Lessons Learned_Managing Remote Workers_2016.pdf

HIT Class of 2016

Tacoma Community College

Lessons Learned:

Managing Remote Workers

UNLOCKING THE FUTURE:

INFORMATION IS KEY

Paula Dascher, RHIA

Manager, Clinical Documentation & HIM Technology

Seattle Children’s Hospital

Seattle Children’s Vision:

•

Provide the

safest, most effective

care possible

•

Control and reduce the cost of providing care.

February 25,

•

Find

cures

and educate

clinicians and researchers

•

Grow

responsibly and

provide access to every

child who needs us.

Talking Points: Lessons from Managing

30 Telecommuters

•

Communication

•

Purpose of Meetings

•

Policies / Procedures

•

Time Off and Flex Time

•

Measuring Workload,

Productivity & Compensation

Clinical Documentation and Distribution

System Diagram

Intelliscript

Voice Recognition

Datacenter - Boston

Dictation

Voice Capture Servers (2)

3M/CSMD

Cerner

Print/Mail/Fax

Digital Voice

Rrecorder

Distribution

Transcriptionist

I-phone/Droid app

Edit/sign

Imagine you work at home and you hear unfamiliar

Communication: Morning Message (email)

6/3/2016

Happy Last Day of May! Looks like it is a winner too –80’s and sunshine! The ride in today sure was pretty. Hope you had a nice holiday weekend. It always seems to rain a little bit on Memorial Day Weekend, but yesterday was sure nice.

Office Staffing today: Paula is on PTO today and will be back tomorrow. Kannis is working from home and Vicky is out sick today.

Exclusion Dictionary word - I’m doing a report where “myectomy” is sometimes showing up in the report as “myomectomy,” thought

that might be one to add to exclusion dictionary.

Here’s “What’s Trending in the Pend” for this week:

Alopeciapalooza (DER) –camp for kids with…yep, alopecia!

accommodative lead or lag (OPH)

Diasend (DIA) website for blood glucose data logging AM (accessory medial) portal/bundle (ORT)

Lelli’s knee test (ORT)

iGaze vision-enhancing computer program (OPH) lancet-shaped macules (DER)

buphthalmos (OPH) – Baran uses this a lot vitrectorhexis (OPH)

rhytides (ENT)

outcropper muscles (ORT)

LSAT (SLE) – term used in sleep studies for lowest O2 sat Pron. “elsat” Provider Names:

Annelise Joslin, ARNP (not Jocelyn Annalise) (NDV) Rob DiBlasi, Mgr of Clinical Diagnostics

Cassady Kintner, LMFTA

Eden Palmer, Medical Photographer

Sound-Alikes:

SPARK (Simons Foundation Powering Autism Research for Knowledge) SPARC (Studying the Physiology of Attention and Regulation in Children)

Meetings on Site: 6/year 2 hours long

Purpose:

•

Connect employees to each other

•

Connect employees to the hospital

environment (barn sour)

•

Speakers invited that interest staff

•

Clarify procedures

Genetics Presentation:

Structural Chromosome Abnormalities

Pure deletion: 46,XY,del(4)(p16) or 46,XY,del(4)(p16pter)

or 46,XY,del(4)(pter-p16)

Mentoring and Continuing Education

Department

New term

Rheumatology

No epidermal

irrational

changes or

inflammation

Orthopedics

Bounce

home test (knee exam)

Neurology

Sphenopalatine

ganglion

Gastroenterology

SIBO

(small intestinal bacterial overgrowth)

syndrome (pronounced “See-bo”)

Dermatology

Collarette

scale

6/3/2016

Essential for one-piece flow,

error proofing, and ensuring

that performance is

measurable!

Documented Policies and Procedures guide

performance

Policies & Procedures

Telecommuting

agreement

Productivity

Expectations

(including

disciplinary action)

Productivity Bonus

Pay Plan

Quality Assurance

Policy

Work Schedules

Time Keeping System

Time Off Policy

Support Phone

numbers

After Hours and

Work Schedules and Deviations

Biggest challenges

:

•

Staff not working scheduled hours or flexing work

hours

•

Staff does not answer the phone when they are

supposed to be working

•

Staff calls in sick, but want to make up the time later

in the week (excessive flex time)

•

Staff is not meeting minimum productivity

expectation consistently (are they working when

they are clocked in?)

Measuring Workload, Productivity & Capacity

Workload:

Dictation is measured in minutes dictated per month

Productivity: Lines transcribed per hour (min. 300)

Goal: Flatten the curve between highest & lowest

performers: Sharing Information Sideways (Yokoten)

6/3/2016

1 2 3 4 5 6 7 8 9 101112131415161718192021222324 Lines/Hr

Transcriptionists

Productivity- Dec 4-17,

2006

Dept Ave: 176.6 lines/hour

0 100 200 300 400 500 600

1 2 3 4 5 6 7 8 9 10111213141516171819202122232425262728 Lines/Hr

Transcriptionists

March 17 - 23,

2014

;

Dept Ave 384 lines/hr

Current Productivity:

385 lines/hour

(average)

Lowest to Highest Range:

275-620 lines/hour

131%

productivity increase

since 2007 (9 years)

•

Patient Care, Safety

•

& Turnaround time

•

Contain

Cost

•

Quality/Accuracy of

the record/ Manage

growth/workload

•

System Stability,

Security/architecture

CIO and Sr.

Director of

Clinical

Applications

Director of

HIM

Pediatrician

in Chief

CFO

6/3/2016

Organizational Drivers

In order to manage COST, manage productivity

•

Reward high

performing team

members

•

Learn from high

performers

•

Have an action plan for

low performers

Productivity Bonus

Plan

Share information

sideways (morning

message, meetings)

Set clear expectations,

measure frequently

Productivity Bonus Structure at Children’s

Base pay

–

plus---

Bonus pay for

productivity above the

department median

Bonus for Quality score

above 99% accuracy for

the previous quarter

Ranges:

366-421 lines/hour

$180-$363 bonus/week

422-476 lines/hour

$146-$556 bonus/week

477 lines/hour and up-

≥ 98% Accuracy

Random Quality Check

•

Every MT gets a

random quality

check every

quarter.

•

Multiple notes,

compared to

dictation voice file.

•

Bonus 10 lines/hr

for 99% + accuracy

Stop and Fix

Abnormalities

Errors

+ Re-Work

= Waste

“Any activity that costs time &

money & does not add value is…

Focus on Error Prevention

6/3/2016

•

We are

accountable

for preventing errors.

•

We

respect

other's input and opinions regarding safety.

•

We work as one

team

to create a safe and reliable

environment.

When information is dictated that contains a discrepancy or

possible error

that may cause harm to the patient

, MTs are

frequently the first line for catching the error, and/or preventing

the error from perpetuating in subsequent documentation.

Seattle Children’s Vision:

•

Provide the safest, most effective care possible

•

Control and reduce the cost of providing care.

February 25,

•

Find

cures

and educate

clinicians and researchers

•

Grow

responsibly and

provide access to every

child who needs us.