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Rajakumar.M, The medical records department head must be more than a skilled technician; he must be both a leader and an innovator in building up a well-organized, efficient department. Constant effort is necessary to keep abreast of advances in both medicine and the technology of recording and retrieving data. The leadership challenge is a demanding one, and to some extent depends on innate talent. But the abilities needed to become a good leader can be developed by studying management functions and techniques. A clear definition of departmental need or problem is of greatest importance when planning. Once the problem has been identified, the planner can gather relevant data, and formulate and review all possible courses of action for solving the problem. After a well-thought decision, specific planning is necessary to ensure the chosen course of action is implemented. Objectives: Leadership objectives are the goals, which provide scope and direction to the department coordinator. The departmental objectives should complement and supplement overall hospital goals, and they should be understood by all. For example, the objective might be inactivating the old medical records. This objective provides direction for the department coordinator and supports the overall hospital goals of providing optimum health care. Policies: Policies provide guidelines for decision-making. A policy is an overall guide, which sets the boundaries within which managerial action will take place. A policy defines the area in which decisions are made but does not provide the coordinator with the decision. An effective policy requires interpretation by the coordinator. Thus, policies aid the coordinator in the decision-making process. Procedure: A procedure is a series of related steps designed to accomplish a specific task. The chronological sequence of steps is the distinguishing mark of any procedure. The medical record coordinator is responsible for planning the departmental procedures, which provide for standardization of tasks. Carefully planned procedures may result in greater productivity with less time and effort. In a medical records department procedures may be written for assembly and analysis of medical records, coding and indexing of medical records, filing and retrieval of medical records, and admitting and discharging of a patient. Once procedures in the department have been planned and tested, it is important to record them in writing, describing each of their phases in step-by-step detail and including correctly completed samples where appropriate. Any employee should be able to follow the procedure with a minimum of questions after initial on-the-job training is completed. The following steps will serve as an illustration for a step-by-step procedure.
General Description: The purpose of this procedure is to maintain accurate records of patients newly registered in the hospital. These records assist medical records personnel in locating both sociological and medical data on each patient. These records are also essential for generating diagnostic, surgical and statistical reports. Tools used in the Procedure:
Written procedures, which have been gathered together into a procedure manual, provide a valuable tool for two reasons. First, it provides an employee who regularly performs a procedure with an exact picture of what is expected Secondly; it is an invaluable aid in cross-training regular employees and in training new employees. It is helpful for a supervisor to go through a procedure with the employee at least once before the employee attempts to follow it by himself. The procedure should include samples of all the forms used in a procedure, which has been correctly filled out according to the procedural descriptions. With all procedures recorded in a written manual and no readily apparent procedural problems, the medical record coordinator often finds it easy to forget about procedural improvements. But, procedures can always be improved and periodic review can result in, for example, increased operating efficiency, lower costs, and better use of employees and/or equipment. Any procedure in the department, which has not been changed in over a year, should be reviewed. Chances are that, after careful review, all or part of the procedure will require changing or streamlining. Certain signals, such as bottlenecks in the flow, inadequate departmental forms, addition of new equipment and data processing systems, high costs, and unsatisfactory performance by employees, will alert the medial record coordinator to the fact that procedural review is needed. It is essential that the coordinator of medical records or the supervisor should be thoroughly familiar with a current procedure before he attempts to improve or replace it. He must make a detailed analysis of each step in order to locate inefficiencies. Flow Process Charting: One useful tool for studying and improving procedures is the flow chart. Each step of a procedure is written on the chart. In preparing the flow process chart, it must be remembered that either an employees actions or the papers being processed are charted. A new procedure may be designed and tested using the current procedure chart form. When a procedure is reviewed, the job description for the employees who carry out that procedure should be reviewed. Differences in the number of operations, transportations, inspections, and delays between the current and proposed new procedure are clues to the effectiveness of the proposed procedure. Job Descriptions: A written procedure is a series of steps carried out to describe the specific job of an employee. Job descriptions spell out the qualifications needed by an employee to perform a job in a satisfactory manner. The following will serve as an illustration for a job specification for a Medical Record Supervisor. JOB DESCRIPTION FOR MEDICAL RECORDS SUPERVISOR
Summary: Under general supervision of the Medical Records Coordinator, supervises 15 medical records assistants in the transaction of all medical records and statistical reports, and verifies that all medical records sent out for patients consultation to the units and specialties are properly returned by the end of each day. Ascertains that all tools and equipments are in proper functioning order at all times. Routine Tasks: With thorough knowledge of the work involved and with regular supervision, and subject to spot check, uses initiative and makes decisions independently during supervision of the department. He/She should be able to perform all the duties of the subordinates during their absence.
He/She should be a graduate with basic knowledge preferably in computers. Should be a good leader, with individual capacity to manage a department. Should cooperate with all the employees of the department and the clinical staff and other co-workers of the hospital. Working Hours: He/She will be working from 7.30 a.m. to 5.30 p.m. every day from Monday through Saturday. He/She will be given 15 minutes coffee break in morning and evening with one and a half hour lunch break. He/She is entitled for public holidays and casual, sick and annual leave as per the hospital norms and rules. Salary: Salary will be fixed according to the hospital norms and rules for the particular category. The qualification and experience of a person will also be taken into consideration while fixing the salary. After successful completion of the probation period, the salary will be raised according to the category and performance of the employee. Line of Promotion: The line of promotion will be based on experience and performance of an employee. He/She may be promoted to the level of the coordinator depending upon the ability and the work performance during the course of his/her carrier. Part of the planning function is providing employees with the proper work environment. This includes planning for office space and location, office furniture and equipment, and spatial conditioning factors such as lighting, color, sound and air. Departmental layout: Proper layout of the medical record department adds to its efficiency and attractiveness. The key consideration in layout is workflow-the flow of record work from desk to desk. Desks should be arranged so that, as far as possible, record work moves in straight line and only a short distance at a time. Temperature, color and lighting: When designing an office layout, the medical record technician should also consider environmental factors such as temperature, humidity and ventilation. These factors have been proven to have a direct effect on employee productivity and comfort. The ideal office temperature is said to be about 70 Fahrenheit with a relative humidity of 40% to 60%. Recommended means of keeping the air moving in the office include air conditioning, window fans, and ventilators. The proper use of color is another important consideration in office design. Effective use of color not only spruces up an office, but also improves working conditions. Psychologically color can affect human emotions, senses, and thought processes, as well as individuals ability to relax. Some colors will have a favorable psychological effect; others a negative effect. Some colors give a lift; others can either hasten or depress mental action. Lighting is another environmental factor, which cannot be overlooked. Light sources on the ceiling can usually provide enough light for the entire office area at a prescribed level of illumination. It is recommended that the medical record technician consult a lighting expert about the most efficient methods for obtaining adequate illumination. Location Requirements: The medical record department is in constant communication with the registration departments of the outpatient and inpatient care units. Every day, many members of the medical staff visit the records for completion of medical records or for records reference. Ensuring prompt completion of, and ready access to, medical records requires that the medical record department be located along the pathway most often used by doctors and in an area near the admitting and discharge office, new and review registration area and front office. If the medical record department is not staffed 24 hours a day, it should be located within easy walking distance from the admitting or outpatient department to ensure staff are able to refer files and retrieve records on an emergency basis. Security surveillance for safeguard of medical record information and equipment when the department is closed should also be considered. Space and equipment requirement: Space allocation should be determined by the departmental services to be provided, the equipment and systems to be used and the daily workload to be handled. Although services vary somewhat from hospital to hospital, services and tasks to be considered when allocating space include record filing cabins, master patient indexing cabin, coding and indexing desk, correspondence desk, outpatient registration area, and admitting and discharge office. The medical record service requires adequate space, which is generally not available and presents a universal problem. Therefore, the Medical Record coordinator should review space requirements frequently to overcome the highly common filing problems in the medical records department. The Medical Record coordinator should ensure in advance the growth of MRD and anticipate and make arrangements for the future requirements and make arrangements to procure the required space. The following equipments are generally required for smooth and efficient functioning of a medical records department. Record File Maintenance: Record file maintenance includes the retrieving, dispatching, receiving, and filing of records in active and, to a lesser degree, inactive files. Open-shelf filing equipment may be 7 shelves, 8 shelves or 10 shelves high. A 3 feet long open shelf with dividers can house an average of 750 outpatient records in one compartment, thus housing 5250 records in a single open-shelf filing unit. If a unit-numbering system is used, adequate shelf space must be provided for growth of records as a result of readmission and repeat clinic visits. A review of records from the past several years is the best source of information for working estimates of the amount of space required. One approach is to tabulate the average number of sheets per medical record of repeat clinic visit and discharged patient over two or three months. This can be achieved by counting the sheets per current episode of care and the sheets for previous episodes of inpatient or outpatient care. This tabulation indicates the size of an average medical record for the hospital. Master Patient Index: The master patient index is the key to locating patient records, and therefore one of the most important tools in the medical records department. The master patient index is a permanent listing of all patients who have ever been admitted to or treated by the hospital. The amount of space allocated for the master patient index depends on the type of equipment or system used for immediate identification of current and past patients. The patient index includes by name, address, birth date, medical record number, and possibly other identifying data. This information may be stored on 2- inch by3-inch or 3 inch by-5inch cards in upright cabinets. Alternatively, the information may be stored in a computer system that includes terminals for accessing the file. The master patient index card is maintained as a permanent record. However, when necessary, names may be pulled by date of last visit or death for inactive storage. |