Health Information Management

Assess each individual's needs to understand how to effectively motivate your coding team

JustCoding News: Inpatient, April 14, 2010

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Motivation is important because it affects performance. It is the process of affecting an individual’s inner needs to work toward the particular goals the individual believes will satisfy those needs. Abraham Maslow is probably the most recognized theorist on this subject. He developed a hierarchy of needs, often depicted as a pyramid. The base includes physiological needs such as food, water, and shelter. Self-actualization needs, which include reaching one’s full potential, are at the peak. Between them are security, social, and esteem needs. Successful managers are able to recognize specific needs in individual staff members and establish goals that enable them to meet those needs. This motivates team members to strive for goals set by management.

Assessing individual needs

New managers may not have been involved in interviewing some team members and may not be aware of their life goals. Remember that one or more of them may have hoped to advance to the coding manager position but were not selected for it. Trying to understand what makes someone tick or what motivates him or her can be a challenge. A seasoned manager may be aware of individual team members’ goals. Similarly, managers promoted from within may be familiar with the life goals of their former peers.

Everyone has goals, sometimes with self-imposed deadlines. They can be professional goals, such as completing the health information technology training program by age 30 or passing the certified coding specialist exam by the end of the year. Often, they are personal goals, such as accumulating enough money to pay off a mortgage or pay for a child’s college education. Both are individual needs that motivate individuals to work. A manager’s goal is ensuring employees’ productivity during their tenure with the organization.

Generational differences

Managers are likely to have staff members representing two, and possibly three, generations—baby boomers, Generation X, and Generation Y. Each generation has different desires and will respond to different management styles and motivational efforts.

Born between 1943 and 1964, baby boomers are the generation that experienced the war in Vietnam and the assassinations of President John F. Kennedy, his younger brother Senator Robert F. Kennedy, and civil rights leader Dr. Martin Luther King Jr. They usually had a stay-at-home mother and a father who was the family’s sole breadwinner. “Be yourself” was this generation’s mantra. Today, baby boomers seek career advancement and material possessions such as larger homes and new cars. Monetary benefits such as bonuses appeal to members of this group. They are known for their work ethic and generally are skeptical of authority figures. They also tend to divorce at a higher rate than their parents.

Born between 1965 and 1980, Generation X grew up with two parents working outside the home. They experienced racial integration and rapid technological changes. This generation also had more exposure to illicit drugs. They typically marry later in life than previous generations and hope for a better family life than they experienced as children; many have parents who divorced. This generation is career minded and seeks career achievement. They are technologically savvy and adopt new applications sooner than their baby boomer colleagues. Their preference for flexible schedules that facilitate participation in family activities reflects a desire for a better family life.

Born between 1981 and 2000, Generation Y grew up in two-income families and in communities that were becoming more racially and ethnically diverse. Technology has surrounded them from infancy. They have experienced terrorism and ecological damage from oil spills. This has inspired an interest in conservation and fiscal responsibility.

Anticipating careers on the fast track is logical when information has always been instantly accessible. Time off may be a greater incentive for this generation than financial rewards; this generation wants to spend time with the family.

Managers must recognize that these descriptions are broad and may not describe everyone born during a particular era. However, these descriptions can help managers understand the influences that drive individual needs.

Managers’ needs

Ensuring that work is completed in a timely and accurate fashion is a coding manager’s primary need. Coding managers who achieve this goal consistently serve as a reminder to upper management that it made the right hiring decision. Ideally, upper management acknowledges the accomplishments of successful managers, perhaps publicly in department meetings, with higher compensation or by assigning greater responsibility. How can managers achieve recognition for a job well done?

Knowing what makes a team member tick is a useful tool for coding managers. Periodically set aside time to meet with each staff member individually. This time should be separate from annual reviews but could coincide with that task. Use this time to:

  • Determine each staff member’s professional goals for the next three to five years
  • Identify staff members’ current skills and identify areas that require improvement
  • Understand staff members’ perceived barriers to achieving their career goals
  • Determine how to structure staff members’ work and learning opportunities to benefit them and the department

Consider the following hypothetical example: Mary is one of your newest coders. She codes outpatient tests, is technologically savvy, and consistently codes 300 outpatient tests daily. She also receives a number of personal calls on her cell phone, but she continues working during those calls. She wants to learn to code ambulatory surgery but has no interest in inpatient coding because “it’s too boring!” She plays soccer after work and anxiously watches the time on her computer screen. Barbara is an inpatient coder who thinks of inpatient coding as solving a mystery. She has little desire to code outpatient tests because “it’s too monotonous!” She has two grown children, one about to graduate from college and the other with a family of her own. Barbara and her husband purchased a new home during the peak of the housing boom. Her husband was recently laid off from his stock analyst position, but he continues to receive some income from his personal portfolio. At 59, he does not anticipate finding a position that pays as well as the previous one. He realizes that he may not find employment because of his age.

These coders require different management strategies and different stimuli to encourage them to work harder to meet management’s needs and their own. Mary wants to learn another type of coding but also finds a flexible schedule appealing. Knowing that she will probably be her family’s sole wage earner for the long term, Barbara probably has concerns about education and mortgage expenses. Keeping both coders’ needs in mind can help their manager develop productivity expectations.

Developing expectations

Accurately capturing conditions presumed present now and in the past, conditions treated, and conditions complicating the treatment of patients is the purpose of the coding function. Doing so requires that coders:

  • Review patient records
  • Interpret and assess physician and other clinician documentation
  • Apply departmental and ICD-9 guidelines
  • Determine which code or codes accurately define the conditions identified and procedures performed during each episode of care

Coders may have other responsibilities as well, however. Managers must consider these additional tasks when they develop work expectations. Regardless, coding expectations always must address accuracy and quantity.

Take the following steps to develop productivity expectations:

  • Collect published coding standards and/or expectations
  • Collect actual information about the coding team’s production
  • Collect payroll information that correlates to the production data captured
  • Calculate average productivity by work type and by individual
  • Establish the overall average by work type
  • Establish a stretch goal for the team
  • Discuss methodology with team members
  • Implement expectations
  • Monitor expectations
  • Review actual results with each team member

Access figures 4.1 and 4.2, which illustrate some of these steps. For example, a stretch goal encourages the team to go beyond the average. Its intent is to provide incentive to those at or below average to stretch to reach the higher performers.

Managers should use data from at least three pay periods for each coder. Ideally, selected pay periods do not include holidays or vacation time. Productivity during holidays and the time preceding and following a vacation is not necessarily an accurate representation. The selected pay periods need not be consecutive, but ideally they should be the same for all team members.

Editor’s note: This article was adapted from chapter 4 in The Coding Manager’s Handbook by Rose T. Dunn, RHIA, MBA, CPA, FACHE, FHFMA, chief operating officer of First Class Solutions, Inc. in St. Louis. For more information, go to HCPro’s Healthcare Marketplace.


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