RS MGMT CH 7 Job Descriptions and Roles in Health Information Management

Job Analysis Method The steps in conducting a job analysis are to:

1. Perform a job needs assessment 2. Obtain approval from administration and the HR department (and management) to conduct a job analysis 3. Create a team or group to evaluate the job tasks; job analysis team 4. Identify the sources of data and the specific job data to be collected; and outline methods of collecting data 5. Collect and aggregate data 6. Create a new or updated job description content It is important to remember that most of the time the HIM manager will perform a job analysis alongside the HR department, which employs individuals who are specifically trained to perform job analyses. In addition, before embarking on the job analysis process, the health information manager should obtain approval from upper management as well as the HR department. In smaller healthcare organizations or nontraditional healthcare settings, an HR consultant may not be available to assist with the job analysis process, so the information contained in this chapter is helpful to an HIM professional embarking on the job analysis process alone

Difference between Job Crafting and Job Redesign

Although the premise behind job crafting and job redesign look very similar, it is important to remember job crafting is initiated by employees and job redesign is initiated by management. see image Job Redesign Job redesign is a management-driven (top-down) method of making work more meaningful for employees. ---> Employee Meaningful Work Most employees desire to perform work that is meaningful to the individuals as well as to the organization. ---> Job Crafting Job crafting is an employee-driven method for creating meaningful work in terms of tasks, relationships, and perceptions.

Job Crafting cont'd Alignment

Although job crafting is employee-driven, the role of management in the process cannot be overlooked. Feedback and communication between the employee and manager are essential to ensure that the employee's job role is still in alignment with departmental or organizational goals (Tims and Bakkar 2010). Positive results demonstrate reinforcement for employees who executed the changes effectively. If the job changes are not aligned with or are contrary to the workgroup objectives, the job crafting is considered a problem and must be addressed by management Job crafting may be an ideal way to embrace some of the fast-paced changes occurring in HIM departments, allowing motivated individuals to engage in more meaningful work. Job crafting may eventually lead to creation of new job descriptions and create additional pathways for growth inside an HIM department.

What is the final goal of the job analysis process? a. Aid in department strategic planning b. Create a new or updated job description c. Increase employee job satisfaction d. Increase employee job productivity

b. Create a new or updated job description

Marsha is creating an updated job procedure for release of information process that comes via email. She will need to create a _________________diagram prior to creating the actual procedure to ensure that all tasks for performing the procedure are identified. a. Job description b. Flowchart c. Policy d. Job reanalysis

b. Flowchart

Elizabeth has been a privacy officer at University Hospital for four years. She likes her job, but feels she could be doing more challenging work. Elizabeth approaches her boss, the corporate director of HIM, with a proposal to begin traveling to hospital-affiliated physician practices to perform privacy audits and educational workshops for the office staff. This is an example of: a. Job analysis b. Job crafting c. Job interviewing d. Job redesign

b. Job crafting

As the assistant director of the HIM department, Judy is responsible for creating a job description for the new application specialist position. As part of the data collection phase, Judy researches the AHIMA Body of Knowledge to locate similar job descriptions already on file. The Body of Knowledge is what source of data? a. Primary b. Secondary c. Tertiary d. The Body of Knowledge should not be a source of data

b. Secondary

Which of the following would be an example of a job specification? a. Assigns ICD-10-CM or PCS codes to all inpatient records b. Performs chart analysis in accordance with department procedures c. Able to type 90 words per minute with 98 percent accuracy d. Supervises second and third shift HIM department staff

c. Able to type 90 words per minute with 98 percent accuracy

Before the actual job analysis process begins, an HIM manager must complete the following: a. Collect primary data to support the job analysis b. Execute a workflow analysis c. Perform a needs assessment d. Write a job description

c. Perform a needs assessment

Which of the following is not a function of the job redesign process? a. Creates the right person for the job fit b. Enhances the quality of work life for the employee c. Realigns the needs of the organization d. Involves employee-driven changes to the job role

d. Involves employee-driven changes to the job role

Which of the following would be an example of a job task? a. Holds an HIM credential of such as RHIA, RHIT, CCS, or CCS-P b. Excellent written and oral communication skills c. Required to sit for extended periods of time d. Releases patient records to third parties in accordance with department procedures

d. Releases patient records to third parties in accordance with department procedures

Jane is responsible for developing the positions needed for scanning inactive records in anticipation of EHR implementation. Since she has no scanning experience, Jane called the supervisors of the scanning function at three different facilities to pick their brains in regard to scanning jobs. This method of data collection for job analysis is the: a. Competency model technique b. Diary method c. Observation method d. Technical conference method

d. Technical conference method

Figure 7.10. Format of a job procedure

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Figure 7.11. Sample job procedure

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Figure 7.12. Basic flowchart symbols

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Figure 7.13. Example of a flowchart for filing transcribed documents into the correct patient's electronic health records

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Figure 7.2. Job responsibility task tool template

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Figure 7.4. Task importance rating scale example

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Figure 7.7. Format of a policy

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Figure 7.8. Sample policy

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Figure 7.9. List of verbs to be used when writing job procedures

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The Three Dimensions of Job Crafting

1. Tasks -Job crafting by assessing job tasks allows an individual to develop his or her job by incorporating a variety of tasks along with providing the description and significance of these tasks. -The individual will add, emphasize, or redesign tasks For example, a health information coding manager's duties may be to provide education to coders, but the frequency and depth of training for coders needs to be reevaluated. The coding manager can provide more frequent coder educational sessions to highlight the ability to train others as an important attribute for his or her job. -In another example, a coding manager redistributes tasks to individuals within his or her workgroups, allowing the coding manager time to focus on higher-level job tasks that bring value to his or her job. 2. Relationships -The second aspect of job crafting is reevaluating and creating meaningful job relationships that enhance an individual's well-being. -The three functions of job relationships that need to be evaluated are building, reframing, and adapting relationships. For example, the HIM coding manager may realize that, in order to craft his or her job so it is more meaningful, he or she will have to build relationships with others in the healthcare organization that value the HIM skills inherent to the coding manager. -Helping other departments understand the clinical coded data they are using to make business decisions adds value to the organization and credence to the HIM profession. The HIM coding manager can also reframe existing relationships by changing the nature of the relationship for a different purpose -Networking with other HIM individuals who have similar job roles may provide the HIM coding manager with ideas for additional job tasks that will broaden the position's scope and create more meaning for the coding manager role. When adapting relationships, one adjusts a relationship to cultivate meaningfulness by providing others with valuable help and support -For example, an HIM coding manager has an HIM management team within his or her department, but the relationships between managers have been adversarial rather than supportive. The HIM coding manager may adapt the daily interactions with his or her peers to be more caring and supportive of other managers within the department. 3. Perceptions Linking perceptions of job tasks to other skills and interests can make the job more meaningful. -For example, the HIM coding manager may have inordinate persuasive and collaborative skills that can be linked to daily management tasks by motivating employees to perform at their best (Berg et al. 2013). An individual can cultivate meaningfulness in his or her position by thinking of the job as a whole rather than as a set of tasks. -For example, if an HIM coding manager perceives the tasks that he or she performs as an important piece of the entire revenue management cycle within the healthcare organization, he or she has an expanded perception of his or her job. Focusing on the more pleasing aspects of a job rather than the tasks an individual does not like can provide a more positive perception of the entire job. - In this example, the HIM coding manager should focus on the positive aspect of teaching coders new skills and improving revenue flow within the organization rather than on the less pleasant aspects of management such as disciplining employees or backlog management.

Job Analysis Terminology

A job "consists of a group of activities and duties that entail units of work that are similar and related" -Examples of typical jobs in HIM are coder, transcriptionist, revenue cycle coordinator, electronic health record (EHR) implementation specialist, and release of information clerk. One job description may be created for each of these jobs or there may be several different job descriptions based on the job requirements or job specifications. -For example, coding may be delineated in three different job descriptions: coder level I, coder level II, and coder level III. A job description is a detailed list of a job's duties, reporting relationships, working conditions, and responsibilities. -Depending on the size of the healthcare organization, each of the jobs mentioned may have one or more employees who complete the tasks and each employee occupies a position within the HIM department. A position or job role consists of different tasks or jobs that are completed by one employee. A health information manager may be required to perform a job and task analysis for particular jobs within the HIM department when a needs assessment notes a gap in performance. A task analysis is a procedure for determining the specific duties and skills required of a job.

Job Descriptions The final step in the job analysis or job design or redesign process is to create meaningful job descriptions that will match the jobs that were analyzed during the job analysis process.

A job description is an official document developed within a healthcare organization for job recruitment; it creates a repository for job tasks and provides the basis for evaluating annual job performance. A job description states the purpose of a specific job along with the duties or tasks for completion of the job, job standards, job context, job specifications, and reporting relationships Job descriptions for all positions within a healthcare organization are created using a standardized job description template. The statements given in the job responsibilities section of the job description template should be written clearly and simply stated with a verb at the beginning of each responsibility. For example, a scanning job responsibility would be to scan records from outside sources with a 98 percent accuracy rate. The verbs employed in each of the job responsibilities should mirror the level of competency required in order to complete the job task. An association of the level of competency or learning can be reflected by using Bloom's taxonomy—which identifies the different levels of learning—to create the verb. see image Figure 7.5 provides a list of verbs along with the level of learning required for the particular verb. Job tasks are often required to be performed at different levels throughout a healthcare organization. For example, a coder and coding manager job description will include the job responsibility of assigning appropriate diagnosis and procedural codes for all patient discharges using appropriate clinical classification systems such as ICD-10 and CPT. However, the verbs used in the job responsibility will differ between the coder and the coding manager. The coder will be responsible for applying and analyzing the code assignments whereas the coding manager will be responsible for evaluating the overall appropriateness of coding

Job Summary

A job summary (or job purpose or scope) describes the key tasks and responsibilities of a job and is usually what is used when posting any job openings in regard to the position. Because job summaries are utilized for recruiting purposes, they must be written to attract qualified individuals to apply for the position. The basic content of the job summary outlines how the job fits within the department and provides an overview of the job requirements. This should be a clear and concise outline of what is required in the job.

Steps of the job analysis process Step 1 Perform a needs assessment

A needs assessment is a procedure performed by collecting and analyzing data to determine what is required, lacking, or desired by an employee, group, or organization. The needs assessment is a process for determining how to close a learning or performance gap as it relates to jobs performed in a particular department. Needs assessment is a process that relies on data collection and analysis to assess the actual job tasks being performed within a department or entire healthcare organization Needs assessment is defines the discrepancy of needs between the current job roles in HIM versus the ideal or expected performance of job roles in the futuristic HIM department "without walls." To narrow the scope more specifically, job and task analysis and competency-based needs assessment are discussed in relation to the development of emerging job descriptions to meet the performance expectations of a technology-based HIM department or other departments in which HIM professionals are employed. Job and task analysis needs assessment focuses on the information about the scope, responsibilities, and tasks of a particular job role. Competency-based needs assessment focuses on determining the competencies needed to complete specific HIM job functions. The 2018 Health Information Technology (HIT) or Health Information Administration (HIA) Competencies developed by the American Health Information Management Association (AHIMA) Council on Excellence in Education in appendix A provides an excellent framework for incorporating specific competencies into job functions within HIM departments or other departments in which HIM professionals are employed. A health information manager or director should regularly assess the jobs and tasks required of the department and assess additional needs based on the gaps between the tasks performed and additional job tasks that need to be completed. The needs assessment may identify current job roles containing tasks that are no longer applicable to the healthcare organization. The needs assessment will then lead to development of job and task analyses that will result in new or updated job descriptions.

Job Procedures

A procedure is a series of related steps given in chronological order that details the prescribed manner of performing work. Job procedures should not be confused with job descriptions, but job procedures should support how the job tasks within job descriptions should be performed. A job description details the duties, reporting relationships, and job specifications for a specific position. A job description is created for a coder, a data analyst, or a cancer registrar. Job procedures are very specific and bring departmental plans down to the level of how and by whom the actual task is carried out. They detail the work that is done by the individuals named in the job descriptions. Procedures are developed for repetitive work in order to provide uniformity of practice, to facilitate personnel training, and to permit the development of checks and controls in the workflow. Some benefits of job procedures are that they: • Provide consistency of practice and results • Help with new employee orientation and on-the-job training • Reduce errors by eliminating some degree of decision-making Job procedures are revised more often than new ones are written. They are revised as jobs change, new technology is acquired, and work processes improve. An HIM manager should consider the repetitive job tasks when deciding when to write a job procedure, such as establishing what tasks need to be done by someone else when coverage for vacation or illness is needed. -Examples would be how to prepare a health record in answer to a court order, how to abstract a record into a cancer registry, or how to review a health record for completeness. When writing job procedures, information about the processes or workflows should be gathered from individuals who actually do the work since they have the most insight into how the procedure operates. Observation, interviews, and task diaries track the actual processes that make up a job procedure. Results from these methods are used to create a step-by-step outline of how each task is performed. Each step in a procedure should begin with a verb statement but should not be more complex than it needs to be. Similar to policies, procedures are formatted according to the preferences of the organization or department. The HR department generally maintains the procedure format for an organization.

Job Analysis and Job Design

As job roles change within healthcare organizations, it is important to ensure that job descriptions are kept current and relevant with the tasks actually performed by the employees. Standardized methodologies can be employed to analyze and design jobs appropriately. It is imperative that all healthcare managers work with the human resources (HR) department to ensure job analysis is performed according to the requirements of the organization. The legal requirements associated with job analysis and the use of job descriptions in the hiring process Effective job analysis and design can ensure that healthcare organizations maximize workforce job skills, therefore improving employee job satisfaction. Appropriate job analysis and design results in job descriptions that provide the healthcare organization with a competitive edge when recruiting individuals to fill jobs and provide a solid foundation for monitoring employee job performance.

Flowchart of Job Tasks

Developing procedures for job tasks are completed in a very systematic manner, and flowchart diagrams are required in order to organize processes that involve a series of tasks. A flowchart is a graphic tool that uses standard symbols to visually display detailed information, including time and distance, of the sequential flow of work of an individual as it progresses through a process. Flowchart diagrams allow managers to demonstrate the way processes are actually performed, but they serve as a basis for improving or streamlining job processes as well. -For example, creating a job procedure for filing electronic transcription reports into patients' electronic health records requires a flowchart diagram to be created so that the tasks within the job procedure are logically performed. Flowcharts can be very complex and very simplistic as necessitated by the job tasks being analyzed. Utilizing good control mechanisms such as task flowcharts, job policies, and procedures will allow HIM managers to provide a framework that support HIM job descriptions. These tools also allow HIM managers to reassess job tasks when challenges are occurring with productivity and quality.

Steps of the job analysis process Step 4. Identify the sources of data and the specific job data to be collected; and outline methods of collecting data

Evaluation of Primary and Secondary Data Sources and Tools for Job Analysis The job analysis team will evaluate the sources of data and methods of data collection for the job analysis. Primary data sources for job analysis are employees or managers who currently perform or oversee the job being evaluated. Secondary data sources for job analysis are information obtained from SMEs, human resource consultants, job data banks, or competency models. It is important to extrapolate data from the primary and secondary data sources in a manner that will assist the job analysis team by quantifying the information to create a meaningful job description.

After all job tasks for each major job responsibility area are collected, the tasks should be ranked or prioritized into how frequently the task is performed and how important the task is to the entire completion process (essential or nonessential job tasks). See figure 7.3 for an example of a task frequency rating scale and figure 7.4 for an example of a task importance rating scale. The job responsibilities that fall into categories three to five (important, very important, and extremely important) should be identified as the major job responsibilities for the current job title and listed on the job responsibility task tool ranked in order of frequency performed

Figure 7.3. Task frequency rating scale example see image

When creating policies, an HIM manager should examine the daily decisions that he or she makes on a repeated basis and translate the decisions into policies.

For example, if employees are repeatedly coming to work dressed inappropriately, a dress code policy is needed. Technological advances will also be a source for needed policies. If a newly implemented EHR has a copy-and-paste function, a policy will be necessary to address the use and consequences for abuse of this function. Each organization will have its own format for writing policies. The HR department generally maintains the policy format for an organization. Some benefits of policies are that they: • Guide thinking and actions throughout the organization or department • Allow for consistent decision-making or standardized actions • Require, prohibit, or suggest detailed courses of action • Reinforce goals and objectives • Permit interpretation, especially in regard to unexpected or isolated circumstances

Introduction

HIM professionals are assuming job roles in nontraditional workplaces where job descriptions must reflect the skills needed specifically for these workplaces.

Steps of the job analysis process Step 4. Identify the sources of data and the specific job data to be collected; and outline methods of collecting data cont'd Secondary Data Collection

In addition to primary data, secondary data collection may be necessary for gathering information regarding emerging job roles or technological changes impacting job roles. The tools that typically collect secondary data during the job analysis process are as follows. • The technical conference method is used for soliciting information about job tasks from a group of supervisors or managers who have knowledge about the job but do not actually perform the job. Individuals from other HIM departments outside of the healthcare organization may be interviewed regarding similar job tasks performed within their HIM departments. This method may be helpful creating a job analysis for a role that is not currently performed in an HIM department, but if the need for this job role was identified in a needs assessment. The technical conference method can be time-consuming and expensive, so limiting the number of outside individuals involved in the conference may be appropriate • The competency model is a method of evaluating competencies for particular job tasks and applying them within the job framework. Competencies are measurable knowledge, skills, abilities, and behaviors that are critical to assessing job performance (Washington State Human Resources 2012). The Health Information Technology (HIT) or Health Information Administration (HIA) competencies developed by the AHIMA Council on Excellence in Education (appendix A) are the type of competencies that may be helpful as a secondary data source for performing a job analysis. These competencies can be inserted with a job analysis tool and employees' performance can be objectively evaluated as to whether or not the knowledge, skills, abilities, and behaviors for the competencies are being met. Some healthcare organizations develop their own set of core competencies that are inserted into all job descriptions. • The Occupational Information Network (O*NET) was developed and introduced by the US Department of Labor in 1995. This network is a standardized, comprehensive online system for performing worker and job-oriented job analysis in the development of job descriptions. O*NET provides a tool that describes jobs from a variety of different perspectives and uses cross-job descriptors that provide a common language to describe and compare jobs (O*NET 2015). • Standardized questionnaires and checklists may also collect secondary data from outside sources during the job analysis process. It is important to note that the tools listed are standardized HR tools and the HR department can assist the manager and job analysis team in deploying the correct data collection tools for the particular job(s) being analyzed. An HIM manager should work with the HR department to select the appropriate data collection tools for the particular jobs being analyzed within the manager's realm.

Job Analysis Method

Job analysis is a structured approach used to identify the unique job tasks performed within each job. Tasks are then organized and aligned appropriately to create a job description that most clearly represents the job being performed. Job and task analyses provide value to an organization whenever there is a substantial change in an organization necessitating new or revised job descriptions for both managerial and nonmanagerial positions. When organizational changes or industry changes affect HIM job roles, a job analysis is required for each of the work processes impacted. The end goal of the job analysis process is creation of new or updated job descriptions and job specifications that demonstrate the actual job functions performed within the HIM department. -For example, HIM integrates technology throughout most departmental functions. Technology changes the workflow, or any work process that must be handled by one or more employee, of the health record within HIM departments so it is important to assess how these changes impact the completion of job tasks for each job function. The importance of job analysis cannot be ignored as HIM departments strive to align HIM positions to the mission and vision of healthcare organizations. Job analysis can provide support for departmental and pay structure. Current and relevant job analysis can provide a competitive edge for an HIM department, assist in appropriate candidate selection, and identify gaps in training needs. Job analysis stemming from changes in workflow can result in the design of new jobs or the redesign of existing jobs. The target of job analysis is not appraising job performance but rather obtaining information about the job itself. Questions should be addressed in terms of what knowledge, skills, and abilities are needed for employees who may perform the job or who are already performing the job. A standardized process should be developed in healthcare organizations for performing a job analysis, and the HR department may already have a methodology that is used for this process

Job Context

Job context—that is, the situations or conditions in which the employee performs the job—should also be included in the job description. This includes working conditions such as the requirement to sit or stand for long periods of time as well as weight-lifting requirements. This section of the job description should also include the risks involved with the position, such as those associated with long-term computer use like eye strain or carpal tunnel syndrome. Job context may be rolled into the job specification section of a job description. This is the section that should include the potential for the individual to perform job tasks remotely on either a full- or a part-time basis. The HIM team of an organization should follow some best practices to ensure job descriptions and job titles are relevant to the overall healthcare schema. Best practices are outlined as follows: • Assess job titles on a regular basis (at least annually) by comparing HIM job titles at healthcare organizations within the region and with other HIM peers to ensure that the healthcare organizations keep pace with the industry. • Tune in to employee grumblings that HIM job titles might not actually reflect the job tasks performed based on the implementation of new technologies and new processes. • Evaluate turnover rates for HIM professionals employed within the healthcare organization, particularly in regard to job titles and job descriptions.

Job Crafting

Job crafting impacts job roles within organizations and is the unsupervised or spontaneous changes to jobs that may or may not be congruent to the goals of the organization. Job crafting is the redefinition of a job by an individual to incorporate his or her own motives, strengths, and passions it is the "action that employees take to shape, mold, and redefine their jobs" In situations where it would be appropriate to initiate a job analysis but only one employee is affected, a formal job analysis may not be realistic to perform, so employing a job crafting exercise with the affected individual may be the best solution. The precipitating factor for job crafting is that it should come from the affected individual and not be driven by management; it is a proactive behavior exhibited by an employee. Job crafting happens at an individual level whereas job redesign is a process in which management decides to change something with an employee's job Job crafters tend to be initiators, independent decision makers, and intrinsically motivated employees who perceive work as a part of their well-being Research indicates that "employees (at all levels and all kinds of occupations) who try job crafting often end up more engaged and satisfied with their work lives, achieve higher levels of performance in organizations, and report greater personal resilience" The dimensions that should be assessed by an individual during a job crafting exercise are tasks, relationships, and perceptions. -Tasks can be reevaluated and new or different processes can be engineered to complete the tasks as long as the result remains congruent with departmental or organizational goals. -Relationships can be revamped and mentorship or succession planning can be considered within the employee's job role. -Creation of a new image regarding the employee's job role in the department or organization can impact the actual perceptions of how the employee's role is viewed by others. By evaluating and changing job tasks, relationships, and perceptions, an employee embraces role innovation, creates a voice for his or her position, develops ideals, and demonstrates personal initiative. All of these tasks require the individual to actively participate and, if implemented appropriately, he or she can greatly improve job performance

Three general concepts emerge from job redesign: job enlargement, job enrichment, and job rotation

Job enlargement allows employees to continue performing their current job tasks employing the same skill sets but expanding tasks to include more of the same type of tasks.

Three general concepts emerge from job redesign: job enlargement, job enrichment, and job rotation cont'd

Job enrichment allows employees to actually broaden their skill set by adding additional tasks that require more or advanced skills.

Steps of the job analysis process Step 2 Obtaining Approval to Perform a Job Analysis

Periodically, the HR department will perform job analyses on positions that have been identified as difficult to fill because of competition in the workforce for the job skills required. Other items that trigger the need for job analysis are sector changes, organizational changes, and employees' perceptions of the jobs being performed in the healthcare organization. Sector changes in healthcare are events triggered by "new technologies, new or revised regulations, and new or revised accreditation or certification standards" -Examples of sector changes that directly impact HIM are the adoption of health information technologies as a result of the American Recovery and Reinvestment Act and the provisions outlined in the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009 portion of the act. -Regulations that impact HIM jobs are changes in prospective payments systems, governmental auditing programs, and implementation of new classification systems. Organizational-level changes that impact the need for health information job analyses are organization-wide initiatives such as implementation of EHR systems, mergers or acquisitions of other health systems, or incorporation of new service lines that directly affect the type of health information data required to provide the services. -All of these organizational-level changes require assessment of the tasks performed within the department and alignment of appropriate tasks to the actual jobs performed. Often, new tasks assumed by the HIM department are layered upon current job tasks without any true analysis of the jobs performed. This may require the health information manager to perform a job analysis about the employees' perceptions associated with the job performed. -If job tasks are inappropriately aligned to actual job titles and job descriptions, employees' perception of job value and job performance may decline It is important for health information managers to identify the factors precipitating the need for a job analysis in order to seek approval to begin the process and to ensure the correct individuals are involved in the job analysis process. The request for approval to have a formal job analysis performed in the HIM department will occur after a needs assessment has been performed. The HIM manager will need to submit a formal request in writing to the HR department outlining the results of the needs assessment and the gaps that are occurring within job tasks. The formal request should include the identified gaps in job tasks and how these missing job tasks impact other jobs within the department. The human resources department may also request approval from the HIM department's executive-level administrator prior to starting a full job analysis.

Controlling Processes for Job Specifications

Policies policies and procedures are the guidance that HIM employees utilize when performing job tasks. -Policies translate goals into comprehensible and practical terms. -They are intended to be overall guidelines that set the boundaries for action. The limits at either end of these actions are stated, defined, or at least clearly implied. -Policies pre-decide issues so that situations that occur repeatedly are handled the same way. -The language found in policies is broad to allow for flexibility to adapt to changing conditions. -Policies should also consider legal, accrediting, and certification mandates as well as any other requirements imposed by external and internal authorities or sources.

Reporting Relationships

Reporting relationships are an important component of job descriptions because they define the working hierarchy—who manages whom. For example, an HIM manager reporting relationship would indicate that the position reports to the director of HIM and that all department technical and clerical employees report to the HIM manager. When health information managers recruit for open positions, it is important that this section of the job description is accurately completed as qualified individuals may be looking for positions that appear to have some job progression or provide guidance of the span of control the individual will have in the job.

Three general concepts emerge from job redesign: job enlargement, job enrichment, and job rotation cont'd....

Rotating job tasks with other employees helps strengthen and broaden the workgroup's capacity to understand the bigger picture of the work performed.

All tasks should be documented on the job responsibility task tool in the same manner. A general format for writing task items should include what task is being performed and to whom or what the task is being performed in order to produce a given job outcome—including the what, why, and how of the job outcome. An example of an HIM task for a release of information clerk would be: Scan incoming release of information authorizations paper documents (the task, or how) into the release of information request system (to whom or what the task is being performed) for processing by the release of information coordinators (the task outcome, or why).

Some additional tips for writing tasks are: • Remove unnecessary words in the tasks to make it as clear and concise as possible. • Do not combine two tasks with the word "and"; break apart multiple tasks into two or more separate items. • Do not be overly specific with each task; for example, "Create a spreadsheet to total the numbers of charts copied by each ROI clerk and divide by the total number of hours worked." Better wording is "Use spreadsheets to track ROI clerk productivity." • Do not use vague terms outlining job tasks. Replace subjective adjectives or adverbs (good, excellent) with more descriptive terms (verify, create, identify) with all tasks. • Do not use acronyms or abbreviations for job tasks. Make sure that you spell out all terms whenever possible (University of California, San Diego 2015).

The AHIMA Body of Knowledge (BoK) is the primary knowledge base for HIM practitioners and is located on the AHIMA website (AHIMA n.d.).

The AHIMA BoK is an excellent resource to consult when creating job descriptions as it contains sample job descriptions for a variety of job titles utilized by health information practitioners. These job descriptions provide key action words that can assist health information managers in the creation of the job tasks related to the specific job description being developed. The US Department of Labor developed a website that can assist with writing descriptions for many positions, including the positions of health records and health information technicians (CareerOneStop 2015). The components of a typical job description are title; to whom the employee reports; job responsibilities or duties; position goals; relationships; job specifications or qualifications; job context; and position summary, scope, and purpose. Most healthcare organizations will have standardized job description formats required for all new or updated job descriptions.

Steps of the job analysis process Step 4. Identify the sources of data and the specific job data to be collected; and outline methods of collecting data cont'd A variety of standardized HR tools can be employed for primary data collection to create a comprehensive assessment of job tasks performed. cont'd

The Job Content Questionnaire -The job content questionnaire (JCQ) is a self-administered questionnaire, composed of questions that measure four main dimensions of the workplace environment. • Decision latitude. This refers to the amount of decision-making required in the job. • Psychological demands of the job. These demands are categorized as emotional requirements, mental effort, and relationship problems with peers or management in the job setting. This dimension also measures the perceived psychological stress associated with a job. • Physical workload. Assesses the amount of physical effort that is required to complete the job. • Job insecurity. Assesses the factors associated with job security, such as job tasks that might be more appropriate for another job or require another skill, degree, or certification level. The most difficult component of the JCQ was creating appropriate questions that assessed jobs in terms of psychological demands. This is an internationally accepted tool that has been translated into a dozen languages and can be nationally standardized for a variety of detailed occupations in several countries. The demand-control model of job strain scale originated from the use of the JCQ and this scale is calculated from score results of the questions related to decision latitude and psychological demands of the job. - The demand-control model relates that job strain (stress) is evidenced by the interaction between job demand and job control. For example, a job with high demand and low control would result in high strain while a job with low demand and high control would result in low strain. This questionnaire is not available in the public domain but can be accessed by submitting a request to the JCQ Center. While the JCQ is provided to most users free of charge, "commercial and very large research projects pay a usage fee to support comparative reliability analysis and instrument development on a nonprofit basis." JCQ is a tool most likely promoted for a broad-scale research study, rather than a typical job analysis process within one or two departments. The JCQ is a reliable tool that can assist healthcare organizations understand the psychosocial elements of work that are negatively impacted by poor or inadequate work design. The Position Analysis Questionnaire -The position analysis questionnaire (PAQ) is a structured job analysis instrument created in 1972 by researchers Ernest J. McCormick, Paul R. Jeanneret, and Robert C. Mecham from Purdue University. This tool is used to measure job characteristics and relate them to human characteristics within the following five categories: • Information input • Mental processing • Work output • Relationships with others • Job context The PAQ is a valuable nonbiased tool for translating job analysis data into job evaluation information for a wide variety of jobs. This questionnaire in its original format or a more up-to-date format can be purchased from Purdue University. The human resources department within a healthcare organization may elect to incorporate this tool as part of the data collection process when performing a job analysis. An HIM manager should work with the HR department to ensure that the tools collecting job task data conform to the standards in that particular healthcare organization.

Participative job redesign interventions are important to ensure the well-being of the employees involved in the process. The job characteristics that can positively impact employee job satisfaction and overall job performance are job control, skill utilization, participation, and feedback

The advantages associated with job redesign are: • Enhancing the quality of work life for individual employees • Increasing organizational productivity as employees complete job tasks congruent with job skills • Increasing on-the-job productivity • Creating the right fit for a job with the right person • Enhancing the sense of employee belongingness (Management Study Guide 2013b)

After a job responsibility or task tool has been completed for each job responsibility, the next step requires aggregation of all similar tasks performed by a position. If the job analysis process evaluated a variety of tasks performed by several individuals, the end result of the process may be several new job descriptions or several current job descriptions rolled into one job description.

The basic premise behind collecting job analysis data is to determine the job requirements and delineate appropriate position classification and grade level assignments. Grade level assignments set forth the criteria between or among the various levels of jobs within an organization and represent the pay scale of the position. It is important in the job analysis process that the level of tasks performed for each job are assigned to the correct grade level so that pay is equitable throughout an organization (OPM 2009). Some additional features of the job analysis process are identifying training needs and other personnel actions such as promotions and performance evaluations

Job Redesign

The change in workforce dynamics and increased use of technology in healthcare, particularly in HIM departments, has altered the alignment of job tasks for many roles ranging from HIM clerks to those managing frontline employees. Job redesign is the process of realigning the needs of the organization with the skills and interests of the employee and then designing the jobs to meet those needs. -For example, in order to introduce new tools or technology or provide better customer service, new positions may be created. Job redesign uses a range of techniques that attempt to increase the variety of tasks employees perform in order to improve motivation and satisfaction at work. Three general concepts (component) emerge from job redesign: job enlargement, job enrichment, and job rotation (see ch 3 for more info) Job redesign allows HIM managers to evaluate employees' job tasks and define each employee's responsibilities without performing a full-blown job analysis. It is important for a healthcare organization to use a model of job redesign that is flexible, given the rapid changes that are occur within healthcare on a regular basis.

Steps of the job analysis process Step 5. Collect and aggregate data Data Aggregation

The data collected from the primary or secondary data collection tools requires aggregation using a method that allows the team to evaluate job tasks relevant to each job responsibility A job responsibility is a function that falls under the main job-holder's work-related tasks. Each job responsibility or function should be listed and beneath each function is a description of each job's tasks. The specific skills and abilities needed to complete each job function should be noted as well as the competencies associated with the particular job. The goal of aggregating all the tasks associated with each job function is not to create a job procedure, which is discussed later, but rather to create a comprehensive list of tasks that relate to each job function. After all tasks are entered into the tool, essential job tasks should be grouped together, and nonessential job tasks should be grouped together. Then, each major job responsibility associated with the job being analyzed along with the essential tasks for that particular job should be outlined in the tool. Next, the skills and abilities associated with each task should be added. Finally, apply competencies or domains from HIT or HIA program competencies (appendix A) or individual healthcare organization competencies to each job task. Tasks and competencies should be linked together by HIM managers in order to demonstrate the job task relationship to each competency.

Job redesign can increase employee job satisfaction and motivation by including employees in the design process.

The following activities should be performed by the HIM manager in conjunction with the employee when performing a job redesign. • Revise the job content by collecting and analyzing job-related information to identify inconsistency between the actual job description and tasks performed by the employee. • Analyze the job-related tasks and categorize them into similar job-task groupings • Compare documented job description tasks against the new job-task groupings • Alter the job tasks based on the actual technology or processes employed, as long as the tasks remain congruent to the job's outcomes. • Realign job tasks and responsibilities in order to increase employee satisfaction and employee motivation (Management Study Guide 2013b).

Steps of the job analysis process Step 4. Identify the sources of data and the specific job data to be collected; and outline methods of collecting data cont'd A variety of standardized HR tools can be employed for primary data collection to create a comprehensive assessment of job tasks performed.

The following are standardized tools used most often to provide meaningful data for job analysis. * The Work Design Questionnaire Morgeson & Humphrey creators WDQ as part of a study to improve work design research. -The WDQ surveyed a variety of workers in different settings with a questionnaire in order to assess specific characteristics related to job tasks. The outcome of the study was that the WDQ results showed good promise to assist practitioners in the design and redesign of jobs in the organization. Although this questionnaire is not specific to healthcare, it may be used with some modifications to collect data on job task characteristics * The Job Diagnostic Survey Introduced in 1975 by J. Richard Hackman and Greg Oldham, the job diagnostic survey (JDS) was developed to evaluate existing jobs to determine if jobs could be redesigned to improve employee motivation and productivity and to study the effects of job changes on employees. The JDS is a questionnaire composed of core job dimensions, critical psychological states, and personal work outcomes. -The items assessed in the core job dimensions are skill variety; task identity; task significance; job autonomy; and feedback from the job, management, and peers. - The critical psychological factors assessed are employees' perception of the experienced meaningfulness of work, experienced responsibility of work outcomes, and knowledge of work results. -Personal and work outcomes are evaluated in terms of general job satisfaction, internal work motivation, and specific satisfactions such as job security, pay, peer, and supervisor relations The JDS has a few limitations that should be taken into consideration when selecting a job analysis tool. -The JDS should not be utilized for diagnosing individual jobs but rather a workgroup of individuals to allow for anonymity in survey completion. This survey tool provides useful information about job tasks and is one of the most frequently cited instruments for assessing workers' perception of job characteristics

Job Specifications

The job specifications or requirements section of the job description outlines the knowledge and specific skills required for a position. Job specifications are qualifications that individuals must possess in order to perform the duties and responsibilities contained within a particular job description. The knowledge, skills, abilities, and other characteristics (KSAOs) necessary to be present upon employment, educational qualifications, and working conditions are all outlined in the job specifications section of a job description. - Knowledge is the formal organized body of factual information that must be present in order to be considered for the position. An example of knowledge is: an individual can apply HIPAA guidelines when evaluating privacy breaches. - Skills refer to the abilities related to the verbal, manual, and mental processing of data and information for a particular job. An example of a skill is: an individual can utilize a spreadsheet application when analyzing statistical data. -Ability refers to the capacity to effectively engage in activities outlined by the job description. An example of an ability is: the individual performs coding of diagnoses employing appropriate classification systems. Other characteristics are items that do not fall into the previous three categories but are necessary in the job environment, such as working well in teams or listening to and following directions. Other characteristics are often the soft skills required to function within a work setting. The KSAOs for all positions are usually described with the minimum necessary qualifications required to be hired for a particular position. KSAOs are often employed by the HR department as a recruitment and screening mechanism to sort through job applicants. KSAOs provide a basis for recruiting qualified individuals for positions as well as providing a career ladder for those already employed in the organization. When KSAOs are identified in all job descriptions, individuals internal and external to the organization can assess their current skill level against any job description within the organization. Employees who have been in a current job for a period of time may actually acquire KSAOs that are applicable to a higher-level job within the organization and thereby create an ability to move up in the organization.

Steps of the job analysis process Step 3 Job Analysis Process Team

The next step in preparing for the job analysis process is to select a team that will assist with the evaluation of the jobs. This team can be comprised of the HIM management, HR consultants, subject matter experts (SMEs), and individual employees. The team members should be vested in the process and knowledgeable regarding the job tasks to be evaluated. It is important to include average to high job performers who can give appropriate feedback on job tasks and who will be engaged in the process. The team should meet on a regular basis with specific agendas, assign specific tasks for all team members to complete, and employ consensus-building techniques at all meetings. The team will provide input based on the data collected during the analysis process about the major job responsibilities and help categorize the job tasks that match each major job responsibility. Performing job analysis as a team divides the work equally; the job analysis process can be very time consuming, but dividing and conquering the work as a team is always beneficial.

Job Title

The title of a job description is very important in today's competitive workforce market as it provides the foundation for attracting qualified candidates for open positions as well as providing a descriptive categorization of jobs in an organization. The job title should clearly describe the level of skills and knowledge required for the role. -For example, job titles such as supervisor, coordinator, manager, or director are clear about the experience level of the employee, while titles like analyst and technician communicate the skills needed to complete the job tasks. In healthcare, it is very important that job titles reflect where individuals fit within the organization. For example, implementation of new technologies in healthcare could require new job titles to be developed to accurately depict the tasks performed Researching titles employed by other HIM departments in the region or within a similar healthcare organization can be very useful as it allows HIM managers to discover applicable job titles for similar jobs within their own organizations. For example, if the HIM department at Mercy Hospital is recruiting for similar positions as other HIM departments within the same region, a creative job title could be a great asset for attracting qualified individuals to the position over other job titles. It is important to realize that if an out-of-the box thinker is required for a position, do not use an inside-the-box title Figure 7.6. HIM emerging job titles see image

Job Tasks or Duties

There are different levels of job tasks or duties that should be included in the job description, classified as broad, intermediate, and specific. The broad-level tasks are the major function areas of the position, such as coding, transcription, and release of information. The intermediate task level is what activity is performed when carrying out the function of the job. The intermediate task level also includes the skills associated with carrying out the activity. For example, in coding, an intermediate task would be the coding of inpatient charts. Specific-level tasks are the actual steps required to complete the activity within the functional area of the job description. Specific-level tasks for coding inpatient charts would be entering ICD-10-CM/CPS into the EPIC billing system. The largest content area in job descriptions are the tasks that should have been identified during the job analysis process. Each major task or responsibility will be described with an appropriate-level verb, and these major job tasks or responsibilities will be the basis for creating measurable job standards or goals for the performance appraisal process. The job responsibility task tool in figure 7.2 allows a health information manager to build job descriptions that accurately reflect the tasks completed by specific job positions.

Which of the following is not a component of job redesign? a. Job analysis b. Job enlargement c. Job enrichment d. Job rotation

a. Job analysis

The following are some tips when assessing if job titles can or should be changed:

• If several employees in an organization share the same title and one individual requests a title change, an assessment should be performed on the entire subset of individuals to decide whether or not a formal job analysis is required. For example, the position title "data quality specialist" may be assigned throughout the healthcare organization to individuals who perform data quality tasks on patient records or healthcare statistics. If one department requests a job title change, this department should work in conjunction with the HR department to perform an analysis of any positions throughout the organization also using this title. • If an individual in a healthcare organization is performing tasks that do not match the individual's job title, the title needs to be updated in order to reflect appropriate job performance. For example, the title "chart management clerk" does not reflect the scope of skills required for an "electronic record management clerk." • Job titles are usually associated with standardized job categories that are connected with pay scales, so managers should always work in conjunction with the HR department when initiating title changes. • It is important to remember that job titles for individuals reflect a career progression and individuals often look for future positions based on advancing skills within the organization or outside of the organization. By adding the word leader or coordinator in a title, it usually reflects some type of managerial or supervisor role. Also, adding levels such as coder I or coder II reflect a career progression in a similar role. HIM professionals may be looking for positions in a healthcare organization where there is room for career progression and evidence of different levels of job roles for both supervisory and nonsupervisory positions. A comprehensive, well-constructed job title is an excellent way to recruit individuals who are looking for mobility within a healthcare organization.

There are five premises associated with a flexible job redesign model:

• Job redesigns are flexible and adjustable for the short term, and some employees are proactive in the process to ensure jobs keep pace with change. • An employee's job performance and perception are important factors in facilitating job redesign initiatives. • Job knowledge by both the manager and employee is a key factor in understanding the impact of job redesign. • Job changes have an impact on an employee's self-efficacy and provide a prediction for an employee's behavior in terms of job performance. • Job redesign processes are dynamic and circular, not just linear, and should be performed whenever changes in job tasks emerge

Steps of the job analysis process Step 4. Identify the sources of data and the specific job data to be collected; and outline methods of collecting data cont'd Primary data can be collected from employees and managers using several different methods and a combination of tools can be utilized to aggregate job task information. The methods are listed as follows:

• Personal interviews may be carried out by the HIM manager or HR consultant with employees who complete the job tasks being analyzed. These interviews should contain a list of structured questions that are asked of all the selected individuals. The HIM management team should evaluate ahead of time whether or not all individuals who complete the tasks will be interviewed or if a select group of individuals should be chosen. Personal interviews are very time-consuming, and the person performing the interviews should be skilled in soliciting information from employees in order to gather pertinent information for the job analysis process. Surveys can also be used to obtain data that can be aggregated and summarized for the benefit of making better decisions. • Observation is a method in which the HIM manager or HR consultant observes the employee or employees who are completing the job tasks. Standardized comment sheets are used to capture key elements of observation. A variety of employees may be observed completing the same job tasks to evaluate commonality between job processes. •The diary or log method is an electronic job-analysis tool that requires employees to complete a daily diary or log of all job tasks completed within a set period. This log is created in a product such as Excel and provides an easy method for aggregating and summarizing data. All employees who complete the job tasks being analyzed will turn in the diary or log for that specified time period and the HIM manager or HR consultant will aggregate the information from all the diaries or logs. Guidance must be provided to those completing the diary or log so that similar data is captured by each employee performing the job task. • Structured questionnaires or checklists may be distributed to all employees completing the job tasks being evaluated. Structured questionnaires or checklists allow for a standardized method of collecting data on job tasks (Fried and Fottler 2008). The manager familiar with the job or jobs being analyzed should create structured questionnaires or checklists based on job content. There are also some standardized questionnaires or tools that can be used (outlined later in this chapter).