • Employee relations and fair treatment • Staffing planning and scheduling • Productivity • Training and development

operational planning

Is the specific day-to-day tasks required in operating a healthcare organization or an HIM department. It is the road map to guide a healthcare organization or department toward the goals of the strategic plan. The operational plan is a shorter and more defined time frame than the strategic plan. Department managers are involved in creating this for their department to propose how to staff and accomplish the work tasks for the coming year.

executive, middle, and supervisory

Management generally includes three levels. They are...

SWOT (acronym for strengths, weaknesses, opportunities, and threats) analysis.

The process to develop a strategic and operational plan begins with a _____.

cash basis accounting and accrual accounting

There are two ways to record the transactions in the financial books. What are they?

Variable cost change like supplies while fixed costs remain constant like rent, wages, and equipment rental.

What is the difference between variable and fixed cost?

Mergers

are business situations where two or more companies combine—one of them continues to exist as a legal business entity while the other(s) cease to exist legally and their assets and liabilities become part of the continuing company.

Policies

are the principles describing how a department or an organization will handle a specific situation or execute a specific process. They are clear, simple statements of how an HIM department will conduct its services, actions, or business; and a set of guidelines and steps to help with decision making.

Risk Management

is a comprehensive program of activities intended to minimize the potential for injuries to occur in a facility and to anticipate and respond to ensuring liabilities for those injuries that occur. This includes the processes that are in place to identify, evaluate, and control risk, defined as the organization's risk of accidental financial liability. A healthcare organization as a whole has this as a type of director to evaluate and manage the potential for injuries that happen during the course of doing business—for example, patient falls, patient infections occurring while being treated, or surgery on the wrong body part. HIM managers must handle risk in terms of coding and billing fraud and abuse. Managers must know the laws and regulations governing HIM functions and educate staff on those items.

Strategy

is a course of action designed to produce a desired (business) outcome

project management professional (PMP) certification

is a credential offered by the Project Management Institute (PMI). Individuals with this certification demonstrate competency in the project manager role and lead and direct projects and teams. The certification examination covers the areas of initiating, planning, executing, monitoring, controlling, and closing the project

budget variance

is a difference in the budgeted revenue or expense amount; for instance, an HIM manager budgeted $10,000 for training coders during the current year and training actually cost the department $11,500. Therefore, the department has a negative budget variance of $1,500. Ideally, a positive variance occurs when the projected revenue is higher or the expenses are lower than projected, meaning the expenditures are within or below the amount that was budgeted.

Project Management

is a formal set of principles and procedures to help control the activities associated with implementing a large undertaking to achieve a specific goal (such as an information system implementation) and has a definitive beginning and end.

Gnatt Chart

is a graphic tool used to plot tasks and shows the duration of project tasks and overlapping tasks; in other words it is used as a method to illustrate the time needed for each task.

SWOT analysis

is a key leadership personnel to determine the strengths of the organization (what the company does well), the weaknesses (needs for improvement), and establishes future opportunities (and evaluates threats to those opportunities). An example of ______ performed by an HIM department found the following: Strengths: Fully staffed long-term employees are all credentialed. Weaknesses: Staff is not trained in the technology being implemented. Opportunities: New technology will increase productivity in the department by 45 percent. Threats: There are members of the staff that are opposed to change and there is a time delay with implementing new technology (Buchbinder 2012)

job description

is a list of duties, reporting relationships, working conditions, and responsibilities for a particular job.

customer satisfaction

is a measurement of a customer's expectation, either by falling short, meeting, or exceeding the expectation. It is usually determined using surveys that measure satisfaction with services provided. In an HIM department, the manager may want to assess this with the process of attaining copies of patient immunization records. Customers can be considered internal or external based on the relationship to the service. An internal customer needing a copy of immunization records could be the surgeon who works for the facility. An external customer is the parent of the patient who needs the records for their child to start playing baseball at the local community center.

job classification

is a method of evaluating a job description against written descriptions of various classification grades.

resource allocation

is a process and strategy of deciding where resources should be used to achieve the mission, values, and goals of the organization. For example, in an HIM department the budget includes an amount of money to be used for information technology systems and the manager must decide between a software system to help with clinical documentation improvement or a system to track information needed for various registries. The manager must prioritize the needs of the department with legal and regulatory issues that may affect the choice of resources. For example, the coding department must have the current coding guidelines each year and cannot work with outdated codes; thus they must purchase updated code books each year.

program evaluation and review technique (PERT) chart

is a project management tool that diagrams a project's timelines and tasks as well as its interdependencies.

Organization

is coordinating all of the tasks and responsibilities of a department to guarantee the work to be accomplished is completed correctly. It is the planned coordination of activities of multiple people to achieve a common purpose or goal. For example, A director or supervisor is responsible for the decisions concerning the division of labor for the HIM department. In an HIM coding department, there may be a priority list of chart types needing coding. The coding supervisor ensures certain employees are responsible for specific charts, thus the common goal of chart coding is accomplished by multiple people

Cash Basis Accounting

is registering the transaction when it occurs, meaning when money is actually received for services provided, or paid for expenses incurred. This type of accounting is usually used in small businesses, because it is easier to manage.

cultural competence

is the ability to accept and understand the beliefs and values of other people and groups and is vital to the overall health of an organization.

expense

is the amount that is charged as cost by an organization to the current year's activities of operation.

Budget Adjustment

is the approval to move funds from one budget to another. For example, an HIM department manager has a coding employee vacancy for a period of time. The amount of money budgeted to pay for that employee is not used, so a budget adjustment could be made to move the unused money into a different fund to cover the cost of something else such as overtime pay for employees who are covering for the unmanned position.

Strategic Planning

is the document in which the leadership of a healthcare organization identifies the organization's overall mission, vision, and goals to help define the long-term direction of the organization as a business entity.

project management life cycle

is the period in which the processes involved in carrying out a project are completed, including the definition, planning and organization, tracking and analysis, revisions, change control, and communication. The following is an example of a project management life cycle as applied to HIM. An HIM department in small community health clinic uses an alphabetic filing system for their paper charts and decides to start using the patient health record number as their filing system. The department manager assembles a project team to manage the conversion to the new filing system. The following terms are defined for this project: • Definition: This outlines the project that is being accomplished by determining the objectives, activities, assumptions, estimated cost, and schedule such as: ○Objectives: To convert the filing system from alphabetic to numerical ○Activities: Identify health record number for each patient, create new filing system, convert all charts ○Assumptions: Assume project will be straightforward with no delays○Cost estimate: Cost of supplies and staff time○Anticipated schedule: Schedule for completion is two weeks • Planning and organization: A project plan lists the steps needed to complete the project with an estimated time frame for each step. • Tracking and analysis: The project team members follow the steps in the plan to determine where there are time delays or problems. • Revision: As the team monitors the project they can determine if changes need to take place in the project plan. • Change control: As changes occur to the plan the team manages these changes. In the chart filing example, the team determines in the middle of the project that the filing system for the charts should be terminal digit filing and not straight numeric and ask to change the project accordingly • Communication: All team members are informed and aware of the exact status of the project

job evaluation

is the process of applying predefined compensable factors to determine their worth. It allows the company to have guidelines and clear boundaries of the scopes of individual jobs.

Accounting

is the process of collecting, recording, and reporting an organization's financial data including the assets, expenses, and liabilities of the company. It is important for the HIM professional to understand these methodologies and budgets so they are prepared to manage a department.

Corporate Compliance

is the process of establishing an organizational structure that promotes the prevention, detection, and resolution of instances of conduct that do not conform to federal, state, or private payer healthcare program requirements nor to the healthcare organization's ethical and business policies. In HIM, compliance includes managing a coding or billing department according to the laws, regulations, and guidelines that govern it. A compliance officer is a designated individual who monitors the compliance process at a healthcare facility.

Work Analysis

is the process of gathering information about what it takes to get a job done. It involves mapping the entire process from start to finish for a task that requires multiple steps. It is the technique used to study the flow of operations and is sometimes called operations analysis. A ____ for completing a trauma registry for the state would include many steps from running a report on all trauma codes, analyzing the records that belong on the registry, completing the trauma registry, and sending the report to the state. A ____ breaks down the workflow into its component parts. The goal is to determine if there are areas that slow the process of the job task under review. It should be completed by detailing every single step of a process.

Strategic Information Systems Planning

is the process of identifying and prioritizing various upgrades and changes that might be made in an organization's information systems.

Management

is the process of planning, controlling, leading, and organizing the activities of a healthcare organization or department within an organization. Securing effective ____ practices within an organization establishes a positive direction to successfully deliver end results, and to do this strategic planning is necessary.

Revenue

is the recognition of income earned and the use of appropriated capital from the rendering of services during the current period

Executive Manager

is the senior management of a healthcare organization, the people who oversee a broad functional area or group of departments or services. This level of management establishes the organization's future direction and monitors the organization's operations in those areas. An _____ in HIM may be the chief information officer (CIO) who is responsible for HIM and information technology (IT). CIOs are responsible for the strategic direction for the organization in terms of information governance (IG) and the technology related to IG.

Supervisory Management

oversees the staff-level employees and monitors the effectiveness of everyday operations and individual performance against pre-established standards. In HIM a coding supervisor is an example of this level of management—this individual may have inpatient and outpatient coders, discharge analysts, and clerks reporting to him or her.