Subject Administration Health/Medical/Hospital Administration Keywords
TOPIC AREA: Management
CAST STUDY TITLE: Application of Management Techniques
Six weeks ago, Melanie Weaver, RHIA, was hired as the Health Information Department Director. Melanie has reason to believe she has had sufficient time to become oriented to the Department and identify some of the problems within the Department that need to be addressed.
Through observation and interaction with the Health Information Department employees, Melanie has noted the following:
1. Sally, the Release of Information clerk, is asking Melanie questions regarding release of information approximately five times per day. Sally appears to be unsure of herself and is afraid she is going to release patient information inappropriately. Requests for information for patient records are backlogged for four weeks. Sally states she is behind on her work because she spends so much time answering phone calls for other department employees. Sally says that responding to phone calls, other than release of information requests, is not supposed to be part of her job.
2. The work performed by the two discharge analysis clerks is inconsistent. One of the clerks requires signatures on all medical record entries. The other clerk requires signatures on only certain entries. It has been noted that the two clerks assemble the patient charts in a slightly different order.
3. The three file clerks bicker among themselves. Two of the file clerks, Anita and Becky, have complained to Melanie that the third file clerk, Sue, does not do her share of the work. They say they have found Sue sleeping on the job.
4. There is no established method to determine which employees should receive merit increases. The department employees state that the last supervisor simply stated they were “all doing a good job” and divided the available merit pay equally. Some of the employees complain that this practice is “unfair,” and that id toes not provide incentive. Some employees say that they work “harder” and do a better job than others and should be rewarded for their efforts.
5. Finally, Melanie also realizes that she has “inherited” (from the former director) too many routine, time-consuming tasks which could be easily handled by one of the other department employees. Melanie believes that the time performed to do these tasks would be better spent implementing good management techniques.
1. For each of the above (1-5):
a. Analyze the situations and identify the problems.
b. Utilizing sound management techniques, develop appropriate solutions for each of the many identified problems. Which of the solutions may have department-wide implications?
c. Should problems and solutions be implemented? If so, in what order?
2. What management techniques could Melanie employ to promote employee acceptance of the solutions? How should the solutions be implemented to help assure successful resolution of the problems?
3. What could be some of the possible outcomes if Melanie chooses to ignore the problems?

TOPIC AREA: Personnel Administration
CASE STUDY TITLE: The Disputed Termination
Tim Brown is the supervisor of the coding section of a medical record department in a 600-bed hospital, and Marlene Jackson is the assistant
director. Jackson supervises coding, record processing, incomplete records, and transcription. For several years, Jackson has been hearing complaints about Brown from the employees in his section. The complaints range from incorrect judgments regarding code selection, to inconsistent behavior in his management practices. These include allegations of “playing favorites,” failure to take responsibility for coding decisions which he made that caused disallowed claims, blaming the backlog on the coders when the claimed the work was distributed unevenly, and that their schedules had been mixed up. They assert that this is not corrected, even when brought to his attention. In fact, he seems defensive and irritated when someone mentions the schedule of work distribution. The coders complain that when one of this “friends” declared that she was “not going to code Medicare patients because they were too hard and took too long,” Brown accommodated her and reallocated the Medicare workload, which had been shared by the three best coders in the past. There are two shifts of coders in order to make the most efficient use of the encoding/grouper system installed two years ago. Two employees refused the shift assigned and Brown changed the schedule for them, according to the disgruntled employees.
Over the years, the relationship between Brown and his supervisor, Jackson, has deteriorated. Jackson tends to avoid confrontations, but employee dissatisfaction is so high, that Jackson decided to make a change and replace Brown. Jackson met with Brown and issued a warning that if the problems were not worked out within three months, he would be terminated. At the end of that time, there was no improvement, and Jackson requested a meeting with you, the Director of Medical Records.
At that time, she informed you of her request to terminate Brown.
In your consideration of the situation, you review Brown’s personnel file, which includes the performance appraisals for the past four years. According to hospital policy, these annual appraisals are to be scheduled on the employee’s anniversary date. You note that the appraisals have been 2-5 months late each year, and that Jackson has rated Brown as consistently “meeting standards” in all of the routine measures for quality and quantity of work. In the comments section, Jackson does make suggestions about how Brown could improve his handling of scheduling and equal treatment of employees. The only documentation of the meeting, where the three-month warning was alleged to have been given, is a note which was not signed by Brown. Brown denies that he had any knowledge of the three-month warning. He objects to his termination and alleges that the comments merely reflect a personality conflict, and that the evaluations clearly show that he was meeting all standards. Jackson responds that these comments are proof for existence of problems, and they were part of the evaluation discussions. You investigate these allegations by interviewing the employees and conclude that there are indications that Brown was an incompetent manager.

1. What action would you take? Why would you take this action?
2. Does Brown have grounds to appeal the decision if he is terminated?
3. Write a memo to Jackson outlining steps that she must take to change supervisory practices.
4. How could this situation have been avoided? Where does the responsibility lie?

TOPIC AREA: Personnel Administration
CASE STUDY TITLE: Performance Appraisal
Kim Madison, transcription supervisor, completed a performance appraisal on Nancy Speed, one of four transcriptionists. Following the appraisal, Nancy became upset about two areas, attendance and employee relationships, on which her performance was rated slightly below average. She states, “That’s not fair! I work twice as hard as anybody else does! I was sick part of last year and that’s why I fell short in those two areas. How did you rate the others?” After her supervisor explained her reasons, Nancy slumps back in her chair and says: “Forget it. You just want to pick on me. This whole thing is stupid.” Nancy also refuses to sign the performance appraisal.
1. Is it possible that Nancy could have been better in attendance and employee relationships than the supervisor rated her?
2. If these areas were deficient on Nancy’s previous performance appraisal, what type of support should she have received throughout the year?
3. What type of documentation should Kim have to support her reasons for evaluating Nancy below average?
4. How does Kim explain to Nancy that she is not “picking” on her?
5. How does Kim explain the importance of performance appraisals to Nancy?
6. Should Kim change the performance appraisal in order that Nancy will sign it?
1. A.
Sally, Release of Information Clerk, claims that she is tasked to handle duties that are not professionally hers thus reducing her efficiency in the central role. Melanie has also noticed that Sally is inconsistent in her roles and constantly asking for clarification. In an objective analysis, there seems to be a problem with workflow and time allocation. The fact that Sally spends most of her time performing support roles, in which she is less experienced, further worsens the situation.
In the second scenario, there is a problem with the inconsistency of work processes despite similar roles allocation. One of the clerks requires a single process in one of her tasks while the other omits the processes in most of her tasks. In the end, the difference in a number of operations reduces the efficiency and delivery speed of one of the clerks thus overworking her....

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