HIM 440 Module 5 Final Project Milestone Two Example

Final Project Milestone Two: From 5.6 Days to 3.0, a Process Improvement Plan for Unbilled Accounts at Kettle Creek

[Student Name]

Southern New Hampshire University

HIM 440: Management of Health Information Services

Final Project Milestone Two

[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.

Final Project Milestone Two: From 5.6 Days to 3.0, a Process Improvement Plan for Unbilled Accounts at Kettle Creek

The Module Four redesign showed that Kettle Creek Medical Center's unbilled accounts are a flow problem, with 42 minutes of work spread over 6.1 days. A redesign on paper does not change anything by itself. This milestone presents the plan for making the change: what the team aims to achieve, which drivers it will work on, how changes will be tested in small cycles, how progress will be measured and who is responsible for each part.

Aim Statement

Within twelve months, Kettle Creek will reduce unbilled days awaiting coding or documentation from 5.6 to 3.0 and, within six months, keep delinquent records below the hospital's accreditation threshold every month, while holding principal diagnosis coding accuracy at or above 95%. The accuracy condition is part of the aim so that speed is never bought with errors.

Driver Diagram

Working backward from the aim, the team listed what has to be true for unbilled days to fall and then what could make each of those things true. Table 1 summarizes the team's diagram. Five primary drivers came from the process map: documentation complete at discharge, documents available immediately, coding work sequenced well, questions answered quickly and enough trained coders.

Table 1. Driver Diagram for the Aim

Note. Developed by the planning team from the Module Four process map.

Testing Changes in Small Cycles

No change idea spreads until it has survived small plan-do-study-act tests. Taylor et al. (2014) reviewed published uses of the method in health care and found that many projects reported a single large change labeled as a cycle, with few documenting a series of small, linked tests or the data used to learn from them. The team will avoid that pattern by starting small, predicting results before each test and writing down what was learned. Table 2 shows the first four cycles.

Table 2. First Four Plan-Do-Study-Act Cycles

Note. Cycles planned by the team; later cycles will depend on results.

Feedback to Physicians

Two drivers depend on physicians. Across the randomized studies Ivers et al. (2012) brought together on performance feedback, they reported average gains that were modest, yet noticeably bigger for clinicians who started well below standard and for feedback that arrived more than once, from someone the clinician respected, with an explicit goal and steps to reach it. Kettle Creek's design borrows each of those features: each physician will receive a weekly list of their incomplete records and open queries, the hospitalist chair of the medical records committee will present monthly results by service and every report will show the target alongside the physician's own numbers.

Measures

Measurement comes in three layers. At the top sit unbilled days, the monthly delinquency rate and principal diagnosis accuracy. Process measures include scanning wait, how often a coder must reopen a chart, median query response time and the share of discharge summaries completed within 24 hours. Balancing measures watch for harm elsewhere: scanning errors on the units, coder overtime hours, physician complaints to the medical staff office and claim denials for coding reasons. Benneyan et al. (2003) describe how statistical process control helps separate real improvement from normal variation, so outcome and process measures will be plotted on control charts, and a change will be judged successful only when the charts show a sustained shift.

Roles and Communication

The coding manager leads cycles two and three, the scanning supervisor and a unit manager lead cycle one and the physician advisor leads cycle four. The director owns the overall plan and reports to the sponsor monthly. A single page with the aim, the current charts and the next tests will be posted in the department and shared with patient financial services and the medical records committee each month, so every group sees the same numbers.

Risks to the Plan

The plan could stall in three places. Unit clerks may not have time to scan during busy discharge periods, so cycle one includes a count of discharges per shift and a fallback to central scanning when a unit exceeds a set number. Physicians may treat weekly lists as another nuisance; the physician advisor will ask the medical executive committee to endorse the feedback before cycle four begins. And vacancies could undo gains if two more coders leave; the market pay review and career ladder are being pursued in parallel, outside the test cycles, because they depend on human resources and budget decisions rather than on department process.

Holding the Gains

Improvements fade when attention moves on. Changes that succeed will be written into department procedures and job descriptions, the unit clerk scanning task will be added to unit orientation, and the discharge summary rule will be proposed for the medical staff rules. Control charts will continue after the project ends, with a trigger for review if a measure crosses its control limit two months in a row.

Conclusion

This plan converts Kettle Creek's redesign into a sequence of small, measured tests aimed at cutting unbilled days to 3.0 and keeping delinquency under the threshold without sacrificing accuracy. A driver diagram ties each change to the aim, plan-do-study-act cycles test changes before they spread, feedback follows the evidence and balancing measures watch for harm. The final project will place this plan within a three-year strategy for the department.

References

Benneyan, J. C., Lloyd, R. C., & Plsek, P. E. (2003). Statistical process control as a tool for research and healthcare improvement. Quality and Safety in Health Care, 12(6), 458-464. https://doi.org/10.1136/qhc.12.6.458

Ivers, N., Jamtvedt, G., Flottorp, S., Young, J. M., Odgaard-Jensen, J., French, S. D., O'Brien, M. A., Johansen, M., Grimshaw, J., & Oxman, A. D. (2012). Audit and feedback: Effects on professional practice and healthcare outcomes. Cochrane Database of Systematic Reviews, (6), Article CD000259. https://doi.org/10.1002/14651858.CD000259.pub3

Taylor, M. J., McNicholas, C., Nicolay, C., Darzi, A., Bell, D., & Reed, J. E. (2014). Systematic review of the application of the plan-do-study-act method to improve quality in healthcare. BMJ Quality & Safety, 23(4), 290-298. https://doi.org/10.1136/bmjqs-2013-001862