HIM 440 Module 4 Work Redesign Short Paper Example

Forty-Two Minutes of Work in Six Days: Redesigning the Path From Discharge to Bill at Kettle Creek Medical Center

[Student Name]

Southern New Hampshire University

HIM 440: Management of Health Information Services

Module Four Short Paper

[Instructor Name]

[Date]

The organization, setting and figures below are a composite written as a model document. No real employer, client, colleague or patient is described.

Forty-Two Minutes of Work in Six Days: Redesigning the Path From Discharge to Bill at Kettle Creek Medical Center

When unbilled accounts rise, the usual response is to ask coders to work faster. At Kettle Creek Medical Center, that response would miss the point. A time study of 60 inpatient accounts showed that the average account spent 6.1 days between discharge and final coding, but the time anyone actually spent working on it totaled about 42 minutes. The rest was waiting. This paper maps the current process, identifies where time is lost, proposes a redesigned process and considers what the evidence says about Lean methods in health care.

Mapping the Current State

The planning team walked the process with the people who do each step and drew a current-state map. Table 1 summarizes it, showing each step, who owns it, the average hands-on time and the average wait before the next step begins.

Table 1. Current-State Process From Discharge to Final Coding

Note. Time study of 60 inpatient accounts by the planning team; composite data.

Where Time Is Lost

Lean thinking classifies activity as value-adding, meaning the customer would pay for it, or waste. By that measure, less than 1% of the elapsed time in this process adds value. The map shows four main wastes. Waiting is the largest: documents sit in transit, in the scanning queue and in the coding queue. Hand-offs multiply delay, because each of six steps has its own queue and owner, and nobody owns the whole flow. Rework appears when coders open charts that are not yet complete, set them aside and reopen them later; the time study found that 38% of charts were opened more than once. Finally, the coding queue is sorted oldest first, so a simple outpatient account can block a high-value surgical case that has all its documentation.

Designing the Future State

The redesigned process changes five things. First, paper documents will be scanned on the nursing unit at discharge by unit clerks using existing scanners, removing the transit time and most of the scanning queue. Second, the coding queue will hold charts until the discharge summary is signed and documentation integrity has reviewed them, so coders open each chart once. Third, the queue will be sorted by a combination of age and expected payment, so older and higher-value accounts rise to the top. Fourth, open queries will follow an escalation rule: a reminder after 24 hours and a call from the physician advisor after 48. Fifth, the medical staff will be asked to adopt a rule, already common elsewhere, that discharge summaries are completed within 24 hours of discharge. Table 2 shows the expected effect.

Table 2. Expected Future-State Waits

Note. Estimates by the planning team; to be verified in a pilot.

What the Evidence Says About Lean

Lean is popular in health care, but its evidence is mixed. Mazzocato et al. (2010) reviewed Lean applications and found that they worked best when organizations used them to understand processes, organize work around patient flow, detect errors early and build a habit of structured problem solving, rather than applying tools in isolation. Holden (2011), reviewing Lean in emergency departments, found reported improvements in waiting and length of stay but noted weak study designs and warned that effects on staff and sustainability were rarely measured. DelliFraine et al. (2010) similarly concluded that the evidence for Lean and Six Sigma in health care was limited by few rigorous studies. For Kettle Creek, the lesson is to treat the redesign as a hypothesis, test it in a pilot and measure both the intended results and any side effects.

People and Side Effects

Redesign moves work between people. Unit clerks will scan documents they currently send away, which adds a task to a busy role and requires training and scanner access on every unit. Physicians will face a firmer discharge summary deadline. Coders may worry that holding incomplete charts reduces their measured productivity, so the productivity standard being developed by the coder working group should count only charts released to coding. Watching for side effects, such as scanning errors on the units or physicians rushing summaries, is part of the design. The director will meet with unit managers before the pilot to agree on how scanning time is staffed, and the physician advisor will present the 24-hour rule to the medical executive committee with data showing how much of the current delay sits with discharge summaries. Presenting the map itself, rather than a verbal complaint about late summaries, turns a request that could sound like blame into a shared view of one process.

Pilot and Measures

The redesign will be piloted on two medical units and one surgical unit for eight weeks. Measures will include days from discharge to final coding, the share of charts opened more than once, scanning errors per thousand pages, query response time and unbilled days for the pilot units compared with the rest of the hospital. If results hold, the new process will extend hospital-wide as part of Milestone Two's improvement plan.

Conclusion

Kettle Creek's unbilled backlog is a flow problem: 42 minutes of work stretched across 6.1 days by queues, hand-offs and rework. Mapping the process made that visible, and a redesign focused on scanning at the source, releasing only complete charts, prioritizing the queue and escalating queries could cut the journey to about 2.3 days without asking anyone to work faster. Evidence on Lean argues for testing that expectation carefully before declaring success.

References

DelliFraine, J. L., Langabeer, J. R., & Nembhard, I. M. (2010). Assessing the evidence of Six Sigma and Lean in the health care industry. Quality Management in Health Care, 19(3), 211-225. https://doi.org/10.1097/QMH.0b013e3181eb140e

Holden, R. J. (2011). Lean thinking in emergency departments: A critical review. Annals of Emergency Medicine, 57(3), 265-278. https://doi.org/10.1016/j.annemergmed.2010.08.001

Mazzocato, P., Savage, C., Brommels, M., Aronsson, H., & Thor, J. (2010). Lean thinking in healthcare: A realist review of the literature. Quality and Safety in Health Care, 19(5), 376-382. https://doi.org/10.1136/qshc.2009.037986