HI550 Unit 2 Department Assessment Example

Five Doors, Two Clocks: A Unit 2 Assessment of Where Work Waits in a Merged Three-Hospital Health Information Department

[Student Name]

Purdue University Global

HI550: Organizational Development and Management for Health Information

Unit 2 Department Assessment

[Instructor Name]

[Date]

Quillan Health, its hospitals, staff and every figure are composite; the model and rule cited are real.

Summary

The health information department at Quillan Health serves a regional medical center, a community hospital at Hollis and a critical access hospital, under one record system since the merger nine months ago. Six streams of work were measured over thirteen weeks. Ranked by days of waiting, release of information comes first and coding third, the reverse of how the department's leaders described the problem. Two stalls explain most of the delay: release requests that arrive by fax or shared email wait a median of three and a half days before anyone logs them, and unsigned operative notes from four surgeons make up 61 percent of the chart completion queue. Both problems sit in the department's helpful mechanisms and its relationships with other groups, not in its staffing or its people.

Methods

The evidence came from four sources. Thirteen weeks of work queue reports from the record system gave arrivals and completions for coding, chart completion and outside record indexing. The release log gave dates of receipt and response for requests that were logged. Because phone calls, walk-ins and loose clinic paper leave no electronic trace, every staff member kept a tally sheet for two weeks. Last, eleven staff across the three hospitals were interviewed for thirty minutes each, after the queue data had been summarized, using the same six questions. Interviewees were told the numbers and asked to explain them, which turned the interviews into a test of the figures.

Days of waiting was computed for each stream as items waiting on a stated date divided by average daily completions. The measure answers a practical question: if no new work arrived, how many working days would it take to clear what is already in line? It also allows streams of very different size to be compared.

The Six Streams

1. Inpatient and outpatient coding: about 1,950 arrivals a week, 1,180 items waiting, oldest item nineteen days, 3.0 days of waiting.

2. Chart completion: about 640 deficiencies a week, 1,410 waiting, oldest 47 days, 11.0 days of waiting.

3. Release of information: about 310 requests a week, 520 open, oldest 34 days, 8.4 days of waiting.

4. Outside records for indexing: about 870 items a week, 690 waiting, oldest 21 days, 4.0 days of waiting.

5. Loose clinic paper: about 260 items a week, 300 waiting, oldest 16 days, 5.8 days of waiting.

6. Amendment requests: about four a week, nine open, oldest 52 days, 11.3 days of waiting, although the numbers are small.

Coding has by far the most items and draws most of leadership's attention, yet it clears its line fastest. Release of information has a sixth of coding's volume and nearly three times its waiting, and it is the stream that carries a legal deadline.

Stall One: The Release Request Nobody Has Logged

Requests reach the department through five routes: the patient portal, mail, walk-ins at each hospital's front counter, a fax line at each site and a shared email inbox. Portal and walk-in requests are entered in the release log the day they arrive, because the portal writes its own entry and the counter staff enter walk-ins in front of the requester. Mail is logged within a day by the release team at the regional center. Fax and email are different. Faxes print at Hollis Community and at the critical access hospital, are scanned to the shared inbox, and wait there with outside email requests until a specialist has time to sort them.

The release log shows the cost. For the 212 requests in the sample that arrived by fax or email, the median gap between the date on the request and the date it entered the log was three and a half days, and twelve percent waited more than a week. The clock that staff watch therefore starts late. The federal right of access gives a covered entity thirty days to act on an individual's request, with one extension of up to thirty more (45 C.F.R. § 164.524, 2024). The department reports a median response time of six business days, which looks comfortable, but the figure is measured from the log date. Measured from receipt, nine requests in the sample passed thirty days without an extension letter.

Interviews confirmed the pattern and added a reason. Specialists described the shared inbox as everyone's job and therefore no one's first task. Two staff believed that the inbox was checked every morning by a colleague at the regional center; the colleague said she checked it when the logged queue was empty.

Stall Two: Operative Notes Waiting on Four Surgeons

Chart completion has the largest days of waiting. When the 1,410 open deficiencies were sorted by type and physician, unsigned operative notes made up 61 percent, and four surgeons at the regional center accounted for most of them. Each of the four operates at two hospitals and dictates through a transcription service that sends notes for signature to an inbox they rarely open at the second site.

Two staff complaints were tested against the data and not supported. Coders at Hollis believed that chart completion delays held up their coding; in fact, only six percent of records waiting for coding were waiting on a deficiency. Release staff believed that chart completion caused their late responses; none of the nine late requests involved an incomplete record. Reporting these results matters because the department's own explanations would have sent effort to the wrong place.

Reading the Stalls Through the Six Boxes

Weisbord (1976) offered six boxes in which a diagnosis can look for trouble, running from what the unit is for and how it is divided, through how its people and neighbors get along and what they are paid in, to who steers and which tools hold it together. The model is used here to locate each stall, not to tour every box.

The release stall sits in helpful mechanisms. The shared inbox is a tool that lets work enter without an owner, a log or a clock. The fix is mechanical: every fax and email request is logged on the day it arrives, by a named person at each site, with the date of receipt rather than the date of logging.

The operative note stall sits in relationships, specifically the relationship between the department and the medical staff. Health information staff send reminders, but the surgeons answer to the chief of surgery, and the department has no channel to that office. Textbook practice places physician deficiency management with the medical staff's own leadership, supported by reports from health information (Oachs & Watters, 2020).

The remaining boxes receive a sentence each. Purposes are clear: staff at every site could state what their stream is for. Structure contributes a little, since three sites report to different supervisors, but neither stall would disappear under a different chart. Rewards do not explain the delays, because no measure praises slow logging. Leadership is engaged, if aimed at coding. The evidence clears these four boxes for now.

Limits

Thirteen weeks may not capture seasonal peaks, and the tally sheets depended on busy staff remembering to mark them. The critical access hospital's volumes are small enough that one absent employee changes its figures. The assessment does not yet include recommendations beyond the two mechanisms named, which belong to the structure analysis and staffing plan that follow.

References

45 C.F.R. § 164.524 (2024). https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-C/part-164/subpart-E/section-164.524

Oachs, P. K., & Watters, A. L. (Eds.). (2020). Health information management: Concepts, principles, and practice (6th ed.). AHIMA Press.

Weisbord, M. R. (1976). Organizational diagnosis: Six places to look for trouble with or without a theory. Group & Organization Studies, 1(4), 430-447. https://doi.org/10.1177/105960117600100405