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Manage the changing nature of HIM jobs

JustCoding News: Inpatient, January 18, 2012

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Times are changing, and, most likely, so are the jobs of your health information management (HIM) staff members.

In some cases, there's a sudden addition of responsibilities, such as the implementation of the recovery audit contractor (RAC) program, explained Elizabeth Layman, PhD, RHIA, CCS, FAHIMA, professor in the Department of Health Services and Information Management at East Carolina University in Greenville, NC.

In other cases, the change is slower. "Think about 1996 and how many e-mails you got. And think about how that has increased in the last 15 years," Layman said at the AHIMA national convention held October 3, 2011, in Salt Lake City. Sending e-mail takes time, even though it may not seem like a significant amount; this time needs to be factored into how long it takes staff members to do their jobs, she said.

In addition, there are shifts in terms of pacing. "We don't have the lead time we used to. You'd get a document via snail mail, you'd then have a few weeks to send it back, and you could figure it into your schedule. Now, you get a report Thursday and you need to turn it around by end of day Friday—and sometimes even that is a luxury," Layman said, explaining that if people have to suddenly drop everything and take care of certain projects or tasks, the way they work changes.

There are other alterations as well, such as increased use of technology and the move to an electronic environment—in particular, the implementation of electronic health records (EHR). "The EHR has altered the nature of work in our departments," she said.

Finally, there are changes in necessary skill sets. RACs, health information exchanges, ICD-10, state registries, and shifts in case mix or client population or service mix mean changes in the skill sets of HIM staff members.

Staff members may need additional project management or financial management skills, Layman said.

Ways to manage the problem

If these changes aren't managed appropriately, you may end up with some issues on your hands, such as declines in performance, careless errors, low productivity, or diminished quality, Layman explained. You may see a lack of motivation or changes in work habits, such as increased staff turnover, absenteeism, tardiness, stress, or burnout.

These changes aren't limited to your employees; they may also manifest in your own behavior. You may suddenly feel that you don't want to go into the office, for example. What should you do?

Some realigning may be in order, according to Layman. This may mean reengineering, restructuring, work or job redesign, or some combination thereof. It's not easy, but it's necessary. "As a manager or supervisor, you're always balancing. You need to balance some more," Layman said.

The step-by-step DESIGN approach

Layman uses the mnemonic device "DESIGN" to describe her approach to department and job restructuring. Consider following the same approach in your own facility:

• Detect, monitor, and collect data related to indicators that have the potential to affect your department. If your department needs to undergo changes, indicators will exist, Layman said.
• Enlist superiors, HR staff members, and employees regarding the potential for redesign. At this point, you'll need to do some prework, Layman said. You need approval from your superior(s), and you need to talk to HR. "When you start to redesign people's jobs, HR is involved. Certain types of tasks need to be by licensed or credentialed people, so talk to HR and risk management," she said.
• Secure additional data and decide on the extent of the possible redesign. Then initiate your redesign plans. You may want to obtain feedback from employees, department supervisors and managers, directors and administrators, or external consultants.
• Identify potential barriers to redesign and develop solutions and contingency plans. Take into consideration hard factors such as organizational structure and features of bureaucracies (such as specialization and departmentalization), as well as soft factors such as job structure, motivational actions, and organizational context (e.g., organizational culture).
• Get feedback from superiors, HR, and your employees. If the feedback is positive, implement the realignment.
• Note the effect the redesign had and recognize and publicly celebrate those who contributed to its success.

Remember, change is constant and necessary, but it is also uncomfortable, and you need to use your change management skills to ready your staff for it, Layman said. "Don't just throw change at people. We let them think it over and come to some conclusions themselves."

Editor’s note: Brown is JRMC's director of medical records. This article was originally published in the January issue of Medical Records Briefing. E-mail your questions to Senior Managing Editor Andrea Kraynak, CPC, at akraynak@hcpro.com.

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