HIM Challenges: The People Factor
By Darice Grzybowski, MA, RHIA, FAHIMA
For The Record
Vol. 34 No. 2 P. 24
This is the first in a series of three articles designed to ascertain the pandemic’s effect on best practices in the HIM department.
The pandemic’s effects can be felt not only in terms of health morbidity and mortality but also in how it created a series of changes in workflow, technology, business practices, and overall staff management. Like most professions, HIM has suffered its share of setbacks, with several aspects having been either temporarily or permanently altered.
This series of three articles aims to examine how COVID-19 has changed HIM work and how to move forward. Part one addresses the changes felt from a “people” or staffing perspective and how they have impacted both the workforce and leadership.
The arrival of COVID-19 directly impacted HIM staffing, with many of the challenges still ongoing. The following are some of the issues that managers and staff have been forced to address:
• a large volume of vacancies created by illness, death, or early retirement;
• the inability of active workers to return to on-site jobs in office settings;
• recruitment demand for open positions and a shortage of available human resources;
• shifts in job responsibilities and a corresponding need for training/education, particularly as it pertained to new codes and recordkeeping (ie, telemedicine visits);
• a lack of expertise among leadership teams in how to deal with remote staff management;
• inadequate technology to deal with staff management;
• staff burnout/frustration;
• backlogs caused by an increase in patient visits due to COVID-19 testing and treatment;
• fluctuating staffing needs caused by surges and restrictions on elective surgeries; and
• staff safety precautions, including physical distancing, masking, vaccination requirements, and the implementation of workplace disinfection processes.
HIM departments should reflect on how they have coped with these challenges and consider ways to develop better responses. The need for creative management of a remote workforce helps address all these difficulties, each of which requires creativity, perseverance, and an openness to learn. Therefore, it’s important to master the fundamentals of managing a remote workforce that needs to adjust continually to changing requirements, legislation, and work volumes.
During the height of the pandemic, students and teachers had no choice but to learn how to make remote learning a success. Office workers had no choice but to adapt to virtual meetings. Grocery stores and pharmacies had to adjust to home-delivered orders. Restaurants had to rely on curbside pickup and outdoor dining to stay afloat.
In terms of health care, providers had to learn how to care for patients via telemedicine visits. And HIM departments, hospitals, clinics, and other professional practices were forced to adapt their staffing and workflows to accommodate a change in daily demands.
There is not one fix that resolved these issues. As facilities gained more experience, a type of acceptance occurred which helped managers cope with constant change. “The only constant is change itself” became a mantra. It is this dynamic that has driven a surge of innovation in process and technologies and greater flexibility when it comes to staffing.
Health care has never been more challenged to respond to mass treatment needs nor had a greater dependency on accurate data. Despite clear guidelines and new codes to capture COVID-19–related diagnostics, there has been much controversy surrounding the use of codes and test results to understand mortality statistics. Combine this with a shortage of coders, and the stress related to staffing and management continues to escalate.
Insights and Best Practices
While many factors can affect the HIM workforce, there’s nothing more impactful than the shift from office based to home based. Management needed to ensure that home-based employees did not become demoralized or feel separated.
• While many auditing teams functioned remotely prior to the pandemic, the needs of many remote employees changed and had to be adjusted accordingly. For example, it was important to create more flexible work hours to accommodate staff who no longer had childcare options or had to homeschool children. Typically, auditing work can be done any time of the day or night, so why not ensure employees have scheduling choices?
• When onboarding new employees, instead of in-person boot camps, managers who can rework the format to deliver content to new employees remotely will come out ahead. Webinar-style training is a good option.
• If staff need to interface directly with clients, electronic platforms can be utilized. Retraining and developing new materials for sales demos to prospective clients, project go-lives, and periodic business reviews can be accomplished electronically.
• Using group tools such as Slack or Microsoft Teams can increase personal connections among team members.
• Develop fun activities. Social activities such as games, quizzes, happy hours, and virtual bingo can decrease stress.
Lee Tkachuk, CEO of Keystrokes Transcription Service who has nearly 30 years’ experience working with remote staffs, points to the following key ingredients to making a successful transition from office to home:
• Ensure staff identify dedicated office space in their home. This can be an actual room or a corner/area of a room. Make sure that there is good ventilation and enough room to work. The chosen area should not be subject to constant interruptions or noise.
• Each staff member should have a computer for work only that is not shared. Avoid the temptation to perform personal tasks, do not download apps, and never allow other household members to use it. Failing to do so could lead to serious concerns, including a failure to protect patient privacy. Health care organizations must have a policy in place that addresses data security.
• Encourage breaks. Every 50 minutes or so, remote workers should be encouraged to take a short break. They should use this time to stretch, walk a little, get a fresh cup of water—anything that gives their eyes, hands, and rear end a break for a few minutes.
• Proper equipment is essential. A supportive and comfortable chair can prevent discomfort or injury, such as headaches and stiffness, and assist with concentration. It’s important that remote staff not sit in one place for too long without movement.
• Have a set start and end time. This is especially important for turnaround times and deadlines and to discourage procrastination. Household members should be aware of these work hours and boundaries should be clear. In addition, avoid visiting neighbors, babysitting, and household chores. Otherwise, the dividing line between personal and work time will become muddied.
• It is tempting to work longer hours or to jump out of bed and sit down at the computer, but it’s important to have the separation of work and home life. Remote staff should take the time to shower, get dressed, and get ready for the day just as if they were heading to the office. While being in pajamas all day sounds fun and tempting, it can make it difficult to achieve that separation.
• Be clear on the employer’s expectations. If there are set work hours, make sure those are planned and adhered to. With less face-to-face communication, it’s important to ensure trust remains high and expectations are clear. Personal appointments should be scheduled for days off or for during nonwork hours.
With fluctuating work volumes, new methods of documentation, evolving technologies, and a work force that has seen incredible change in a short period of time, HIM managers will need to adapt quickly and lean on each other’s expertise to survive. Part two of this series will examine the workflow processes and assistive technologies being developed to support these new challenges.
— Darice Grzybowski, MA, RHIA, FAHIMA, CEO and founder of H.I.Mentors, has been an HIM administrator, consultant, educator, author, and international speaker for more than 35 years.