HIM 440 SNHU Gateway Healthcare Systems Case Study

1
[Instructions: Please format your paper per APA guidelines. Include the title page requirements,
the headings/subheadings already provided for you, an introduction, the body of your paper
using the headings/subheadings provided, a conclusion paragraph, a reference page, and in-text
citations to match the references. Please be sure to remove all of these instructional notes before
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[Note: To complete this template, replace the bracketed text below with the relevant
information.]
[Full Title of Paper]
[Student Name]
Southern New Hampshire University
HIM-440: Management of Health Information Services
[Instructor Name]
[Date]
2
[Title of Paper (Centered and Bolded)]
[In this section, you will write a brief introduction.]
Summary
[This section coincides with the first critical element on the rubric. You will summarize
the issues in the HIM department related to the merger.]
Compliance
[This section coincides with the second critical element on the rubric. You will address
the compliance issues noted in the case study in this section.]
Cultural Diversity
[This section coincides with the third critical element on the rubric. You will address the
cultural issues impacting quality and productivity.]
Mission and Vision
[This section coincides with the fourth critical element on the rubric. You will analyze
the mission and vision of each hospital.]
SWOT Analysis
[This section coincides with the fifth critical element on the rubric. You will analyze the
strengths, weaknesses, opportunities, and threats facing the HIM department. You will complete
each SWOT analysis matrix AND include a brief summary of your findings in this section.]
St. Catherine’s
Strengths
[Insert text.]
Opportunities
[Insert text.]
Weaknesses
[Insert text.]
Threats
[Insert text.]
3
St. Luke’s
Strengths
[Insert text.]
Opportunities
[Insert text.]
Weaknesses
[Insert text.]
Threats
[Insert text.]
Hickman
Strengths
[Insert text.]
Opportunities
[Insert text.]
Weaknesses
[Insert text.]
Threats
[Insert text.]
Unified HIM Department SWOT Analysis
Strengths
[Insert text.]
Opportunities
[Insert text.]
Weaknesses
[Insert text.]
Threats
[Insert text.]
Conclusion
[In this section, write a brief summary of your findings above. Be sure to include
references and the corresponding in-text citations. A reference page is located following this
page.]
4
References
[Insert references in APA format.]
HIM 440 Milestone One Guidelines and Rubric
Overview: For a healthcare organization to be effective in meeting information management needs, the Health Information Management (HIM) department
must operate with a clear vision and purpose and be able to forecast needs across the continuum of care and healthcare enterprise. It is essential for the HIM
department to run efficiently and effectively while maintaining the highest levels of quality and quantity set forth by preestablished standards and
measurements. Health information managers are also charged with overseeing the training and development of staff to ensure compliance with rules,
regulations, and organizational needs.
This milestone covers the first section of the final project: Initiation and Preparation Phase. It provides you with an opportunity to receive early feedback from
your instructor that you will incorporate into your final submission.
Prompt: Review the Gateway Healthcare Systems case study and analyze the state of the unified health information management department of Gateway
Healthcare Systems during the initiation of the merger. Identify the current position of the department to inform the key initiatives of the improvement plan.
Specifically, the following critical elements must be addressed:
I.
Initiation and Preparation Phase: In this section, you will review the case study. You will analyze the current state of the health information
management department during the initiation of the merger. You will identify the current position of the department to inform the key initiatives of the
improvement plan. You will include the following elements:
A. Using the details provided in the case study, summarize the issues for the health information management department during the merger.
B. From a compliance standpoint, determine current challenges the health information management department is experiencing.
C. Explain the impact of cultural diversity on the productivity and quality of the health information management department.
D. Analyze the mission and vision of the organizations in the merger to inform and create a unified mission and vision for the health information
management department.
E. Using the SWOT analysis completed in the previous module, identify the strengths, weaknesses, opportunities, and threats facing the health
information management department as a result of the merger.
Rubric
Guidelines for Submission: Your Milestone One paper should be a 3- to 4-page Microsoft Word document, excluding the title and reference pages, with double
spacing, 12-point Times New Roman font, one-inch margins, and sources cited in APA format. Use the Milestone One Template found in your learning
environment to assist you with this assignment and to submit your work.
Critical Elements
Initiation and
Preparation
Phase: Summarize
Proficient (100%)
Summarizes the issues of the health
information management department
during the merger based on the details
provided in the case study
Initiation and
Preparation
Phase: Compliance
Determines challenges the health
information management department is
experiencing from a compliance
standpoint
Explains the impact of cultural diversity
on the productivity and quality of the
health information management
department
Initiation and
Preparation
Phase: Cultural
Diversity
Initiation and
Preparation
Phase: Mission
and Vision
Analyzes the mission and vision of each
organization involved in the merger to
inform the mission and vision statement
for the health information management
department
Initiation and
Preparation
Phase: SWOT
Identifies the strengths, weaknesses,
opportunities, and threats facing the
health information management
department using the SWOT matrix
included in the assignment template
Articulation of
Response
Submission has no major errors related
to citations, grammar, spelling, syntax,
or organization
Needs Improvement (75%)
Summarizes the issues of the health
information management department during
the merger based on the details provided in
the case study, but response contains
inaccuracies
Determines challenges the health information
management department is experiencing from
a compliance standpoint, but response is
cursory or contains inaccuracies
Explains the impact of cultural diversity on the
productivity and quality of the health
information management department, but
response is cursory or illogical or lacks
justification
Analyzes the mission and vision of each
organization involved in the merger to inform
the mission and vision statement for the health
information management department, but
analysis is cursory or illogical or does not
contain information about all three
organizations
Identifies the strengths, weaknesses,
opportunities, and threats facing the health
information management department using a
SWOT matrix, but response contains
inaccuracies, is incomplete, or is not contained
in the SWOT matrix included in the assignment
template
Submission has major errors related to
citations, grammar, spelling, syntax, or
organization that negatively impact readability
and articulation of main ideas
Not Evident (0%)
Does not summarize the issues of the
health information management
department using the provided case
study
Value
18
Does not determine challenges the
health information management
department is experiencing from a
compliance standpoint
Does not explain the impact of
cultural diversity on the productivity
and quality of the health information
management department
18
Does not analyze the mission and
vision of each organization in the
merger
18
Does not identify the strengths,
weaknesses, opportunities, and
threats facing the health information
management department using the
SWOT matrix included in the
assignment template
18
Submission has critical errors related
to citations, grammar, spelling,
syntax, or organization that prevent
understanding of ideas
Total
10
18
100%
HIM 440 Gateway Healthcare Systems Case Study
St. Catherine’s Medical Center recently announced it will be merging with St. Luke’s Hospital
and Hickman Community Hospital to form Gateway Healthcare Systems, all located within the
same metropolitan area in the Midwest. You have just been hired as the healthcare system’s
HIM director overseeing all three hospitals. Each facility’s department manager or supervisor
will report to you.
Hospital Profiles
St Catherine’s Medical Center
HIM Department Mission: Grounded in the Catholic mission of service, we strive to provide
accurate patient health information services to all patients with care, concern, and dignity.
HIM Department Vision: Provide patients with their health information with sensitivity and
respect to their privacy.
Profile: St. Catherine’s is affiliated with the Catholic faith and includes an active convent on its
campus. It is an 850-bed acute care level-one trauma facility located in the suburbs. The staff
and patients come from a variety of ethnic backgrounds and are linguistically diverse. About
60% of St. Catherine’s staff is Catholic, but the hospital abides by legal hiring practices and
insists that all employees are treated with respect, including those who fall outside the tenets
of Catholicism. In fact, the HIM department has two staff members with hearing impairment
who work in the coding section. They have been investigating ways to offer more opportunities
to potential employees with physical needs, but with the high volume of reading and direct
customer service provided to patients, it has been difficult to accommodate.
St. Catherine’s has a reputation of providing quality care to all patients and will not turn away a
patient based on ability to pay. It is located in one of the wealthier suburbs of the city and has a
strong record of employment retention, even though the average salary level is lower than
those of its competitors. St. Catherine’s implemented a new EHR last year and continues to
work out new policies and procedures for the new system. Its dictation system was
implemented seven years ago. The productivity level has been critically low since implementing
the new system.
Due to recent budget cuts, St. Catherine’s cannot offer overtime to staff. The HIM department
has many long-term employees that do not have formal health information education or
credentials. The current coding productivity level is, on average, two inpatient charts per hour
per coder, and 10 outpatients (including ED patients) per hour per coder. The coding quality
consistently exceeds 95%, per the internal coding auditor.
Coding productivity standards were established six years ago using ICD-9 standards, at four
inpatient charts per hour. The productivity standards remain at four inpatient charts per hour,
despite complaints from coders that the standards are unreasonable.
St. Catherine’s last TJC site visit was in October of last year. Overall, the hospital fared well on
inspection; however, the HIM department was cited for not having a time stamp on orders in
the EHR. (For more information, review regulations RC.01.01.01, EP19 in The Joint Commission
E-dition Manual).
There have been complaints in the department that some staff do not abide by the break
schedule, and some take longer lunches than allowed. Management has not addressed this
with staff for fear of losing some of their most knowledgeable and credentialed staff. It has
been reported that some of the seasoned coders who have been on staff for more than 25
years are still using the manual coding book rather than the encoder that was implemented five
years ago, stating that this saves them valuable time; however, the more recently hired coders
are using the encoder system.
St Luke’s Hospital
HIM Department Mission: To provide providers, residents, and staff with timely access to
patient health information for purposes of treatment, research, and reimbursement.
HIM Department Vision: Promoting research through state-of-the-art health information
management and technology.
Profile: St. Luke’s, established in 1942 as a Methodist hospital but no longer a faith-based
facility, is a very busy, 400-bed inner-city teaching hospital that provides critical care services to
many patients without healthcare coverage. It services the most diverse patient population in
the city in terms of ethnicity, religion, class, ability, sexuality, and age; however, its staff
diversity is low except in the area of age diversity. The youngest employee is 19 years old and
the oldest is 72.
St. Luke’s has experienced a high volume of staff turnover during the past three years and does
not currently have a HIM manager or director on staff. While it does have credentialed HIM
staff, it has difficulty keeping them on board for more than two years.
St. Luke’s is using a first-generation EHR that was implemented seven years ago and has
difficulty communicating with the other systems in the department and organization. Because
of the issues with interoperability, the lab sends down daily batches of paper lab reports that
are scanned into the EHR. The encoder was just implemented last year; however, only one
coder was thoroughly trained on the new encoder, and she resigned over a year ago. Coding
staff frequently use the manual coding books because they cannot seem to find the accurate
codes with the encoder. They spend a great deal of time looking up codes in the coding book,
then going to the paper binders with the coding clinics to ensure that they are assigning the
correct codes. Coding productivity standards were revised after the implementation of ICD-10.
Current productivity standards are set at two inpatient charts per hour.
The coding supervisor is a new graduate with less than a year of inpatient coding experience.
She does not get along well with her subordinates, who are older and have much more
experience. Coding productivity is being met per the performance expectations established ten
years ago; however, coding quality is consistently rated at 85%, per the external auditing firm.
Hickman Community Hospital
HIM Department Mission: To assure protection of patient health information at all times.
HIM Department Vision: Committed to serving the local community’s health information needs
and ensuring patient information is secure.
Profile: Hickman is a non-faith-based, 90-bed community hospital located in the oldest part of
the city. It has historically served a predominantly low-income, Caucasian patient population,
which is comprised mostly of Medicare and Medicaid payers. It has recently been seeing a rise
in Muslim patients due to a new mosque in the neighborhood. Hickman Community Hospital
has provided services to its local community since 1922, and it is the oldest facility of the three
merging organizations.
This facility has accessibility issues and was deemed noncompliant with ADA guidelines during
the last Joint Commission accreditation survey. Since the hospital staff and patient population
are primarily of one ethnicity, the hospital has not seen the need to address cultural diversity
training, and therefore it was found noncompliant with TJC standards on leadership.
The employees of Hickman are like family—they stick together. While Hickman is the lowestpaying hospital in the area, the family culture has contributed to the longevity of its staff.
The HIM department does not currently have any AHIMA-credentialed staff members and does
not have any coding quality or quantity expectations in place for the part-time staff members
responsible for coding the charts. Hickman is still using paper-based records and manual coding
books and resources for coding and billing resources. Hickman currently has a ten-day
turnaround time from discharge to final bill dropped, and there is currently no specified
number of charts that should be completed on an hourly or daily basis by coders.
The acting HIM manager has been employed by Hickman for 35 years and is very fond of her
staff; she insists they do the best job in town. Her job as acting HIM manager was meant to be
temporary while Hickman searched for a credentialed replacement. The one candidate who
met all qualifications was determined “not a good fit” by the hiring committee. He was a 32-
year-old African American male and a wheelchair user. Currently, the HIM department does not
have any diversity in ethnicity or physical ability among staff members.
Preliminary Observations
During the first month in your new position as HIM director of Gateway Healthcare Systems,
you spent a week at each hospital getting to know staff, reviewing policies and procedures, and
making general observations.
While visiting with staff at St. Catherine’s, you noticed a few staff members were discarding
paper forms with patient-identifying information into the trash can underneath their desks,
instead of disposing of the forms in the document shredder located in the front office. You also
noticed that the “release of information” staff did not log out of their computers when they
were away from their desks.
At St. Luke’s, you overheard a discussion in the main lobby elevator between two nurses
discussing patient Mary Smith’s prognosis. When you arrived in the HIM department, there
were stacks of paper forms and old paper records scattered throughout the department with
the patient information openly displayed. In the connecting hallway that patients frequently
travel through, you found several carts of records that revealed patient-identifying information.
At Hickman Hospital, you arrived to find the staff sitting around having coffee while several
patients were waiting to be assisted with obtaining copies of their health records. The releaseof-information clerk came running into the office with a paper copy of a record to hand to one
of the patients in line, and said, “Here you go, Mrs. Brown; here’s the copy of your record from
Dr. Taylor’s office. He’s our best psychiatrist on staff! You’re in good hands!” Once all of the
patients had been waited on, the staff began discussing each patient’s requests along with their
diagnoses, medical treatment, and prognosis. At this point, you called an urgent staff meeting.
Current Facility Staffing
Name of
Facility
Number of
FTEs/PTEs
St. Catherine’s
St. Luke’s
Hickman
55 FTEs/15 PTEs
40 FTEs/5 PTEs
3 FTEs/10 PTEs
Number of
Management
Staff
5
10
1
Number of
Credentialed
Coders
4
10
0
Number of
Transcriptionists
6
8
2
Number
of
ROI Staff
6
1
0
National Performance Measurement Standards


ICD-10 Coding Productivity Study Highlights Emerging Standards
New Study Illuminates the Ongoing Road to ICD-10 Productivity and Optimization
Number of
Support Staff
FT/PT
49
16
10
Top Five Diagnoses by Hospital
St. Catherine’s
Diagnoses
Average Length of Stay
(ALOS)
Average Time to Code
in Minutes
Chronic Obstructive
Pulmonary Disease
(COPD) with Major
Complication/
Comorbidity (MCC)
10
39
Gastrointestinal (GI)
Hemorrhage with
Comorbid Condition
(CC)
11
45
Pulmonary Edema and
Respiratory Failure
9
43
Septicemia or Severe
Sepsis without
Mechanical Ventilation
(MV), 96+ Hours with
MCC
17
53
Spinal Stenosis, Lumbar
Region with Combined
Anterior/Posterior
Spinal Fusion with MCC
12
130
St. Luke’s
Diagnoses
ALOS
Average Time to Code
in Minutes
Intracranial
Hemorrhage or
Cerebral Infarction with
Comorbid Condition
(CC) or Tissue
Plasminogen Activator
(tPA) in 24 hours
6
38
Renal Failure with MCC
8
42
Spinal Stenosis, Lumbar
Region with Combined
Anterior/Posterior
Spinal Fusion with MCC
10
121
Sepsis, Unspecified
18
Organism,
Tracheostomy with MV
> 96 hours or Principal
Diagnosis Excludes (PDX
EXC) Face, Mouth &
Neck without Major
O.R.
65
Septicemia or Severe
Sepsis without
Mechanical Ventilation
(MV), 96+ Hours with
MCC
43
13
Hickman
Diagnoses
ALOS
Average Time to Code
in Minutes
COPD with MCC
8
46
Heart Failure and Shock
with MCC
10
55
Normal Newborn
1.5
30
Renal Failure with MCC
10
62
Vaginal Delivery w/o
Complicating
Diagnoses
2
45
Module Two Assignment: Issues and SWOT Analyses
Tracy McNeill
HIM-440 Management of Health Information Service
Southern New Hampshire University
Dr. Shelley C. Safian
March 11, 2022
HIM 440 Module Two Assignment Template
Current Issue Facing New HIM Department Manager
Staffing and Departmental Relationships
When nurse managers, rather than management, make decisions on appropriate caregiver proportions, it results in greater
worker motivation improved morale. However, addressing appropriate staffing levels in HIM would aid in decreasing the intention to
quit the organization and respective profession. Rising patient contentment and improved nursing retention are all benefits of having
enough workforce size in the HIM. A scarcity of nurses causes mistakes and more significant morbidity and death rates. Nursing
burnout and grief are prevalent with the high client-to-patient ratio. Similarly, due to low physician-to-client levels, deaths occur in a
care setting (Haddad, Annamaraju & Toney-Butler, 2020). As a manager, there is a need to stress providing HIM employees with
assistance to accomplish a successful job. The facility needs to motivate the staff to take the approach independently (Schön Persson
et al., 2018). Whenever the administrators talked about having great connections among the team, they made the point that workers
operated for medical consumers, which necessitated the establishment of a tolerant environment by managers. Additionally, the
management should establish an atmosphere where sentiments get recognized and team members operate based on professionalism.
Productivity and Compliance
Invention and compliance are necessary elements in the HIM department. As a manager, there is a need to foster compliance
with various technological changes and implement policies to prevent low output. However, the resources and systems that enable a
medical facility must improve efficiency rather than hinder it. The facility requires flexible technology as healthcare adopts new
quality care and payment models. Equipping care personnel with agile technology will become extremely important. As a manager,
another challenge in HIM is to think about whether the present technology and resources available to the facility can assist in
achieving the goals listed. However, the facility requires effective communication and a range of health software applications and
media, including electronic and unstructured data. Healthcare facilities need Safe transmission of patient data across care workers to
increase cooperation and coordination of care.
SWOT Matrix
St. Catherine’s
Strength
•
•
The facility established under Catholicism got holistic
Weaknesses
•
core values and principles based on sympathy,
some employees could take longer breaks from the
compassion, and excellent services.
workplace.
Regardless of the client’s social or economic
•
background, the facility anticipates delivering quality
•
The health information and management section
experiences low output.
care
•
No overtime compensation to workers
The implementation of Electronic Health Records
•
Unrealistic coding standards
abbreviated HER systems enhances the quality and
•
Employees got inadequate knowledge and skills
timely care delivery (Booth et al., 2021).
•
The HIM team members experience poor motivation;
The facility providers care on the moral principle of
respect and inclusion of team members in advocating for
a conducive working environment.
Opportunities
•
The facility can incorporate development healthcare
Threats
•
programs by involving HIM in improving team
•
services, which might scare care consumers
members’ skills and knowledge.
•
Unqualified team members result in poor quality services
The facility shall entice more care consumers due to the
•
Increased waiting lines due to long periods spent on
thrilling and attainable core values
•
Healthcare facilities with low productivity lead to poor
The quality of care and patients experience shall result
from technological innovation such as EHRs
coding
St. Luke’s
Strengths
•
•
Technological and research use enhances effective care
•
Unqualified coders
delivery
•
Low employee diversity
The facility envisioned providing quality care by
•
Old technology use in care delivery
minimizing time waste during patient data access.
•
High turnover among team members
Opportunities
•
Weaknesses
Healthcare improvement through adopting new
Threats
•
technology
•
Recruitment of new coders
•
Retaining HIM team members by providing a conducive
environment for care practices
Poor quality care services result in an adverse patient
experience
•
Incompetent staff and employee’s high turnover results
in a poor image in the facility
Hickman
Strengths
Weaknesses
•
Healthcare experience leads to better health outcome
•
Absence of diversity in healthcare delivery
•
Better employee retention increases care efficiency
•
Unqualified staff members
•
Non-compliant to leadership standards
•
Poor technological advancement
Opportunities
Threats
•
Integration in health technology
•
Low bed capability might devastate the facility
•
Employee training
•
Inadequacy in care delivery leads to poor patient
experience
•
Closure due to failure to comply with healthy regulations
•
Inefficiency care delivery leading to poor outcome
Unified HIM Department SWOT Analysis
Strengths
•
Creativity in the workplace gets enhanced through
Weaknesses
•
healthcare diversity.
•
•
Employees shall adopt various skills and care operations
negative effect on service delivery
•
Patients’ experience is affected by unethical conduct in
through exploring technological innovations
healthcare. Physicians should observe the ethical code of
The facility’s adoption of technology shall result in
behaviour such as respect compassion when delivering
quality healthcare delivery and improve patient
care
experience
•
Incompetent staff members in care facilities got a
Facilities with common goals aid in retaining HIM team
members
•
The facilities status gets affected in situations with low
productivity
Opportunities
•
Threats
•
Employees would prefer working in a conducive
environment that motivates service delivery
•
service providers
Healthcare facilities with quality care delivery experience
•
a high number of patients seeking medical attention
•
•
legal action might take charge in handling unprofessional
Technological innovation results in quality, timely and
need for financial support to enhance technological
innovation among facilities with outdated systems
•
Resistance to change and diversity will result in low
effective care delivery.
Patient; clients will prefer healthcare facilities with
Patients’ medical information can be retrieved when
varying care options.
needed through technological innovation
SMART Goals
1. Cultural Diversity
During the few months of care delivery, HIM seeks to achieve balanced multiculturalism. For effective achievement of cultural
diversity, the present personnel would be evaluated for people’s willingness to code, following the established guidelines and the
accreditations and expertise. The Equal Employment Opportunity Commission regulations shall get enacted in the recruitment of new
workers (U.S. DEPARTMENT OF LABOR, n.d.). Once competent personnel has been selected for retention, the institution shall start
recruiting new staff that replaces shortage. Women and men from various religious and cultural origins and people from multiple
locations need to participate in the program.
2. Human resources:
In a year, the resource manager of the HIM section will have developed into a competent, conscientious, and dedicated to an
institution’s aims. Because I do not want to push individuals into acting in a specific manner, I will offer sufficient time to adapt to the
new environment in which they will continue operating. Using principles like authenticity, transparency, responsibility, and justice, I
shall establish standards of ethics for all employees and contractors. As a result, the personnel will be held to the highest
professionalism and adhere to the moral requirements necessary in a hospital context. This will aid in the development of a workplace
culture that encourages collaboration, innovation, and dedication to the given tasks.
3. Compliance
In months to come, Gateway Healthcare anticipates implementing ICD-10 coder efficiency and optimization guidelines to
ensure compliance. A crucial component of such an initiative should be the recruiting of competent personnel, as well as the
instruction to current employees. Furthermore, the organization shall implement the most recent version of electronic health records to
guarantee integration with healthcare devices (Booth et al., 2021). Compliance will ensure that staff adheres to the utmost code of
ethics, with the importance of sustained effort, honesty, and respect, all having a crucial part.
References
Booth, R. G., Strudwick, G., McBride, S., O’Connor, S., & López, A. L. S. (2021). How the nursing profession should adapt for a
digital future. BMJ, 373. https://doi.org/10.1136/bmj.n1190
Haddad, L. M., Annamaraju, P., & Toney-Butler, T. J. (2020). Nursing shortage. StatPearls [Internet].
https://www.ncbi.nlm.nih.gov/books/NBK493175/
Schön Persson, S., Nilsson Lindström, P., Pettersson, P., Andersson, I., & Blomqvist, K. (2018). Relationships between healthcare
employees and managers as a resource for well-being at work. Society, Health & Vulnerability, 9(1), 1547035.
https://doi.org/10.1080/20021518.2018.1547035
U.S. DEPARTMENT OF LABOR. (n.d.). Equal employment opportunity. U.S. Department of
Labor. https://www.dol.gov/general/topic/discrimination

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