HI305 Unit 10 Operations Improvement Plan Example

From Discharge to Fully Scanned in Two Days: A Unit 10 Operations Improvement Plan Removing Two Paper Streams, Barcoding the Rest and Measuring Whether the Imaging Queue Really Shrinks

[Student Name]

Purdue University Global

HI305: Management of Health Information

Unit 10 Operations Improvement Plan

[Instructor Name]

[Date]

The hospital, its units, the baseline figures and targets are composite; the methods and sources cited are real.

Aim

Before the close of the second quarter, the median time from a patient's discharge to the last loose document being scanned and indexed will fall from 8.5 days to 2 days or less, for all inpatient and emergency discharges, while indexing accuracy stays at or above 99.5 percent. The plan follows the improvement model of Langley et al. (2009): state the aim in numbers, decide in advance how a gain would be recognized, and try each change small before spreading it.

Why This Measure

The department has tracked its backlog in days of work waiting, which matters to the team. Physicians and the hospital care about something else: how long a record stays incomplete after discharge. The new measure follows each record from discharge until its last scanned document is indexed. It is calculated weekly from the imaging system's timestamps and the discharge date. Medicare's hospital conditions set thirty days after discharge as the limit for completing a record under 42 C.F.R. § 482.24, so a record that waits eight days for scanning leaves physicians little time to complete their part.

Measures

Outcome measure: median days from discharge to fully scanned, weekly. Process measures: pages arriving per week by source; share of pages arriving with a barcoded cover sheet; preparation seconds per page from a monthly ten-batch time sample. Balancing measure: indexing accuracy from the quality analyst's weekly 2 percent review, because faster work could mean less careful work. The plan also counts overtime hours, so improvement is not bought with fatigue.

Causes Found Earlier

The workload analysis showed arrivals of about 41,600 pages a week against capacity of about 168 productive hours, with two new sources, the cardiac rehabilitation clinic and the emergency department discharge checklist, accounting for a quarter of the volume. The time study showed preparation took three times as long as scanning, mainly removing staples and sorting pages by encounter. Barcoded batches indexed about twice as fast as those done by hand. These findings point to three changes, ordered by the size of their likely effect.

Change 1: End Two Paper Streams

The emergency department will move its discharge checklist to electronic signature on the tablets already used for consent, removing about 5,400 pages a week. The cardiac rehabilitation clinic will enter exercise logs directly into the record at the session rather than printing them for scanning, removing most of its 5,200 pages a week. Each will be tested for two weeks on one shift before full adoption. Owner: the HIM director, working with each department's manager. Prediction: weekly arrivals fall by about 9,000 pages, and the median falls by at least three days within a month. The fastest page to scan is the one that was never printed. Removing a quarter of the paper does more than any change inside the department could.

Change 2: Barcoded Cover Sheets on Two Units

The two medical units that send the most paper will print a barcoded cover sheet for each patient's loose documents at discharge. Owner: the imaging supervisor with the unit clerks. Test: two weeks on one unit, measuring the share of batches arriving with a sheet and indexing time per page. Prediction: indexing time for those batches falls by about half.

Change 3: Paper Sent Unstapled and Sorted

Units will send loose paper unstapled in the discharge envelope, with consents on top. Owner: the supervisor and the nurse managers. Test: one unit for two weeks, measured by the monthly preparation time sample. Prediction: preparation time falls by about two seconds a page.

How Improvement Would Show

The team will chart the weekly median over time, beginning with eight weeks of baseline. Improvement is shown by a run of six or more weeks below the baseline median, or a clear downward shift after each change, using the run chart rules common in health care improvement work (Perla et al., 2011). Accuracy must stay at or above 99.5 percent throughout; if it falls for two weeks in a row, changes pause until the cause is found.

What Would Mean the Plan Failed

If the median is still above four days after all three changes, the problem is capacity, not process, and the department needs a further staffing change. If arrivals do not fall after Change 1, the electronic replacements are not being used, and the barrier must be found before moving on. The plan treats either result as information rather than as defeat.

Who Is Involved

The plan depends on people outside the department, so it names them. The emergency department's nurse manager and its clinical informatics nurse own the move to electronic signature for the discharge checklist. The cardiac rehabilitation clinic's coordinator owns the change to direct entry of exercise logs. The unit clerks on the two medical units own the cover sheets, with the imaging supervisor providing the printer setup and a five-minute training at each unit's huddle. The specialists own the time samples and the quality review. The HIM director chairs a fifteen-minute review every two weeks where the run chart is read and the next test is chosen. Without named owners outside HIM, the department would be left trying to change other people's work from the scanning room, which rarely succeeds. Naming owners also means the review meeting can ask a person, not a department, what happened with each test.

Risks

The first risk is that the electronic replacements slow down the departments that adopt them, which would make staff there quietly return to paper. The two-week tests on one shift are designed to show this early. The second risk is that a falling backlog leads the hospital to cut the new half position before the gain is stable. The plan asks that staffing stay unchanged until the median has held at two days for eight weeks.

Sustaining the Gains

Once the aim is met, the outcome measure moves into the department's monthly report to the HIM committee. Each new paper form proposed anywhere in the hospital will be reviewed by HIM before it is printed. Improvement that depends on one supervisor's attention tends to fade when that person moves on, and the review rule keeps the gain in place after the project ends.

References

42 C.F.R. § 482.24 (2024).

Langley, G. J., Moen, R. D., Nolan, K. M., Nolan, T. W., Norman, C. L., & Provost, L. P. (2009). The improvement guide: A practical approach to enhancing organizational performance (2nd ed.). Jossey-Bass.

Perla, R. J., Provost, L. P., & Murray, S. K. (2011). The run chart: A simple analytical tool for learning from variation in healthcare processes. BMJ Quality & Safety, 20(1), 46-51. https://doi.org/10.1136/bmjqs.2009.037895