HIM 520 Module 7 Final Project Milestone Three Example

Final Project Milestone Three: One Team, One Log, Redesigning Release of Information at Sycamore Bend Health

[Student Name]

Southern New Hampshire University

HIM 520: Leading as a HIM Professional

Final Project Milestone Three

[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 Three: One Team, One Log, Redesigning Release of Information at Sycamore Bend Health

Release of information is where the public meets the health information department: patients requesting their records, attorneys, insurers, other providers and government agencies. At Sycamore Bend Health, it is also where the merger's differences are most visible. The Milestone One assessment identified divergent procedures as one of four leadership challenges, and release of information is the clearest example. This milestone redesigns the function, paying attention both to the process and to the jobs of the 19 people who do the work.

The Current State

Table 1 compares the three site teams. Each uses its own log, fee schedule and procedures. Turnaround ranges from 4 days at the flagship to 13 at the acquired hospital, where two staff handle the highest volume per person. A spot audit found that the acquired hospital had also sent two records to the wrong requester in the past quarter, both caught only after the recipients called.

Table 1. Release of Information by Site, Last Quarter

Note. Department data for the last quarter; composite organization.

What the Research Suggests

Two bodies of research inform the redesign. From their realist synthesis of hospital Lean projects, Mazzocato et al. (2010) concluded that such efforts paid off when hospitals treated them as a way to study and standardize processes and build habits of problem solving, rather than applying isolated tools. That supports a single process built from the best of the three sites. Humphrey et al. (2007), in a meta-analysis of work design research, found that jobs offering autonomy, task variety, significance, feedback and social support were associated with higher satisfaction and performance. That warns against a pure assembly line in which each person handles one narrow task all day. Patients' experience matters too. Posing as patients, Lye et al. (2018) phoned top-ranked hospitals, and the answers about formats, speed and price often clashed with the hospitals' own forms, the kind of inconsistency three separate procedures produce.

The Redesigned Process

All requests will enter one system-wide log in the vendor software already used at the flagship. Requests arriving by mail, fax, portal or in person at any hospital will be scanned into the log the same day. The log will sort requests into four streams: patient requests for their own records, continuity of care requests from other providers, legal and insurance requests and government requests. Each stream has a standard record set, a verification checklist and a target turnaround, from same day for continuity of care to ten days for legal requests. Patient requests will use one fee schedule consistent with federal guidance, and patients will receive the same information about formats, fees and timing regardless of which hospital they call.

Designing the Jobs

The team of 19 will be organized as a single unit with a lead, but jobs will not be reduced to single tasks. Each specialist will be trained in two streams and rotate between them weekly, which adds variety and allows coverage during absences. Specialists will own a request from receipt to release rather than handing it along a chain, giving them autonomy and a complete piece of work. Each will see a weekly dashboard of their turnaround and accuracy, which provides feedback from the work itself. And the team will meet by video twice a week, keeping social support in a group that will be partly remote.

Staffing Model

The combined volume of about 3,900 requests a month, at a sustainable pace of about 200 requests per specialist, requires 19 to 20 specialists, which matches the current staff when the acquired hospital's overload is spread across the team. The lead role will be filled by a current specialist from the community hospital, whose knowledge of all four request types made her the strongest candidate. One onsite specialist will remain at each hospital to help walk-in requesters and handle urgent in-person needs, while the others may work remotely. Volume will be reviewed each quarter, since patient requests are rising as more people use the portal, and the model will add a specialist whenever sustained volume exceeds 210 requests per person.

Guarding Against Misdirected Releases

Speed must not come at the cost of accuracy. Every release will pass a two-identifier check matching the patient's name and date of birth on the request against the record being released, and every legal and insurance release will receive a second-person check before sending. The two misdirected releases at the acquired hospital will be reviewed as breach risk assessments by the privacy officer, and the team will track misdirected releases monthly with a target of zero.

Involving Staff and Phasing the Change

According to Harrison et al. (2021), hospitals get more from change frameworks when those frameworks are joined to hands-on improvement that includes front-line staff. A design group of five specialists, at least one from each site, drafted the four streams and checklists, and the full team reviewed them before approval. The move will happen in three phases over four months: first the single log and fee schedule, then the four streams at the flagship and community hospital and finally the acquired hospital, whose staff will be given time to learn the software before their paper process ends.

Measures

Success will be judged by median turnaround by stream, misdirected releases, patient complaints about records requests, fee errors in audits and staff engagement scores for the team. The goal for the first year is a median of five days or less for patient requests at every site and no misdirected releases.

Conclusion

Centralizing release of information gives Sycamore Bend one process, one log and one standard for patients, while job design keeps the work varied, owned and connected. Involving staff from all three hospitals in the design and phasing the change respects the concerns the assessment identified. This redesign becomes a central piece of the final leadership plan.

References

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

Humphrey, S. E., Nahrgang, J. D., & Morgeson, F. P. (2007). Integrating motivational, social, and contextual work design features: A meta-analytic summary and theoretical extension of the work design literature. Journal of Applied Psychology, 92(5), 1332-1356. https://doi.org/10.1037/0021-9010.92.5.1332

Lye, C. T., Forman, H. P., Gao, R., Daniel, J. G., Hsiao, A. L., Mann, M. K., deBronkart, D., Campos, H. O., & Krumholz, H. M. (2018). Assessment of US hospital compliance with regulations for patients' requests for medical records. JAMA Network Open, 1(6), Article e183014. https://doi.org/10.1001/jamanetworkopen.2018.3014

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