Chapters 18.1 & 18.2
docx
keyboard_arrow_up
School
SUNY Westchester Community College *
*We aren’t endorsed by this school
Course
150
Subject
Health Science
Date
Dec 6, 2023
Type
docx
Pages
4
Uploaded by EarlMantis3687
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
improvements in postoperative surgeries. Having exhausted the expertise and ideas of the
internal PI team, the CEO contacted external experts and assembled a team to come and consult
with the internal PI team. Both teams were put into a small conference room and given five hours
to review the collected data and the changes that had been made with little to no results. The
external view of the outside experts, along with a detailed decomposition of the processes related
to the suite, pointed to the construction process. Pulling the specifications and reports from the
construction process, the team had questions for the construction contractors about the grade of
materials used in the room. Specifically, they were concerned that the walls and flooring were
too porous to be properly sterilized. The contractor confirmed the suspicion and came up with a
solution to recover the walls and floor with appropriate materials. Monitoring infection rates
closely, the suite reopened for use. Weekly dashboard reports were given to all stakeholders and
showed no postoperative infections. At a review meeting at one month, the postoperative
infection rate had dropped to a level lower than before the new surgical suite was opened.
Real-World Case Discussion Questions
1.
What are the pros and cons of involving outside experts, which occurred in this case?
There are many pros and cons of involving outside experts as occurred in this case.
One pro would be gaining insight from someone who is not part of the organization.
Experts can help provide a solution to the problem because they can help see the
bigger picture and note the flaws of the organization. A con would be that these
experts don’t belong to the organization and might not care as much to put all their
effort into improving the facility as the actual workers of the organization would. Not
caring enough can lead to flaws or a problem possibly being overlooked.
2.
Why is the use and monitoring of dashboard reports important in managing
performance improvement in a healthcare organization?
The use and monitoring of dashboard reports is very important in managing
performance improvement in a healthcare organization because they provide the most
up to date and real time data that can be essential in the decision making process.
These reports help to overall improve the way the facility functions and progresses.
3.
What PI techniques were used by this hospital to determine the cause of the
postoperative infection rate increase?
The PI techniques that were used by this hospital to determine the cause of the post-
operative infection rate increase were a PI team was created using people from
several departments. Together, they went over the data and made the necessary
changes. The cause couldn’t be determined, so, the team kept working together to be
able to come up with a solution. Outside experts were brought in to help find a
solution.
Your preview ends here
Eager to read complete document? Join bartleby learn and gain access to the full version
- Access to all documents
- Unlimited textbook solutions
- 24/7 expert homework help