HIM 520 Module 3 Final Project Milestone One Example

Final Project Milestone One: Three Cultures, One Department, a Leadership Assessment at Sycamore Bend Health

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Southern New Hampshire University

HIM 520: Leading as a HIM Professional

Final Project Milestone One

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[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 One: Three Cultures, One Department, a Leadership Assessment at Sycamore Bend Health

A merger combines org charts quickly and people slowly. Sycamore Bend Health's health information department now has one director and one budget, but its 132 staff still describe themselves by their former hospital. This milestone assesses the department as it is, before the leadership plan proposes what it should become. It covers structure, culture, engagement, staff voices, outside stakeholders and the leadership challenges that follow.

Structure

The department has four functional teams across three sites. Coding, with 67 staff, is mostly remote and reports to one coding manager. Record completion and scanning, with 28 staff, operates separately at each hospital. Release of information, with 19 staff, is also site-based, with three different request logs. Clinical documentation integrity, with 18 staff, sits in the department at two hospitals and under nursing at the third. Five supervisors report to the director, but their spans range from 9 to 31 staff.

Three Inherited Cultures

Each former department brought its own culture. The flagship hospital's team ran on published targets and friendly competition, with results posted by name. The second hospital, a community facility, relied on long-tenured staff, informal routines and loyalty to a manager who has since retired. The acquired hospital's team valued collaboration and weekly check-ins but felt the acquisition was imposed on them. Cummings et al. (2018) found that relational leadership styles in health care were associated with better staff satisfaction and retention than task-focused styles, which helps explain why staff from the third hospital describe the flagship's culture as cold, while flagship staff see the third hospital's as slow.

What the Engagement Survey Shows

The system's annual engagement survey, completed by 104 of the 132 staff, shows sharp differences by former site. Table 1 summarizes four items.

Table 1. Engagement Survey Results by Former Site (Percent Favorable)

Note. System engagement survey, 79% response rate; composite data.

What Staff Said

The director held nine listening sessions with 38 staff across roles and sites, asking what was working, what worried them and what they needed. Three themes dominated. Staff from the acquired hospital felt their procedures were being replaced without explanation. Coders at every site said they learned about changes from emails rather than conversations. And many staff, including those who scored highest on engagement, did not know how their jobs would change. The item on raising concerns deserves particular weight. Edmondson (1999) linked a team's sense that speaking up is safe to more learning behavior and better results, so low scores on that item at the flagship and acquired hospital signal that problems may be surfacing late.

Stakeholders Outside the Department

The department's leadership task extends beyond its staff. Physicians at the acquired hospital face new record completion rules and a different query process. Nursing leaders at the third hospital manage its documentation integrity staff and are uncertain about moving them. Finance expects a single release of information fee schedule and faster coding. Human resources is working through pay harmonization. Each group will judge the department by how changes affect them, so the leadership plan must include how the director will communicate with and involve each one.

Four Leadership Challenges

The assessment points to four challenges. The first is trust, which is lowest at the acquired hospital and depends on explaining decisions and keeping promises. The second is voice: staff at two sites do not feel safe raising concerns, which delays problem solving. The third is uncertainty about roles, which feeds turnover; Hom et al. (2017) describe how people who cannot see their future in an organization become easier to lure away. The fourth is divergent procedures, with three ways of completing records and releasing information, which frustrates staff and confuses physicians and requesters. Harrison et al. (2021) observed that the change models hospitals rely on repeatedly put the people being changed at the center, a principle that governs how the three sets of procedures should be merged.

The Director's Own Starting Point

An honest assessment includes the leader. The director came from the flagship hospital, where the target-driven culture was normal, and several staff at the acquired hospital assume the merger means their ways will simply be replaced by the flagship's. That assumption is partly the director's to disprove. It also means the director's instinct to fix procedures first may reflect the flagship's culture rather than what the whole department needs. Recognizing this bias is one reason the plan puts trust and voice ahead of standardization, and why staff from the acquired hospital will lead two of the procedure work groups.

Early Steps Already Taken

Three small steps began during the assessment. The director stopped posting individual coding results by name, replacing them with team results and private individual reports. Supervisors at all three sites now hold a monthly joint meeting so that problems are raised across sites rather than only within them. And the director committed to answering every question raised in listening sessions in writing within two weeks, a promise tracked in a shared log. These steps are modest, but they test whether the department can see leadership keep its word before larger changes arrive.

Priorities for the Leadership Plan

The plan should address trust and voice before procedures, since unified procedures imposed on a team that does not trust leadership will fail. Its priorities, in order, are: a clear account of how each role will change, delivered in person; regular two-way communication with every team; a training and development plan that treats the three sites' expertise as assets; unified procedures developed with staff from all three hospitals; and balanced spans of control for supervisors. The next two milestones will develop the training plan and the work design for release of information.

Limitations

The survey was conducted system-wide and not designed for this assessment, and staff who chose to attend listening sessions may not represent everyone. The director's own position may shape what staff were willing to say, which is why the plan includes anonymous follow-up questions.

References

Cummings, G. G., Tate, K., Lee, S., Wong, C. A., Paananen, T., Micaroni, S. P. M., & Chatterjee, G. E. (2018). Leadership styles and outcome patterns for the nursing workforce and work environment: A systematic review. International Journal of Nursing Studies, 85, 19-60. https://doi.org/10.1016/j.ijnurstu.2018.04.016

Edmondson, A. (1999). Psychological safety and learning behavior in work teams. Administrative Science Quarterly, 44(2), 350-383. https://doi.org/10.2307/2666999

Harrison, R., Fischer, S., Walpola, R. L., Chauhan, A., Babalola, T., Mears, S., & Le-Dao, H. (2021). Where do models for change management, improvement and implementation meet? A systematic review of the applications of change management models in healthcare. Journal of Healthcare Leadership, 13, 85-108. https://doi.org/10.2147/JHL.S289176

Hom, P. W., Lee, T. W., Shaw, J. D., & Hausknecht, J. P. (2017). One hundred years of employee turnover theory and research. Journal of Applied Psychology, 102(3), 530-545. https://doi.org/10.1037/apl0000103