One Resident's First Month
Week 1
This week I began my regulatory agencies rotation. I spent three days in Health Information Services (medical records). This rotation included learning about the birth certificate registry process, medical coding, risk compliance, and learning the medical records journey from when a patient is discharged to when the medical record is filed. The hospital currently has paper medical records, however we are transitioning to electronic. Thus far, only our Emergency Department uses electronic medical records. It was an eye-opener to walk through the mazes of charts. As I mentioned in my last journal, good documentation is very difficult to achieve. We have one medical coder dedicated to clarifying what physicians wrote in their charts. We also have an entire room dedicated to charts needing physicians’ signatures. I also sat down with our Director of Health Information Services to go over policies and procedures, especially those concerning compliance with the Joint Commission standards. She showed me the tracing method that the Joint Commission uses and together we “traced” 10 charts.
I also spent a day with our Chief Compliance Officer/Risk Manager. We discussed the different litigation we’re currently involved in and a patient death case that was about to be discussed at a Root Cause Analysis Meeting, which I was invited to join.
Friday I went into town for the Health Association Board of Trustees Meeting. My preceptor was on the Board this past year helping with the Political Action Campaign (PAC) and soliciting participation from hospitals within the state. This particular meeting focused on inpatient rebasing and reform as proposed by the state legislature. We were informed of the political actions and proposed budget cuts in healthcare and asked to participate in the upcoming Advocacy Day.
Week 2
This week I spent time with our Manager of Performance Improvement (PI). She’s currently going to school to get her Masters in Healthcare Administration. I went to a patient safety meeting, a Joint Commission meeting, the Performance Improvement Committee (PIC) meeting, the Root Cause Analysis meeting, and the annual Home Care meeting discussing Fiscal Year 2007’s performance indicators and 2008’s goals.
I was also asked to join the committee to implement a new HR/Payroll automation system. I read over the proposed vendor’s contract and sat in on several conference calls to discuss/amend the contract. Although I am not much of a participant in the calls, it has been a great experience dealing with contracts, contract negotiation, outside vendors, and consultants. It’s easy to see how much information can be “hidden” within a contract and how the writer of the contact will try to word things in their favor and on their terms. We have to dissect every line to clarify its true intent to make sure we are getting what we asked for, are paying as agreed upon, and that there aren’t hidden terms and conditions. It’s tedious and the legal jargon can get quite confusing.
I’m a part of the patient satisfaction TEAM meeting, which is a meeting for nurse managers to discuss various issues and suggest new ideas to raise patient satisfaction. However, the Administrator of Patient Satisfaction was caught up in another meeting, so I had to start the meeting without her. We had just hired two new nurse managers, so it was an opportunity for me to meet them and share our patient satisfaction initiatives and goals.
Week 3
This week I spent three days in Payroll learning their processes and seeing the managed chaos surrounding them. It was good to see how the new automated system would take care of the issues they’re having and lessen the chaos. This was also a pay-week, so I got to witness the rudeness of some employees when asking for early checks or complaining about how they were paid. Many manual checks had to be written. There were lines outside of the payroll office on payday and the day after.
I was asked to help with a new data-integrity project. The Administrator of Information Services has wanted to solve this issue for some time and is making progress. She has faced resistance from managers who don’t want to be accountable for their data. The issue is that data is floating around the hospital and no one knows who its owner is or if it’s accurate. This project’s aim is to map out all generated reports, the party responsible for them, which people get the reports, whether the data is valid, etc.
Thursday was Health and Human Services Day. There’s a county-wide leadership program that takes about 20 people a year from various industries who want to learn more about the county. They spend one day a month at various institutions and have weekly sessions discussing the county’s leadership. This day happened to be about health and human services. My preceptor was asked to be a guest speaker and talk about the healthcare industry. It was interesting to hear him field questions like “Why does an aspirin cost $25 at a hospital?” I think he did an excellent job of explaining the current challenges that hospitals are facing. After the Q&A, we toured the rehabilitation hospital, which produces custom-made prosthetics. They let us behind-the-scenes of the laboratory. A question was asked about the soldiers coming home from war, where they go, and who pays for it. The tour leader didn’t know the answer, so I stepped up and mentioned the center I visited during one of our Friday Morning Sessions.
I spent Friday in the HR Department. It was both a good and bad day. Because of Good Friday, many people had taken the day off, making it very slow. It provided me an opportunity to ask lots of questions, but it was bad because I couldn’t witness their day-to-day. I did get to watch the mediation process between union employees and management, however. There was a misunderstanding over the wording of a job description. Halfway through, the union representative began to understand what management was saying, but he had spent days arguing his side and couldn’t give in now. The management clause is especially important in union contacts because it states that management has the ultimate right to conduct business.
During the weekly meeting with my preceptor, I discussed my anxiousness over working on projects and getting my hands dirty. All along I’ve been involved in various projects, but I haven’t done much. He was glad I brought this up and said he didn’t think I’d enjoy shadowing for very long and that there are a lot of projects that need to get done just waiting for an eager person to take them on. He said to shorten my rotation schedule and that he and the Vice Presidents would discuss the best project for me to start on.
Week 4
This week was an unusual week: two of our managers in Patient Financial Services handed in their resignation, our Chair of the Board of Trustees’ wife was a patient in our hospital, our Chief Nursing Officer and one of our Directors of Nursing were asked to resign, and one of our new nurse managers had a brain aneurism and was declared brain dead.
As I said in my last journal, people need to change or people need to change. I had noticed from Day 1 which members of management weren’t on board and this week two of those people were let go. The nursing staff’s reactions were interesting. The nurse managers gathered and were told the news. The following morning I heard comments like “It’s about time,” “Well, they didn’t do anything anyways,” and “When is the other Director of Nursing going to be let go, too?” The next day, several candidates interviewed for the Chief Nursing Officer position.
This week we had our ED 30-minute service guarantee meeting to discuss our progress and the next steps. I was asked to draft a letter of apology to be sent to patients if we didn’t see them within 30 minutes of their arrival, as well as a policy and procedure for this guarantee. We also had a phone conference with another hospital’s Emergency Department Director who has implemented the 30-minute guarantee at his hospital. He said they don’t charge the patient if they weren’t seen within 30 minutes, but they only do so if the patient complains about their wait time. He said on average they only meet the 30-minute guarantee 65% of the time, but pay less than 10% of the time.
I spent a day with the guys in Facilities. I learned their daily routines and how they round on each unit. They give each patient a get well card with a number to call if there are any problems with their room. While they are on the units they write down notes about anything that needs fixing and add it to the master log. At their morning break, the log is divided and each person completes their list along with their daily work. I was very surprised by how caring these gentlemen are towards our patients. At the end of the day I sat down with the Plant Manager and the Administrator of Facilities and told them how impressed I was. I told them that their guys cared more about the patients and this hospital than most of the nurses and other employees I know and that their department is to be commended. I’m not sure how they got to this state of caring, but they need to teach other departments. The Administrator of Facilities assured me that it wasn’t always this way, but through a mix of management and the guys’ positive attitudes, everyone came around. He said everyone here is accountable for their actions. You don’t even have to ask someone to do something; if they see a problem, they will get it done. The daily log of issues after they round in the morning is more for documentation purposes than a way to hold them accountable.
While I was in Facilities I saw the log of patient complaints. A vast majority were about turning on the television or telephone services. On the patient’s nightstand, they place a card that lists the patient complaint number they should call if there is an issue. I suggested that instead of printing the same information on both sides, on one side they should write out “To order television services, dial this number, to order telephone services, dial this number, etc” similar to what you see in a hotel room. They loved my idea, and I worked with our print shop to get some trials made to see if it reduces these types of phone calls.
This week was the Finance Committee of the Board and the quarterly Board of Trustees meeting. The Finance Committee gave an update of our fiscal year 2007 audit and our budget status. The Board of Trustees meeting had several guest speakers. Our Director of Breast Health discussed her progress this last year and the future of Women’s Services. We also had a guest from another hospital talk about another facility joining the system, what we should offer in order to make it happen, and what they would be willing to give in return.
Week 5
This morning both our Chair of the Board of Trustees’ Wife and our new Nurse Manager passed away. Interviews continued for the Chief Nursing Officer position. I continued my various projects and set up the last of my rotations. Today was the first day for our new Manager of Organizational Development. This newly created position was filled by a non-healthcare person with experience in organizational development for major industrialized companies. We’re excited to bring him on board. Thus far, there has been no manager orientation. Whether promoted up the ranks or newly hired, managers are thrown in to sink or swim. I think it will be great to have someone on board to help new managers navigate the hospital.
I’m hoping to work with him on physician relations and physician orientation. I was given reports indicating our physicians’ needs and wants, which included a physician liaison to help orientate physicians to the hospital; a sort of “go-to” person when a physician has no idea who the appropriate person to contact is. I think it would be an interesting and fun position to have, but I don’t think I want to limit myself to only physician relations. I will keep it in mind, however, when the time comes to create a position for myself.
Lessons Learned
In Summary
I’m very happy that I’m involved in
many different projects. I’m even more excited that I will have an opportunity
to lead a project in the near future. I wish I could have made the trip to