Education Module for Health Record Practice based on ihfro modul
UNIT 6 ‑ ADMINISTRATION AND MANAGEMENT OF THE
HEALTH RECORD DEPARTMENT
The health information management/health record professional must meet the leadership challenge in his/her quest to develop an efficient and effective health record department. The management of a health record department involves carrying out the basic management functions of planning, organizing, human resource development, directing, and controlling. This unit introduces the participant to the management process and its application to the management of the health record department of a health care facility.
At the conclusion of this unit the participant should be able to:
1. state four basic management processes and discuss each in relation to their role as a health information management/health record professional
2. draw an organization chart for the facility in which they work and for the health record department
3. draw a flow chart to indicate the flow of activities within the health record department
4. write a job description for each position within their department
5. illustrate the ability to plan for recruitment, selection and training of health record staff
6. solve a problem from within the health record department using the steps as set out in this unit.
THE MANAGEMENT PROCESS
The management process involves planning for the future, organizing and developing both human and material resources. It also includes directing individuals or groups to assist willingly and harmoniously in accomplishing the objectives of the facility and controlling the efficient use of resources in achieving those objectives. These processes can be expanded as follows:
1. This is the process by which an organisation, facility or sub‑section of a facility, such as the health record department attempts to plan effectively for the future. It includes:
- establishing objectives and selecting future courses of action
- developing assumptions about the expected future environment in which goals are to be met for instance, a manual or automated environment
- identifying and selecting alternate courses of action which are available to meet the set objectives
- initiating activities within the department which will be necessary to translate plans into action, and
- critically reviewing and evaluating the outcome. That is, were the planned objectives achieved, if not, why?
2. The planning process for all health information management/health record professionals therefore would be to:
- set achievable objectives relative to the perceived requirements of the department
- examine the present environment and forecast changes that are likely to influence the department in accomplishing the objectives. With the ever increasing developments in technology, health information management/health record professionals must be alert at all times to technological advances, particularly to computer applications in health care
- identify alternative courses of action, evaluate these alternatives in light of previous assumptions made, and then select the course of action, which, after careful deliberations, appears to be the one which will best suit the department’s requirements. This is part of the decision‑making process in management
- implement the plans with check points to indicate progress during implementation
- evaluate the implemented plans with regard to effectiveness, efficiency and achievement of the department’s objectives (Huffman, 1990).
Planning at all levels provides direction and a sense of purpose. It helps health information management/health record professionals cope with change and contributes to the performance of other management functions.
Planning the physical layout of the health record department is discussed in Unit 8.
This is the process by which employees in the health record department and the jobs they do are related to each other. It consists of dividing work among groups and individuals and providing the coordination required between individuals and group activities. This is often referred to as the division of labor.
Organizing also involves the establishment and recognition of managerial authority.
Individual work tasks must be organized into distinct jobs. This is part of what is normally referred to as job design.
1. Job design, job analysis and work satisfaction
Job design involves specifying job content, work methods used for the job and the relationship between and among individual jobs within the department.
Each job should be assembled into work units within the department. In turn, the combination of work units within the department must be logically combined to form an overall organisational framework. And finally, the design of individual jobs and work units within the department, as well as the overall framework of the facility must be related to the environmental influences within the community.
Once jobs have been defined, further information relating to the proposed content of each job should be collected. This process is called a job analysis and will help the health information management/health record professional determine the skills, knowledge and abilities required to do the job and at the same time clarify lines of responsibility and authority. When working through this process, it is important to remember that job content will alter with various changes in technology and the health information management/health record professionals must predict, wherever possible, for future changes.
This identification of the work to be performed in each job provides an extremely important basis for planning personnel requirements. Because of its importance with regard to recruiting and selection, a job analysis should describe not only content, but also specifications.
If the health information management/health record professional is involved in planning a health record department for a new hospital, he or she will rely heavily on their skills and knowledge of health record management, which will enable them to design the anticipated jobs and conduct a job analysis. If the department is being redesigned in an existing hospital, the health information management/health record professional will need to analyze existing jobs within the old department and predict future changes. The tools used in the second case could be a combination of observation and an interview with each staff member.
When organizing the work within a health record department the following should be kept in mind.
a) Job description and specification
Job analysis will provide two types of information (i) a job description and (ii) a job specification. Job descriptions actually describe the characteristics of a job. Job specification will indicate the skills required for each job, e.g. typing and transcription.
b) Improving work satisfaction
How to induce employees to perform work that is boring and unsatisfying is a matter of concern to employers. The subject of work satisfaction is an extremely complicated one that defies any simplistic explanation or solution. There are many variables that help to determine whether or not work in a particular job will prove satisfying to a particular employee performing it. These variables include:
i) Variables relating to the work of an employee
Variables considered to have an effect upon the satisfaction to be derived from a job include:
- variety (tools, equipment, activities and workplace)
- autonomy (independence and control in performing job)
- interaction (number and types of inter‑relationships)
- knowledge and skill (time required for proficiency)
- responsibility (closeness of supervision and cost of mistakes)
- task identity (how one’s contributions add to the total effort)
- feedback (being kept informed)
- pay (wages and fringe benefits)
- working conditions (physical work environment)
- cycle time (time required to perform a unit of work)
ii) Individual differences among employees
A major difficulty in determining how to increase job satisfaction stems from the individual differences among employees. Differences in abilities, backgrounds, and social conditioning affect the specific psychological need patterns of employees and the specific returns that each may seek from work. As a result of these differences, work that is boring, repetitious and unchallenging to one individual may be satisfying to another. Methods used to increase satisfaction, therefore, must take into account not only the structure and working conditions of jobs, but also the needs of specific individuals.
iii) Differences in abilities
Employees who have the ability to perform their jobs well are more likely to gain satisfaction from their work. Jobs, however, must provide employees with the opportunity to utilize their abilities to the fullest extent. Otherwise, under-utilization can be a source of dissatisfaction.
iv) Differences in attitudes and personnel adjustment
Employees who are well adjusted emotionally are more likely to be satisfied with their job situations than those who are not. Furthermore, if dissatisfaction stems from causes within the individual, it is not likely to be reduced significantly by changing the job design or work environment. Neither are these individuals likely to resolve their internal problems by moving from one employment situation to another.
v) Differences in perceptions of equity
It is essential that the various financial and psychological rewards employees receive from their work be equitable, both in terms of what is demanded of them, and in terms of what others are receiving for their work. Even more important, these rewards must be perceived by the employees as being equitable. Otherwise, the satisfaction and benefits that might be derived from effective job design and employee‑job matching may be reduced substantially.
vi) Differences in occupational prestige
Employees may derive satisfaction from the prestige of their occupation and/or reputation of the organization in which they work. It is a source of satisfaction for employees to have friends and acquaintances know that they are part of a prestigious organization and making a contribution to it, even if only in a very small way. In fact one study indicated that occupational prestige contributes more to job satisfaction than does work autonomy, authority or income.
vii) Satisfaction through job enrichment
Job enrichment essentially is an extension of job enlargement (i.e., giving employees a greater variety of duties to perform), which may involve increasing autonomy and responsibility of employees, or including them to a greater extent in the decision‑making process. It provides employees with the opportunity to make greater use of their knowledge and skill by becoming more involved in planning, directing and controlling the work of their jobs. Job enrichment may include delegating to a work group greater authority for self‑management. It also may include improving communications to the extent that employees are made more aware of the fact that good performance will be recognized and will contribute toward the attainment of both personal and organizational goals. The basic contribution of job enrichment, therefore, is to make their work more meaningful and to provide employees with a greater sense of responsibility and better knowledge of the results of their endeavours.
2. Formalizing organizational structure
Organization charts are the most common method used to formalize the structure of an organization.
a) Organization chart
An organization chart is merely a graphic representation, or blue print, of all positions in a facility and departments of that facility and how they are connected. The position with the greatest authority is located at the top. Solid lines are used to show line relationships, that is, those positions that have a direct responsibility in accomplishing the objectives of the organization, and indicate to whom each position reports thus clarifying the position’s authority and responsibility. Dotted lines are used to show staff relationships, that is, those positions that are of an advisory nature.
No organization chart can totally reflect the facility’s structure. The informal relationships between employees are generally omitted.
The organization chart should be updated every time there is a change in reporting relationships. It is therefore important to date the organization chart.
A flow chart of the work in the health record department should also be prepared, and kept updated, to identify any problem areas.
b) Organizational manuals
The departmental manager must set goals and objectives and provide scope and direction for his/her staff. S/he must be a good leader, a good listener and a good planner. The department must have a clear set of policies and written procedures.
Policies provide guidelines for decision-making; they define the area in which decisions are made but do not provide the manager with the decision. Thus, the policies aid the manager in the decision making process. It is important that policies be followed consistently, especially as they apply to personnel issues. Lack of consistency may result in staff issues relating to fairness and equity.
A procedure is a structured, action-oriented list of sequential steps involved in carrying out a specific job or solving a problem (LaTour and Eichenwald, 2002). It is a series of related steps designed to accomplish a specific task. The health information management/health record professional is responsible for planning the department’s procedures and providing for a standardization of work tasks within the health record department. Each procedure must be carefully planned to help with productivity and reduce time and effort.
When establishing procedures the following points should be considered:
- display the title and revision date
- determine all the steps required for a procedure and use only the minimum needed to carry out the procedure
- determine the best sequence for the performance of each step in the procedure
- number each step, and begin each activity with an action verb
- review procedures which might be affected by changes in other procedures
- test a procedure before putting it into everyday use
- evaluate the procedure after it has been used for several weeks.
If applicable, include samples of completed forms. All procedures should be written and updated regularly to eliminate redundancy.
3. Organizational change and development
Change is an integral part of the work of any organization and health information management/health record professionals must be prepared for change within the facility and within the functioning of their own department. They must learn to deal positively with resistance to change. This would require the following:
- continued in‑service education programs for staff
- open lines of communication between staff and the health information management/health record professional
- participation and involvement of staff in planned change
- facilitations and support of staff during and after a planned change
- negotiation and agreement with staff relating to changed work conditions and other issues
- co‑operative work performance both from management and staff
- feedback to staff on effective changes and appreciation of work undertaken by staff in the implementation of the change.
4. Developing human resources
Staffing and human resource management is the process of assuring that competent workers are selected, trained and rewarded for their assistance in helping the facility and department achieve their objectives. Being effective in this area also includes providing a work climate in which employees can experience satisfaction and development.
Developing human resources, therefore, includes:
- employment planning
- advertising for new staff
- recruiting quality applicants
- selecting the best person for the job
- orientating the new staff member to the facility and the department
- training and developing new employees
- appraising work performance on a regular basis (at least once a year)
- compensating the competent worker with the right remuneration.
Directing, also referred to as leadership, and interpersonal influence is the process of inducing individuals (peers, superiors, sub‑ordinates) or groups to assist willingly and harmoniously in accomplishing the objectives of the facility and the department.
This is the process of ensuring the efficient use of resources and achieving the objectives of the facility. It involves:
- establishing standards of performance of staff and self
- comparing current performance against established standards to determine the departments progress toward the set objectives
- actively working to reinforce a high quality of services by the department and correcting any shortcomings or problems as they occur.
E. PROBLEM SOLVING
This is an extremely important function of a manager, particularly within a very busy health record department.
1. Problems must be dealt with efficiently and effectively and should not be handled lightly or ignored.
2. Steps in the problem solving process include:
- Defining the problems (What is wrong?)
- Identifying causes and underlying relationships of the problem. (What caused the problem?)
- Analysing the evidence relating to the cause of the problem. This can become quite detailed and difficult.
- Developing alternative courses of action and identifying consequences of the action. (What can be done to solve the problem?) You may come up with a number of alternatives.
- Selecting the ‘best’ alternative and developing defined steps to implement the selected alternative.
- Evaluating the outcome of the implemented solution. (Has it been effective? Is the problem resolved?)
Management is a complex issue. We would all like to be considered a good manager. If you remember the basic management principles outlined in this unit, and supplement your knowledge by further reading, you will develop good managerial skills. Remember, however, no one is perfect and no matter how hard we try we all make mistakes at some time. We are often not as effective or efficient as we would wish to be. We are, however, capable of learning from our mistakes and by continually learning, become more effective and efficient in our jobs.
To be a good manager, therefore, the health information management/health record professional should set objectives for the services of his department and continually work towards:
- improving work performance of staff
- improving work satisfaction
- planning for change and implementing change
- improving the layout of the department
- organizing effective and efficient work flow
- setting standards of work performance for staff
- directing the services of the department to see that health records are readily available for patient care at all times
This unit briefly covers some important areas of management and as discussed at the beginning of these learning packages the material presented is not definitive. There is still a lot to learn and we strongly advise that you continue to do so by reading, listening and participating in as many educational activities as possible.
1. Why is planning and organizing so important for a health information management/health record professional?
2. Draw an organization chart of a health facility and of a health record department.
3. Draw a flow chart to indicate the flow of activities in a health record department.
4. Write a job description for your position.
5. Identify a problem and work through the steps of problem solving.
1. Huffman, Edna K. Health Information Management. 10th ed. Berwyn, IL: Physicians Record Company, 1994.
2. Johns, Merida, ed. Health Information Management Technology: An Applied Approach. Chicago: AHIMA, 2002. (Note: A good source for a health record director’s job description can be found in this book in Appendix A page 816 and an organizational chart in Figure 20.1 page 766.)
3. LaTour, Kathleen, Eichenwald, Shirley, ed. Health Information Management: Concepts, Principles and Practice. Chicago: AHIMA, 2002. (Note: A good source for organizational charts can be found in this book in Figure 231 page 560 and a sample flow chart Figure 22.1 page 528.)
4. Skurka, Margaret. Health Information Management: Principles and Organization for Health Information Services. San Francisco, CA: Jossey- Bass, 2003.
selesai@hak cipta Dr Iwan Suwandy,MHA 2010