Determining a Productivity Benchmark

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