Most of the traditional HIM
roles are straight production based. Chart analysis, coding, release of
information, scanning/filing, etc., are all about completing tasks in a set
amount of time. While newer HIM roles in areas such as auditing, patient
portal support, Information Governance and the like are not set tasks, the core
functions of your department are, and as such, setting meaningful and
justifiable production standards is an important practice.
I’ve had the unfortunate
opportunity to have to testify in an employee separation case about how we came
about our production standards and whether or not they were “fair.”
Developing standards is as important to keeping the hospital running as it is
to protecting you and your organization.
Thus, I’ve always used a three
part plan when I need to create or update a production standard.
Step 1: Are there national
benchmarks? What are other hospitals doing in this area?
I want to be upfront and let you
know that when it comes to setting production rules, I think national
benchmarks or hospital comparisons can be a big waste. It’s been said
hundreds of millions of times, but no two organizations are alike. No two
hospitals have their EMR’s set-up exactly the same to make chart analysis equal
between facilities. No two document imaging processes are alike.
Think of all the differences in volumes, systems used, whether forms have
barcodes or not, etc. I think that, for production at least, it’s too
hard to say that what hospital X does, hospital A can copy.
Having said that, by
understanding industry numbers, it can give you some cover should you ever have
to justify it down the road because if you say you want your inpatient coders
to code 37 charts per day, but everyone else is doing ~21, something tells me
you’re going to have problems.
When we updated our scanning
production rates about two years after go-live, one of the first things we did
was ask our system vendor about their recommended standards. We asked an
outside consultant we’d used what her thoughts were for the go-lives she’s
supported. We posted on list serves such as – shameless plug alert –
AHIMA’s Engage
site to solicit numbers.
The goal was just to get an idea
of what was going on in the industry at that point. We would try to
stratify responses to find likes institutions – Academic medical centers,
safety-nets, same EMR vendor, etc. – but in the end, this was really just used
as support should we need it.
Step 2: Perform a time study
by the staff doing the task
Soliciting staff input, whenever
possible, is definitely the way to go. I know that’s not earth-shattering
stuff, but if people feel like they had some say in how they’ll be judged,
their more prone to go along with it.
Thus, obtaining staff input,
even if it ends up on the cutting room floor, is a good idea.
So when it comes time to update
production standards, we sit down with staff and ask them to conduct their own
time study – typically over a two week period at a minimum – and then share
their results with us.
Some staff will continue to work
just fine and do as they’ve always done, while others may use this opportunity
to go slower trying to get a lower – and thus more easily attainable –
production standard. I’ve always been a fan of the saying “Don’t assume
your staff are malicious,” and for the most part I don’t, but it’s human nature
and some staff will dip their production thinking they’re helping
themselves. News flash: they aren’t.
Anyway, by having staff perform
these time studies, it makes them feel like they have some control. We
sometimes perform blinded time studies to get a more accurate count, meaning
the management team will pick a two week period and use it for determining
staff production times, without letting the staff know. It’s kind of
sneaky, but offsets people who under perform on purpose.
Step 3: Have the management
team perform a time study
My last step is always to have
the rock stars of a role – typically the team lead, supervisor or manager –
then do their own time study. They typically work faster – maybe even
better – than staff who do the work day in and out. They’ll follow the
exact same parameters as the staff in the Step 2, but they almost always have a
higher production rate.
So what happens next?
What I’ve typically done is
averaged the time study results from the staff and management team, and then
add 10%. So, for example, if when doing an ROI time study we found that
the staff processed, on average, 50 requests per day and the team leader did
60, their average is 55, with 10% added on top to make our goal 61 (I always
round up for production).
You might think that this
method isn’t exactly the fastest way to get this done, and hey, I 100%
agree. But coming from someone who has had those standards scrutinized
under oath, taking a little longer to make sure you have a justifiable standard
isn’t a bad thing.
One other thing to keep in mind:
I like to think that most standards should be checked and reviewed at least
annually. It doesn’t mean that you’ll update them each year, but with the
HIM functions changing so quickly now, the days of having that one standard for
filling paper charts and having it set for years is a thing of the past.
It also keeps your staff on their toes and working to the top of their abilities.
Seth Jeremy Katz, MPH, RHIA
President Elect
