Chapters 18

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Dec 6, 2023

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Chapter 18 Performance Improvement Darcy Carter, DHSc, MHA, RHIA Miland N. Palmer, MPH, RHIA Real-World Case 18.1 Memorial Hospital has been undergoing significant growth over the past few years. After the hospital implemented their new electronic health record (EHR) system, the HIM department scanned the paper health records that were being stored in the filing room and the filing room was no longer needed to store health records. Because of the growth within the healthcare facility, the filing room was recently transformed into a space for the clinical documentation integrity (CDI) team. This space is directly adjacent to the coding area. The proximity of the CDI team to the coding team has facilitated significantly increased interaction between the two groups. The CDI team often approaches members of the coding team regarding cases they are working on. Gina is the coding manager at Memorial Hospital, and she has been reviewing the last two quarterly coding audits of her team. She finds that the coding quality has dropped over the past six months. Performance indicators on productivity have also dropped during this period. Using benchmarking, Gina compares her coding team’s productivity and quality metrics with similar-sized hospitals within her organization. As she anticipated, her facility’s coding quality and productivity are below that of other healthcare facilities in her organization. Gina conducts a root-cause analysis to help identify the cause of the decline in both the productivity and quality of the coding being performed by her team. Real-World Case Discussion Questions 1. Conduct a root-cause analysis (just as Gina would have done in this case) to determine the reason for the decline in performance metrics for both quality and productivity. Root: The productivity and quality of the HIM departments work has decreased significantly over the past 6 months. Cause: The CDI office being so close to the HIM department The contributing factor to the HIM department decline in quality and productivity may be caused by the CDI office constantly distracting the HIM department with questions they may have about the cases they're working on. This constant interruption is causing the HIM department to become behind in their work, thus causing a decline in their quality and performance. A possible solution for this is creating an online platform for the departments to communicate with each other to ask any questions they may have on the cases they're working on, instead of interrupting the HIM department while they are working on the work they need to get

done. This would still allow the CDI to get any answers they may need for their cases and allow the HIM department to answer back to their questions when they get a chance. 2. What are the contributing factors that were identified by the root-cause analysis conducted for question 1. One contributing factor that was identified in the root-cause analysis, is that the CDI staff is constantly interrupting the HIM department with questions on their cases and pulling the HIM staff away from their work. Another contributing factor identified is that the departments are too close to one another, allowing for these distractions to take place. 3. How could high reliability and mindfulness methodology be applied to this case? High reliability and mindfulness methodology could be applied to this case by creating an environment that eliminates or minimizes the number of distractions between the two departments. When Gina realizes that there are these distractions happening, she should come up with a way to eliminate these distractions. Gina should also apply the mindfulness methodology to the CDI staff by showing them how their recent movement of their office is causing distractions for HIM staff and ask them to be mindful of the HIM staff’s duties. When all the employees are aware of these issues, they can be mindful to other and stay focused on their duties and tasks. Real-World Case 18.2 A large acute-care hospital located in the US was plagued with a poor reputation, high readmission rate, and weak profitability. As a last resort, the hospital board of directors fired the CEO and conducted a national search for a replacement. The new CEO selected by the board had been running a very successful hospital in a different part of the country. This new recruit was skilled and knowledgeable in PI. She had first-hand experience with methods like Lean Six Sigma and HROs. She came on board and immediately initiated training and much-needed culture changes. Hospital-wide PI teams were assembled to assess and prioritize the improvement needs of the hospital. Taking each of the highest priority issues, following the process of identifying measures, measuring performance, analyzing data, identifying the improvement opportunity, and continually monitoring performance they were able to make drastic changes in every department. Through this transition process and over the course of a year the new CEO realized sizeable cost savings. Through the PI process, priorities for new equipment and infrastructure were set. One high priority item was a new surgical suite with updated technology. The board approved the construction of the new suite and purchase of the new equipment. Because of the implemented PI processes and monitoring, one month after the surgical suite opened the hospital epidemiologist noticed a spike in postsurgical infections. A PI team was assembled with representatives from the surgery service, housekeeping, nursing, infection control, and HIM. The team meticulously evaluated and improved each of the procedures related to the new surgical suite. Continued monitoring only demonstrated minor

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